Establish a Comprehensive Multi-Organ Allocation Policy 2025

At a glance

Background

Some organ donors are able to donate several organs: a heart, lungs, liver, intestine, two kidneys, and a pancreas. Additionally, some transplant candidates need multiple organs, like a heart-liver transplant, or a liver-kidney transplant. OPTN Policy dictates when some organs need to be offered together to one candidate but does not list a standard order across different organ-specific match runs. Current multi-organ allocation policy contributes to limited access to transplant for some single-organ candidates, such as pediatric, medically urgent, and highly sensitized candidates. Organ Procurement Organizations (OPOs) report having to spend a lot of time determining how to allocate multi-organ combinations from donors. There has been wide community support for standardizing multi-organ allocation and promoting equity in access for multi-organ and single-organ transplant candidates.

Supporting presentation

View presentation

Proposed changes

• The Committee has developed seven multi-organ donor allocation tables to establish consistent allocation of organs from donors with at least two different organs available for donation.
• The seven multi-organ donor allocation tables would account for approximately 98% of deceased donors who donate to multi-organ recipients, based on data from July 2023-June 2024.
• In order to make allocation fairer, the Committee is proposing that some single-organ candidates, such as pediatric, medically urgent, and highly sensitized candidates, have priority over some multi-organ combinations.
• To help make the complex rules for multi-organ transplants easier to follow, a computer-generated plan would be created for each donor that would guide OPOs and transplant teams step-by-step through the allocation process. It is expected that the computer-generated plans would be created for roughly 80% of organ donor match runs.
• Lastly, the Committee proposes developing training for OPOs and transplant teams before the new policy starts, to help them adjust and follow the new rules. After the policy is in place, it will be important to closely monitor how things are going.

Anticipated impact

• What it's expected to do
  • Promote equitable access to transplants among multi-organ and single-organ transplant candidates
  • Promote transparent, consistent and efficient allocation across all OPOs

Terms to know

• Multi-organ allocation: offering more than one organ from a deceased donor to the same waitlist candidate.
• Multi-organ donor allocation plan: a computer-generated donor-specific plan to guide the user through the applicable multi-organ allocation table.
• Multi-organ donor allocation table: a table in OPTN Policy directing the order in which OPOs make offers across organ-specific match runs when a donor has more than one organ at least two different organs available for donation.
• Match run: computerized ranking of transplant candidates based upon donor and candidate medical compatibility and criteria defined in OPTN Policy.

Click here to search the OPTN glossary

Read the full proposal (PDF)