Where will my liver come from?

UNOS divides the United States into 11 regions for organ distribution purposes (see Figure 7). Patients waiting for liver transplantation in a specific region most likely get a liver from their own region, typically from the local organ procurement organization (OPO). An OPO is an organization that is accepted as a member of the OPTN and is authorized by the Centers for Medicare and Medicaid Services (CMS) to procure organs for transplantation. Each OPO has a defined geographic procurement territory within which the organization concentrates its procurement efforts. A region can have one or more OPOs providing organ procurement services to various locations in the region.

When a deceased donor liver becomes available, a standardized protocol is followed to place the organ in the proper candidate on the waiting list. The liver waiting list emphasizes the degree of illness but also incorporates the locations of the donor and the recipient. Status 1 patients have the highest priority for the donor liver first within the local (OPO) territory and then within the region. If there are no status 1 candidates on the regional list, the liver goes to the candidate with the highest MELD score above 15 within the local area. If no candidates satisfy this criterion, then the liver stays within the region and goes to the person with the highest MELD score above 15. If no candidates in the region have a MELD score greater than 15, then the liver goes to the person with the highest MELD score first in the local area and then in the region. If there are still no appropriate recipients, the liver is offered to a status 1 patient outside the donor’s region. This system ensures that the sickest local/regional patient has the best opportunity to undergo liver transplantation.