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Matching Donors and Recipients

The Organ Procurement and Transplantation Network (OPTN) makes organ matches. It runs the national database of patients waiting for a transplant in the United States.

Policies control how the system matches donor organs to patients on the waiting list.

What are the common matching factors?

Blood type and body size factor into a match.

Other factors include:

  • how bad the patient’s medical condition is;
  • the distance between the donor's and the patient’s hospital;
  • the patient's waiting time; and
  • if the patient is available. For example:
    • If they can’t contact the patient.
    • If the patient has an infection or other reason that they can’t do the transplant. 

The most important factor is the organ itself. Some organs can survive outside the body longer.

There’s a different policy for each organ. Read about how the system decides who gets which organs.

The OPTN assigns a status code to patients waiting for a heart transplant. The code relates to how urgently they need a heart. 

How long can a heart survive outside the body?

A heart can only survive outside the body for four to six hours.

How do they decide who gets the heart?

The transplant team offers a heart first to people near the donor's hospital. 

If no one near the donor is a match, the team searches farther away.

Body size is important in heart matching. The donor's heart must fit comfortably inside the receiving patient’s rib cage.

Lab values, test results, and disease diagnosis help decide the best person to get the lungs. 

They use this information to create a score. The score depends on: 

  • how badly someone needs a transplant; and
  • how long they expect the patient to survive after the transplant.

The common factors help decide who gets the donated lung(s).

How long can lungs survive outside the body?

Lungs can only survive outside the body for four to six hours.

What’s most important in deciding who gets the lungs?

These factors are most important:

  • Body size — lungs must fit within the rib cage.
  • Distance between hospitals.

The transplant team offers lungs first to people near the donor's hospital. If no one near the donor is a match, the team searches farther away.

 

Patients who need a heart-lung transplant on the OPTN Heart Waiting List and the OPTN Lung Waiting List.

If a heart becomes available, the patient will receive the donor’s lung too.

If a lung becomes available, the patient will receive the donor's heart too.

How long can both organs survive outside the body?

Heart and lungs only survive outside the body for four to six hours.

How do they decide who gets the heart-lung transplant?

The transplant team gives heart-lungs first to people near the donor. If no one near the donor is a match, the team searches farther away.

Livers can survive the body for 12 to 15 hours. They can travel farther than hearts and lungs.

Who gets priority for a liver transplant?

They offer a donor liver first to whomever matches the common factors and has the highest MELD or PELD score. This shows the most need. 

The first patient’s surgeon may not accept the organ. If this happens, they offer the liver to matching patients with the next highest MELD or PELD scores. They do this until someone accepts the organ.

They also consider the distance between the patient’s and the donor’s hospitals.

Use the common factors to understand how the OPTN matches possible donors to patients who need them.

This includes:

  • blood type;
  • length of time on the waiting list;
  • if the patient who needs the transplant is a child; and
  • the body sizes of the donor and receiving patient.

What else do they use to match kidneys?

  • A negative lymphocytotoxic cross match
  • The number of HLA antigens in common between the donor and the receiving patient based on tissue typing

How long can a liver survive outside the body?

Many kidneys can survive outside the body for 36 to 48 hours.

This means they can consider more patients from a wider area.

A pancreas match depends on how well the blood types match. The system also looks at how long a patient has been on the waiting list.

Transplant teams perform a pancreas transplant at the same time as a kidney transplant. As a result, the kidney needs to match as well.

How long can a pancreas survive outside the body?

The pancreas can survive outside the body for 12 to 18 hours.

A donor intestine matches to someone on the waiting list when the ABO blood group is identical.

What can happen if the ABO blood group isn’t identical?

There’s a higher risk of graft-versus-host disease (GVHD). This is a violent immune reaction. It happens between the white blood cells in the donor organ and the body of the patient who received the organ. It can lead to death.

What else do they consider when making an intestines match?

The stomach shrinks in many patients waiting for intestines. Most of the time, the donor has to be smaller than the patient so that the intestine will fit.

People who get intestinal transplants can get a severe infection from cytomegalovirus (CMV) and Epstein-Barr virus (EBV).

  • They usually match patients who have never had CMV with CMV-negative donors.
  • They usually match patients who have never had EBV with EBV-negative donors.

How long can the intestines survive outside the body?

The intestines can survive outside the body for 8 to 16 hours.

 

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