{"id":3217,"date":"2021-11-10T15:30:00","date_gmt":"2021-11-10T07:30:00","guid":{"rendered":"https:\/\/transnovo.com\/news\/%e7%be%8e%e5%9b%bd%e5%99%a8%e5%ae%98%e6%8d%90%e8%b5%a0%e5%92%8c%e7%a7%bb%e6%a4%8d%e5%88%86%e9%85%8d%e5%88%b6%e5%ba%a6%e7%9a%84%e5%8f%91%e5%b1%95%e4%b8%8e%e7%8e%b0%e7%8a%b6\/"},"modified":"2021-11-10T15:30:00","modified_gmt":"2021-11-10T07:30:00","slug":"%e7%be%8e%e5%9b%bd%e5%99%a8%e5%ae%98%e6%8d%90%e8%b5%a0%e5%92%8c%e7%a7%bb%e6%a4%8d%e5%88%86%e9%85%8d%e5%88%b6%e5%ba%a6%e7%9a%84%e5%8f%91%e5%b1%95%e4%b8%8e%e7%8e%b0%e7%8a%b6","status":"publish","type":"post","link":"https:\/\/transnovo.com\/en\/news\/%e7%be%8e%e5%9b%bd%e5%99%a8%e5%ae%98%e6%8d%90%e8%b5%a0%e5%92%8c%e7%a7%bb%e6%a4%8d%e5%88%86%e9%85%8d%e5%88%b6%e5%ba%a6%e7%9a%84%e5%8f%91%e5%b1%95%e4%b8%8e%e7%8e%b0%e7%8a%b6\/","title":{"rendered":"Development and current status of the United States organ donation and transplantation allocation system"},"content":{"rendered":"
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Click on the blue word to follow us<\/strong><\/p>\n<\/section>\n<\/section>\n

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In the Transplantation Technology Session held in Hangzhou, China in 2021, we had the honor to invite Mr. Sam Ho, the director of OPO in Chicago, U.S.A., to give us an introduction of OPO in the U.S.A., and the following content is extracted from his speech.<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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In the Transplantation Technology Session held in Hangzhou, China in 2021, we had the honor to invite Mr. Sam Ho, the director of OPO in Chicago, U.S.A., to give us an introduction of OPO in the U.S.A., and the following content is extracted from his speech.<\/p>\n


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In 2020, despite the impact of the New Crown epidemic and organ donation policies, the U.S. has a high number of 12,588 deceased donors and a deceased donor rate of 38.03 per million people, surpassing Spain as the world's number one organ donor country. The US is expected to have 14,000 deceased donors and 36,000 transplants in 2021. China's 2020 deceased donor rate is 3.61\/1 million people.<\/p>\n<\/section>\n

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The highest percentage of deceased donor organ transplants in the United States in 2020 will be kidney transplants, followed by liver, heart, and lung transplants.<\/p>\n<\/section>\n

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In the United States, there are nearly 110,000 patients waiting for transplantation, the majority of whom are waiting for kidney transplants, followed by those waiting for liver transplants, heart transplants, kidney\/pancreas transplants, and lung transplants, among others. The average wait time in the U.S. is 2.2 years, and the median wait time varies widely from state to state, ranging from 1.3 to 10.5 years.<\/p>\n<\/section>\n

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History of Organ Donation Laws in the United States<\/strong><\/p>\n<\/section>\n<\/section>\n

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The Uniform Determination of Death Act of 1981 defines \"death\" as (1) the irreversible termination of circulatory or respiratory function, or (2) the irreversible termination of the function of the entire brain, including the brainstem. 1984 United Network for Organ Sharing (UNOS) established. 1986 UNOS receives federal authorization to administer the Organ Procurement and Transplantation Network (OPTN). 2000 OPTN established by federal law.<\/p>\n


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Below is the structure of the U.S. government's management of organ donation and transplantation, which is administered by the Department of Health and Human Services (DHHS) under three administrations: the Health Resources and Services Administration (HRSA), the Centers for Medicare and Medicaid Services (CMS), and the Food and Drug Administration (FDA). All organ transplants are administered by HRSA.<\/p>\n<\/section>\n

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OPO refers to a medical specialized organization or institution that relies on qualified medical institutions and consists of surgeons, neurological surgeons, physicians and nurses in the Department of Critical Care Medicine, and human organ donation coordinators, etc., and is engaged in the acquisition, repair, maintenance, preservation, and transportation of human organs of citizens after their deaths.<\/p>\n


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There are 57 OPOs in the U.S. Each OPO is assigned a Donor Service Area (DSA) and provides services to donor hospitals and transplant centers within that DSA.<\/p>\n<\/section>\n

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The OPO donor service area shows diversity, including population, area size, number of deceased, number of donors, and donor ethnicity, as shown below.<\/p>\n<\/section>\n

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Some OPOs have ICU rooms for effective organ and patient management. Some OPOs have operating rooms for effective organ recovery. Some OPOs have their own laboratories for expedited donor-related testing. Laboratory tests performed in OPOs include ABO\/Rh, histocompatibility, infectious disease serology and nucleic acid testing, intraoperative point-of-care (POC) testing, organ biopsies, microbial cultures, and renal perfusion. Clinicians have a great deal of influence over whether or not a donor kidney requires mechanical perfusion in the U.S. Some transplant centers will explicitly ask the OPO to mechanically perfuse the donor kidney.<\/p>\n<\/section>\n

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Summarizing the donation process for deceased donors<\/strong><\/p>\n<\/section>\n<\/section>\n

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01<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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Identifying potential donors<\/strong><\/p>\n<\/section>\n

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Includes patients with brain death\/neurologic damage, no eye\/speech\/motor response, and off life support.<\/p>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n

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02<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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Hospital referrals<\/strong><\/p>\n<\/section>\n

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Call the local OPO within 1 hour.<\/p>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n

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03<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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Donor coordinators sent to hospitals<\/strong><\/p>\n<\/section>\n

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Contact donor family and next of kin; authorization to donate (organs, tissues, eyes, research); medical\/social history evaluation; blood drawn for ABO, HLA, and infectious disease testing.<\/p>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n

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04<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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Donation management<\/strong><\/p>\n<\/section>\n

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Transfer to OPO in-house ICU unit; standard monitoring and care and management of hemodynamic and physiologic changes in the donor; organ-specific assessments (e.g., pulmonary bronchoscopy, cardiac echocardiography).<\/p>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n

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05<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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organ allocation<\/strong><\/p>\n<\/section>\n

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UNOS performs organ matching; gives organs to transplant centers; draws blood for crossmatching.<\/p>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n

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06<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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Organ Repair<\/strong><\/p>\n<\/section>\n

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Transplant center coordinates and schedules surgery (at donor hospital or OPO); arranges for surgeon and support staff; does SARS-CoV-2 testing if needed; performs POC testing intraoperatively.<\/p>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n

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07<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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Organ preservation and transportation<\/strong><\/p>\n<\/section>\n

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Perform organ biopsies, organ perfusion, and arrange for organ transportation if needed.<\/p>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n

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08<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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transplants<\/strong><\/p>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n

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Porting the distribution system<\/strong><\/p>\n<\/section>\n<\/section>\n

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UNOS enacted on March 15, 2021 a new system on organ allocation. The system is a new distance-based allocation method designed to improve the fairness of transplantation. The allocation method is based on a fixed range of 250 nautical miles (460 km) by measuring the distance between the donor hospital and the transplant hospital, based on the number of individual kidney allocation points allocated first to patients within the 250 nautical mile range, with a proximity score of 0-2 points. Patients outside the 250 nautical mile range are then assigned a proximity score of 0-4. Patients over 2500 nautical miles (4600km) receive 0 proximity points.<\/p>\n<\/section>\n

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Allocation was also based on other factors such as waiting time, ABDR HLA match, age, presence of a previous living donor, number of HLA DR mismatches, and degree of HLA sensitization based on corrected population reactive antibodies (CPRA).<\/p>\n<\/section>\n

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Summary<\/strong><\/p>\n<\/section>\n<\/section>\n

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The U.S. organ donation and transplantation allocation system has been evolving, and OPOs, as human organ procurement organizations, play an important role in organ donation and transplantation.<\/p>\n<\/section>\n

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Scan the code to follow us<\/strong><\/p>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n

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Micro Signal\uff5cTx New Solution<\/p>\n

Jianfeng Medicine, focus on transplant industry<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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