How Organ Procurement Works

What Is an OPO?

Organ Procurement Organizations (OPOs) are federally designated organizations responsible for coordinating organ donation within specific geographic service areas. There are 57 OPOs in the United States, each covering a defined region and working with hospitals to identify potential donors, obtain family authorization, and coordinate organ recovery and allocation.

OPOs are the critical link between a potential donor in a hospital and the transplant centers that will perform the surgery. Without OPO coordination, the complex logistics of organ recovery, preservation, and transport would be impossible within the narrow time windows required.

The Donation Process: Step by Step

When a patient dies in a hospital under circumstances that may allow organ donation, federal law (the Conditions of Participation) requires the hospital to notify the local OPO. The process then unfolds in several stages:

1. Referral and evaluation. The OPO assesses whether the patient is a medically suitable donor based on age, cause of death, medical history, and organ function. Not all deaths result in viable donation, only about 1-2% of hospital deaths occur under circumstances that allow organ donation.

2. Family authorization. OPO staff approach the family to discuss donation and obtain authorization. Even if the deceased was a registered organ donor, families play a significant role in the process. Authorization rates vary by OPO and are a key performance metric.

3. Medical management. Once authorization is obtained, the OPO manages the donor medically to preserve organ function. This can involve maintaining blood pressure, oxygenation, and other vital functions for hours while matching and logistics are coordinated.

4. Matching and allocation. The OPO enters donor information into the UNOS matching system, which generates ranked lists of potential recipients for each recoverable organ. Transplant centers are contacted and either accept or decline each organ offer.

5. Recovery and transport. Surgical teams recover the organs (sometimes from the local transplant center, sometimes from teams that fly in from other centers). Organs are preserved in cold perfusion solutions and transported, often by chartered flight, to the recipient's transplant center.

OPO Performance Variability

OPO performance varies significantly across the country, and this variation directly affects how many organs are available for transplant in each region. HRSA and CMS track several performance metrics:

• Donation rate: Donors per million population in the service area
• Conversion rate: Percentage of eligible donors who become actual donors, ranges from under 50% to over 80% nationally
• Organs recovered per donor: The average number of usable organs from each donor, higher values indicate more efficient recovery

Recent CMS reforms (finalized in 2022) established outcome measures that require OPOs to meet performance benchmarks or face decertification. This represented the first meaningful accountability mechanism for OPOs in decades and is expected to increase organ recovery rates nationwide.

How OPOs Relate to Transplant Centers

Transplant centers within an OPO's service area receive priority for locally recovered organs before they are offered regionally and nationally. This geographic proximity is why patients on waiting lists at centers in high-donation areas may have shorter wait times, not because the center is better, but because the local OPO recovers more organs.

When evaluating transplant centers on PlainTransplant, keep in mind that a center's transplant volume is partly a function of its OPO's performance. Browse our transplant center directory and state pages to see how transplant activity varies geographically.

Frequently Asked Questions