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How is the Organ Placed

Generating a List

The United Network for Organ Sharing (UNOS) maintains a list of people who are potential transplant candidates and this can be accessed by the New England Organ Bank (NEOB). The Transplant Institute sends UNOS the patients' medical information for placement on this list. NEOB is involved with making sure the organs are allocated to the correct patient.

The list has each person's medical and biological information that are necessary for matching with potential donors - details that are important for liver allocation. The most important listing criteria are blood type, weight, and Model for End Stage Liver Disease (MELD) score. Liver transplants require blood type compatibility, although in emergency situations blood type incompatible liver transplants can be done. We have developed a very successful protocol for doing these transplants that has been published and used by other centers.

Livers must also be matched by size. In liver transplantation, matching organ size from donor to recipient is very important. Today, thanks to new harvesting and preservation techniques, surgeons can take a deceased donor liver and reduce its size for a closer recipient match. These protocols make it possible for the donor to weigh much more than the recipient.

Finally, every patient listed for liver transplantation is assigned a MELD score based on three laboratory values: creatinine (measure of kidney function), INR (measure of clotting function and liver function), and bilirubin (measure of liver function). The higher your MELD score, the greater your risk of dying is without a liver transplant.

Livers are allocated to the person with the highest MELD score within a blood group and with consideration for size. Patients with liver cancer get extra MELD points so that they can be transplanted before the tumor grows to a point where it is no longer curable.

Getting a liver from the list is NOT based on financial or celebrity status, religion, sexual orientation or gender.

One Hour to Accept or Decline

If UNOS determines that you meet all criteria, our transplant team gets an offer for that liver to be given to you. The BIDMC transplant team accepts or refuses the liver for you based on:

  • Established medical criteria
  • The condition of the organ
  • Risk factors for a poor transplant result or disease transmission
  • Your current medical status

Our transplant team has only one hour to accept or refuse an organ. This includes the time it takes us to locate you. We may need to decline the liver if you cannot be reached in 60 minutes. If we decline the liver, then the NEOB offers it to the next potential recipient on the list. Please make sure we are always able to reach you.

Allocating deceased donor organs is a complex process. If you have any questions, please ask your transplant team.

Contact Information

Transplant Institute
Beth Israel Deaconess Medical Center
Lowry Medical Office Building, 7th Floor
110 Francis Street
Boston, MA 02215