It appears to be a complicated process, but it really isn't. It all starts with the location, age, blood-type, and size of the donor. This information is uploaded into OPTN's (Organ Procurement and Transplant Network) computers. This is where are the waiting lists are maintained. The computer spits out the list of candidates by priority. A call then goes out to the center responsible for the most critical patient. The center then must decide whether or not to accept the organ. If they choose to decline, a call goes out to the center for the next candidate in priority.
My research suggests that 60% of donated livers are turned down for various reasons. This sounds bad, but so many things are considered before an organ is accepted. The sickest candidate may (at that moment) not be able to withstand surgery, the organ then is offered to the next sickest patient in the local area or to the regional area depending on status. The candidate may not be able to make it to the hospital in time or develops a case of ‘cold feet’. The size of the organ must be considered--the candidate must be able to accommodate the organ. The medical history of the donor also plays a factor—some conditions might pre-dispose the recipient to illness. Sometimes, damaged livers are offered and could be accepted depending on the medical urgency. Offers of split livers are also made. In a life or death situation, the candidate may accept a damaged liver in order to buy some more time.
This may sound scary, but understand that the candidates are directly involved in the decisions. If a center is contacted by OPTN offering a liver to one of their candidates and they decide to decline the offer, they must notify the candidate.
I gotta go to work. Have a great day!