How the US organ transplant system works and what to ask to improve your chances

It’s not always patience and luck that get patients off the organ transplant waiting list and into the operating room. Unlike in many areas of medicine, experts say there’s a lot of variation in the U.S. Knowing there are differences and what to ask might help.

“I had to ask a lot of questions to figure out what it was that I could do to move the needle,” said Katherine Screws of Phoenix, who got a rare intestine transplant after she decided to get on the waiting list at more than one hospital to increase her chances. It can be difficult to learn how to navigate that search, but there’s publicly available information about which hospitals perform the most of each type of transplant, plus their waiting times and outcomes. Long used by experts analyzing the transplant system, the Scientific Registry of Transplant Recipients, or SRTR, database has new patient-friendly tools developed in the hopes that more would-be transplant recipients will use it.

“People are making these really high-stakes decisions without understanding the options,” said Dr. Allyson Hart of Minnesota’s Hennepin Healthcare Research Institute, who helped design the tools. Different transplant centers have different criteria There are about 100,000 people on the U.S.

transplant list at any given time, the vast majority of whom need a kidney. With just over 49,000 transplants performed in the U.S last year, more people than ever are getting new organs. It’s mostly thanks to over a decade of increases in donations from the deceased, which are recovered by organ procurement organizations, or OPOs.

But more organs are needed to meet the demand, and different transplant hospitals have different criteria for who they’ll accept on their waiting list. Sometimes, “if a patient receives a ‘no’ at one place, they can go somewhere else and be successfully transplanted,” said Dr. Syed Ali Husain, a kidney specialist at NYU Langone Health.

Each transplant program’s waiting list is linked to a national automated matching system. OPOs enter information about viable organs into that system, which generates lists of possible matches at multiple hospitals in order of priority. When the OPO offers an organ, the transplant team must quickly decide if it’s a good choice for that patient or the offer moves to the hospital with the next-in-line candidate.