UNOS

UNOS
Name	United Network for Organ Sharing
Formation	1984
Headquarters	Richmond, Virginia
Region served	United States
Leader title	President and CEO

UNOS

The United Network for Organ Sharing is a non-profit organization that administers the scientific and logistical system for human organ transplantation in the United States. It operates the national organ procurement and allocation infrastructure, maintaining the national waiting list and coordinating with organ procurement organizations, transplant centers, and federal agencies such as the United States Department of Health and Human Services and the Health Resources and Services Administration. The organization develops policy, maintains registries, and facilitates research to improve outcomes across transplant types including kidney transplantation, liver transplantation, heart transplantation, lung transplantation, and pancreas transplantation.

History

The organization was founded in the aftermath of federal efforts including the National Organ Transplant Act of 1984 and subsequent policy debates involving stakeholders like the Advisory Committee on Organ Transplantation and leaders from major hospitals such as Massachusetts General Hospital, Mayo Clinic, and Johns Hopkins Hospital. Early coordination involved collaboration with regional entities such as the United Network for Organ Sharing predecessors and national networks influenced by pioneers including Thomas Starzl, Joseph Murray, Norman Shumway, and transplant programs at University of Pittsburgh Medical Center and Cleveland Clinic. Over decades, significant events including litigation, regulatory actions by the Centers for Medicare & Medicaid Services, and policy revisions after incidents involving allocation and waitlist management have shaped organizational evolution. Major technical and policy shifts paralleled advances exemplified by the development of the Model for End-Stage Liver Disease score and research from institutions such as Stanford University School of Medicine and University of California, San Francisco.

Organization and Governance

Governance structures include a board of directors and committees composed of representatives from transplant centers, organ procurement organizations, patient advocacy groups like American Transplant Foundation and professional societies such as the American Society of Transplantation, American Society of Nephrology, and United Network for Organ Sharing-affiliated stakeholders. The board interacts with federal regulators including the Health Resources and Services Administration and legal frameworks under the National Organ Transplant Act. Operational leadership engages with executives from major hospitals and public health institutions such as Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, and academic centers like Columbia University Irving Medical Center. Committees address policy development, ethics review, data management, and quality oversight, often consulting with organizations including the Organ Procurement and Transplantation Network and advisory entities like the Institute of Medicine.

Organ and Tissue Allocation and Matching System

The organization operates a computerized matching system that integrates clinical criteria developed with input from experts at institutions such as Harvard Medical School, Yale School of Medicine, and University of Pennsylvania Perelman School of Medicine. Allocation algorithms incorporate medical urgency metrics derived from scores like the Model for End-Stage Liver Disease and concepts used in lung allocation score research. The matching system connects donor information from donor registries and regional organ procurement organizations including Gift of Life, LifeSource, and Mid-America Transplant Services, enabling offers to transplant teams at centers such as UCLA Medical Center and Mount Sinai Hospital. Policies for allocation and distribution have been influenced by court rulings, federal guidance from the Department of Justice and HHS Office of General Counsel, and consensus documents from societies like the Transplantation Society.

Transplant Programs and Services

Services coordinated include organ offer management, waitlist maintenance, patient registration, and support for specialty programs in pediatric transplantation at centers including Children's Hospital of Philadelphia and Boston Children's Hospital. The organization supports programs for living donation with partnerships involving the National Kidney Foundation and clinical protocols from academic programs at University of Michigan Health and Northwestern Memorial Hospital. It facilitates cross-center exchanges such as paired kidney exchange programs pioneered by teams at Emory University Hospital and Mount Sinai Medical Center, and supports logistical operations including transportation networks linked to regional hospital systems and companies like FedEx in medical transport partnerships.

Research, Data and Quality Improvement

A central registry aggregates transplant outcome data used in publications with collaborators from universities including Duke University School of Medicine, University of California, San Diego, and Johns Hopkins Bloomberg School of Public Health. Data registries inform quality metrics monitored by Centers for Medicare & Medicaid Services and research funded by agencies such as the National Institutes of Health and foundations like the American Heart Association. Quality improvement initiatives include performance reviews of transplant centers, post-transplant outcome tracking, and analyses on organ discard rates that reference studies from journals associated with New England Journal of Medicine and The Lancet.

Ethics, Policy and Advocacy

Ethical frameworks and policy positions engage with bioethics scholarship from institutions such as Georgetown University and legal scholarship from Harvard Law School and Yale Law School. The organization participates in advocacy efforts related to donor registration campaigns alongside groups like Donate Life America and responds to policy proposals from the United States Congress and regulatory actions by the Health Resources and Services Administration. Debates on allocation equity, living donation compensation prohibitions under the National Organ Transplant Act, and cross-border transplantation issues involve engagement with international bodies like the World Health Organization and professional societies including the International Society for Heart and Lung Transplantation.

Category:Organ transplantation organizations