Transplantation in the twenty-first century is a huge business. Kidneys, livers, hearts, pancreata, lungs, and small intestine, either alone or in combination, are transplanted every day. The complexity of the surgery and care of the patients is almost rivaled by the intricate regulatory system that governs transplantation in the United States. Success in transplantation is propelled by surgical and medical expertise but also by adhering to local, state, and federal rules and regulations. Unlike the days of old, starting a transplant program now requires gargantuan amounts of paperwork, organization, and money. In this chapter, we will review some of the history of transplantation, the development of regulatory requirements, and the day-to-day necessities for running successful transplant programs. This chapter will concentrate on the transplantation of kidneys and livers, although many of the requirements are similar for the transplantation of other organs.
KeywordsUniform Anatomical Gift Act (UAGA) National Organ Transplant Act (NOTA) Organ Procurement and Transplantation Network (OPTN) United Network for Organ Sharing (UNOS) Centers for Medicare and Medicaid Services (CMS) Organ procurement organization (OPO) Donor service area (DSA) UNET Human leukocyte antigen (HLA) Model for End-Stage Liver Disease (MELD/PELD) Independent Donor Advocate Team (IDAT)
- 1.Starzl TE. My thirty-five year view of organ transplantation. History of transplantation: thirty-five recollections. UCLA Tissue Typing Laboratory. 1991;145–79.Google Scholar
- 3.Calne R. Recollections from the laboratory to the clinic. History of transplantation: thirty-five recollections. UCLA Tissue Typing Laboratory. 1991;227–41.Google Scholar
- 4.US Department of Health & Human Services. Organdonor.gov. Retrieved from: https://organdonor.gov/about-dot/laws/history.html
- 5.A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to examine the definition of brain death. JAMA. 1968;205(6):337–40.Google Scholar
- 6.National Conference of State Legislatures (NCSL). Con-Certificate of Need State Laws. August 25, 2016. Retrieved from: http://www.ncsl.org/research/health/con-certificate-of-need-state-laws.aspx.
- 8.Habbous S, Arnold J, Begen MA, et al. Duration of living kidney transplant donor evaluations: findings from 2 multicenter cohort studies. Am J Kidney Dis. 2018; in print. Habbous S, Garg AX, Lam NN. Optimizing efficiency in the evaluation of living donor candidates: Best Practices and Implications. Current Transplant Rep. 2018;5(1):55–63.Google Scholar