Organ transplantation is when a donated organ is surgically transferred to another person. Organ transplant typically occurs due to end-stage organ failure, which may occur due to multiple disease states (see table 1).
Table 1: Disease States that may Lead to Organ Failure
|Organ||Selected diseases that may lead to organ failure|
|Heart||Heart failure, cardiomyopathy, coronary heart disease|
|Kidney||Polycystic kidney disease, end-stage renal disease due to hypertension or diabetes|
|Liver||Hepatitis, acute liver failure due to medications, hemochromatosis, nonalcoholic steatohepatitis|
|Lung||Chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis, cystic fibrosis|
|Intestine||Short gut syndrome|
When the physician determines that a transplant is necessary, a referral is made to a transplant program. The patient should be encouraged to obtain a copy of Partnering with Your Transplant Team, a free handbook from the U.S. Department of Health. It provides the patient and family with information about the process, including an overview of the transplant process and how the patient can best navigate the system (UNOS, 2019b).
After a transplant is decided on, an organ procurement organization (OPO) helps. The OPO has two major roles. It works to coordinate the donation process when an organ becomes available and works to increase the number of registered donors. There are 58 OPOs in the United States and two in New Jersey. The OPO is a critical component of the donation process and has personnel available at all times to help in the process.
Specifically, the OPO will evaluate the potential donor, contact the Organ Procurement and Transplantation Network (OPTN), run a match-list, work with family members and arrange for the transport and recovery of donated organs. All OPOs are certified by the Centers for Medicare and Medicaid Services and must be members of the OPTN.
In addition to the OPO, multiple organizations are involved in the transplant process. These include the transplant hospital, the OPTN and the United Network for Organ Sharing (UNOS).
Every transplant hospital in America is an OPTN member and must have a transplant surgeon and a physician with training/experience in the type of organ that is transplanted.
The OPTN is a unified transplant network created in 1984. The network is non-profit, operated privately, and under federal contract. The organization works to increase the supply of donated organs and increase the effectiveness and efficacy of organ donation.
UNOS manages the transplant system in the United States. It is a private non-profit organization with multiple responsibilities (see Table 2).
Table 2: Selected Responsibilities of the United Network for Organ Sharing
- Maintain the organ transplant data base
- Provide assistance to patients and families in the process of organ transplantation
- Educate the public and health care professionals
- Manage the waiting list
- Develop policies and procedures
- Monitors organ matches
- Operate the OPTN
After the patient has selected a transplant program, an evaluation is set up to determine if the patient is a candidate and to provide help with finances. The transplant coordinator works with the recipient and is involved in the testing, evaluation and getting the patient on the national waiting list. If the transplant team determines that the patient is a candidate, they are listed on the OPTN national list of all individuals awaiting a transplant.
Patients need to understand the financial commitment to the transplant process. It is important to work with the insurance company to help the patient understand the personal cost for the donor. In 2008, the average cost of a transplant of one kidney was 259,000 dollars, and a heart-lung transplant was 1,200,000 dollars (The National Kidney Foundation, 2017). Regarding the donor, it does not cost the patient's family or estate anything postmortem.
Once on the national list, wait times are variable, and patients need to be educated about average wait times for their organs. The longest wait time is for kidney transplantation, averaging 3-5 years (The National Kidney Foundation, 2017).
Patients should be encouraged to take care of themselves while waiting for a transplant. They should be instructed to maintain their doctor appointments, take all medications, exercise (as appropriate), eat healthily, and do not smoke, drink alcohol or do illegal drugs. Patients must always be prepared with adequate transportation if they are notified that an organ is available.