An Organ Procurement Organization (OPO) is a non-profit entity that coordinates the process of organ and tissue donation for transplantation within a specific geographic region. OPOs act as the designated liaison between the hospital, the donor’s family, and the national organ allocation system. Federal law authorizes OPOs as the sole organizations permitted to perform this function. There are 57 federally designated OPOs operating across the United States, each responsible for maximizing organ donation within its assigned service area.
Core Functions in the Organ Donation Process
OPOs manage the medical and logistical challenges of deceased donation, starting immediately after a potential donor is identified in a hospital. Specially trained clinical coordinators perform a thorough medical and social history evaluation to determine the suitability of the organs and tissues for transplant. This assessment involves reviewing medical records, performing a physical examination, and conducting necessary laboratory tests to screen for infectious diseases.
The OPO performs clinical management of the deceased donor to ensure the organs remain viable until recovery. For brain-dead donors, the OPO coordinates goal-directed therapy with hospital staff to maintain specific physiological parameters. This management phase often follows the “Rule of 100,” which includes keeping the systolic blood pressure, urine output, and partial pressure of oxygen (PaO2) all above 100.
After national matching, the OPO coordinates surgical recovery, which is performed by specialized transplant surgeons and recovery personnel. The OPO prepares the organs for transit by flushing them with an ice-cold preservation solution containing electrolytes and nutrients. This solution slows metabolic processes and helps maintain the organ’s condition.
The recovered organs are packaged in sterile containers and placed on wet ice to maintain a stable, cold temperature, a process that minimizes the destructive effects of cold ischemia time. OPOs manage the complex logistics of transporting these time-sensitive biological materials, utilizing various methods like commercial flights, chartered planes, or ambulances to deliver organs to transplant centers across the country. The Centers for Medicare & Medicaid Services (CMS) certifies OPOs every four years based on outcome measures, such as the donation rate and the transplantation rate.
Working with Donor Families and Hospitals
The OPO’s work involves intense personal interaction with donor families during a time of profound grief, requiring specialized training and compassionate care. A designated representative searches state and national donor registries to confirm the deceased individual’s authorization status. If the individual has not registered, the OPO representative approaches the next of kin to discuss donation and obtain legal consent.
These conversations are handled with sensitivity and are timed to occur only after the attending physician has informed the family of the patient’s death or imminent death. OPOs also provide support to the grieving family, including long-term grief resources and remembrance programs.
The relationship between the OPO and local hospitals is formally established and required by federal law, which ensures Medicare and Medicaid participation. This statute mandates that hospitals must have a written agreement with their designated OPO and must notify the OPO of all patients who have died or whose death is imminent, based on specific clinical triggers. The timely referral of these potential donors allows the OPO to assess medical suitability and begin donor management before life-sustaining measures are withdrawn. This required coordination ensures that no potential donor is missed.
The National Allocation System and OPOs
The OPO serves as the gateway to the national Organ Procurement and Transplantation Network (OPTN), which is managed by the United Network for Organ Sharing (UNOS). Once authorization for donation is obtained, the OPO inputs relevant donor data, such as blood type and body size, into the OPTN’s central computer system, known as UNet. This system then generates a rank-ordered list of potential recipients from the national waiting list.
The OPO follows standardized criteria set by the OPTN to allocate organs, ensuring the process is equitable and medically sound. Organ matching is based purely on medical and logistical factors, explicitly excluding personal characteristics like wealth or social status. Core matching factors include blood type compatibility, organ size matching (especially for pediatric patients), and the medical urgency of the recipient.
Geography also plays a substantial role in the allocation process, due to the limited time organs can survive outside the body, known as cold ischemia time. The system prioritizes candidates located closer to the donor hospital, especially for organs with the shortest preservation times, such as the heart and lungs. The OPO then begins the process of offering the organs to transplant hospitals, moving down the rank-ordered list until a transplant center accepts the organ for a waiting patient.