On October 1, 1987, UNOS became fully operational as the nation's Organ Procurement and Transplantation Network (OPTN). Shortly thereafter, the country's first organ allocation policies were established. This new national system maintained priority for local use of organs. For the first time OPOs were accountable for allocating organs according to the UNOS computer printout. Since its inception, UNOS has established a national waiting list for individuals in need of organ transplants, a national system for computerized matching of potential recipients with available organs, a 24 hour central office to ensure access to the recipient list, methods to assist OPOs in distribution of organs to transplant centers, and standards for organ recovery and transplantation.7

UNOS policies mandate evaluations that the RSC should perform prior to offering organs for transplant. The policies include: verifying that death has been pronounced according to applicable laws, identifying conditions which may influence donor acceptance, obtaining the donor's history, reviewing the donor's medical chart, performing a physical examination of the donor, obtaining the donor's vital signs, and performing pertinent tests.

The pertinent tests include lab tests for each organ and serology testing on all donors. The serology tests required include a hepatitis screen including HepBSAg and anti-HCV, RPR or VDRL, FDA licensed anti-HIV 1 and HIV 2, anti-HTLV 1, and anti-CMV.7 Local transplant centers may also request additional tests.

The UNOS policy for equitable organ allocation attempts to strike a balance among the following principles: to enhance the overall availability of transplantable organs, to allocate organs based upon medical criteria, to give equal consideration to medical utility and justice, to provide transplant candidates reasonable opportunities to be considered for organ offers within comparable time periods, taking into consideration similarities and dissimilarities in medical circumstances as well as technical and logistical factors in organ distribution, and to respect autonomy of persons. Relevant to the principle of medical utility: number of people receiving successful transplants, patient survival, graft survival, quality of life, cost/ benefit ratio, availability of short term treatments, transplant center performance, and OPO performance. The principle of justice: medical urgency, time waiting, medical disadvantage, reasonable access and information, and equitable access.7 The rationale for achieving objectives of equitable organ allocation is in obtaining balance between each objective. Therefore, the balance is among maximizing the availability of transplantable organs, maximizing patient and graft survival, minimizing disparities in consistently measured waiting times until an offer of an organ for transplantation is made among patients with similar or comparable medical/demographic characteristics, minimizing deaths while waiting for a transplant, maximizing opportunities for patients with biological or medical disadvantages to receive a transplant, minimizing effects related to geography, allowing convenient access to transplantation, minimizing overall transplantation-related costs, providing for flexibility in policy making, and providing for accountability and public trust.7

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