Understanding Transplant Waitlists

When you or a loved one is facing organ failure, it can be hard to understand how the organ transplant waitlist works. Let’s take a look at how the waitlist operates and answer common questions about the transplant waitlist.

Most people incorrectly assume that when a person is added to the waitlist, it’s like joining the back of a long line. A better way to understand being ‘added to the waitlist’ is to think of it as joining a large pool of people

The United Network for Organ Sharing, known as UNOS, is responsible for managing the national waitlist and determining organ matching protocols and list management.

Quick facts about transplant waitlists

• More than 100,000 people are waiting for an organ donation
• Most people on the waitlist are waiting for a kidney transplant
• The second-highest is liver transplants
• There are 11 transplant regions in the US (a UNOS zoning system)
• Texas and Oklahoma make up Region 4
• There is a national waitlist and regional waitlists (see below)
• There are no “place numbers” on waitlists

Common Questions about Transplant Waitlists

How do I get on the national list?

Methodist Dallas Medical Center is one of six transplant hospitals in North Texas that can evaluate you to determine if you are a good candidate for transplant. If you are approved for transplant, you will be automatically listed on the national list and the Region 4 list. Our transplant team can answer questions about how to start this process.

What is the difference between the national list and a regional list?

UNOS manages the national list and the 11 regional lists. The regional lists are part of the national list. A patient does not get listed on one without the other. Every person on an organ transplant waitlist is on the national list as well as at least one regional list. Why are there regional lists? Since organs are often allocated (offered) regionally first for practical and medical reasons, the US is divided up into 11 different regions.

Can I list at more than one hospital (transplant center) in my region?

Technically, yes. If all the hospitals (transplant centers) in a region use the same or similar listing criteria, then it is unlikely you will be approved for listing by a second hospital. If there are hospitals within a region that have different enough listing criteria, then you could potentially be listed at multiple hospitals within the same region.

Can I be listed in more than one region?

Yes. Some patients get evaluated and listed in more than one region. Some potential downsides of this choice are the hassle and cost factor. Insurance may have limits on where they will cover you being placed on a waitlist. For example, they only cover costs incurred within your immediate region. Travel expenses are another consideration.

How are organs matched?

When an organ becomes available, using detailed information about both the donor and potential recipients, the UNOS computer system creates a unique “match run” — a ranked list of candidates eligible for a specific organ. Each match run is tailored to the individual donor and organ. Candidates ranked highest on the list are typically those with the most urgent medical need and/or those expected to have the best outcomes following transplantation.