UNOS: Cadaver Organs May Only Go to Patients on the "Match Run"

Donated organs may no longer be given to patients who are not on the "match run," a computer-generated list that determines the order in which people awaiting transplants are to be offered an organ or set of organs.

The United Network for Organ Sharing (UNOS) board of directors, meeting in Scottsdale, AZ, ordered the change as part of steps designed to prevent a repeat of the February mix-up that occurred in the case of Jesica Santillan, who died after receiving organs from a donor with an incompatible blood type (see Transplant Week story).

While organ placement has long been governed by the match run, the change ends an informal practice that occurs a little over one percent of the time. In 2002, there were 256 patients like Jesica Santillan who received transplants even though they were not on the match-run list generated for those donor organs.

While patients who need transplants are often described as being on a waiting list, there is actually no master waiting list. Instead, patients are all listed in a national computer registry.

The computer-generated match run -- created only when a donor makes organs available -- includes only the patients whose blood type, size and distance from the donated organ make them medically appropriate recipients.

But sometimes, for a variety of reasons (eg, a change in the health of the transplant candidate), none of the candidates on the match run can use an organ in question. Or their doctors decide that the organ is not suitable (eg, too small), and decline to accept it.

In these cases, transplant coordinators -- anxious to keep the organs from being wasted -- frequently call around and ultimately send the organs to doctors seeking to help a borderline patient.

In adopting the new policies, UNOS now requires that if none of the patients on the match run can use a particular organ, the organ procurement organization (OPO) -- after identifying a potential alternative recipient -- perform a new match run to verify that the organ and recipient would indeed be compatible.

"In any instance in which a transplant center attempts to accept an offer for a transplant candidate not on the match run, the host organ procurement organization will be responsible for determining why the candidate is not on the match run and communicating that information to the transplant center," UNOS said said in a statement. "The organ will not be allocated to any patient not on the match run. If a match run is exhausted, an OPO may give transplant programs the opportunity to update transplant candidate data before re-running the match."

Other Sources: UNOS