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Antibody

A protein made by the body's immune system in response to a foreign substance. Exposure to foreign cells from a previous transplant, blood transfusion, or pregnancy may cause a transplant recipient to make antibodies that can react against subsequently transplanted cells, tissues, or organs.

Chimerism

The simultaneous existence and function of components of both the donor's and the recipient's immune systems in the same patient, resulting in cross-regulation of immune system activities.

Cohort

The observations selected for a study based on a specific time period. For example, in this report the cohort of transplant recipients includes all transplants performed between 1992 and 2001.

Crossmatch

A test to detect preformed antibodies in a potential recipient's blood against antigens on the surface of a potential donor's cells. A positive crossmatch means that the recipient has antibodies against the donor's cells. With a few exceptions, a positive crossmatch makes successful transplantation between that donor and recipient pair impossible.

Human Leukocyte Antigen System (HLA System)

Human Leukocyte Antigens (HLA), also known as histocompatibility antigens, are molecules found on all nucleated cells in the body. Histocompatibility antigens help the immune system to recognize whether or not a cell is foreign to the body. These antigens are inherited from one's parents. Human leukocyte antigens are used to determine the compatibility of kidneys and pancreata for transplantation from one individual to another. The major groups of HLA antigens are HLA-A, HLA-B, and HLA-DR. The values shown in this report are based on the six HLA antigens (two each for the A, B, and DR loci) reported for both donors and recipients. Tables reporting the level of HLA mismatch indicate the number of HLA antigens found in the donor that are not shared by the recipients. Generally speaking, the smaller the number of HLA mismatches the better the compatibility between donor organ and recipient.

Justice

As applied to the medical ethics of transplantation, justice refers to allocation of organs to those patients in the most immediate need. Issues of justice are balanced by concerns of utility that, in this context, refer to allocating organs to those individuals who will make the best use of them. An example would be whether a potential recipient facing imminent death without a transplant but with a poorer chance of long-term survival should be given a transplant in preference to another individual with less immediate risk of death but a better long-term prognosis.

Medical Urgency Status Codes

Each candidate on the liver and heart waiting lists is assigned a status code which corresponds to how medically urgent it is that he or she receives a transplant. Medical urgency status for liver and heart is reported in the waiting list, recipient, and survival tables. Listed below are the definitions for each code, covering the last 10 years.

National Organ Transplant Act (NOTA)

The National Organ Transplant Act (1984 Public Law 98-507), approved October 19, 1984 and amended in 1988 and 1990, provided for the establishment of the Task Force on Organ Transplantation; authorized the Secretary of HHS to make grants for the planning, establishment, and initial operation of qualified OPOs; and established the formation of the Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR).

Organ Preservation

Between procurement from a donor and transplantation into a recipient, organs require special methods of preservation. The length of time that organs and tissues can be kept outside the body varies, depending on the organ, the preservation fluid, and the temperature.

Panel Reactive Antibody (PRA)

The percent PRA value is a measure of a patient's level of sensitization to donor antigens. It is the percentage of cells from a panel of blood donors against which a potential recipient's serum reacts. The PRA reflects the percentage of the general population that a potential recipient makes antibodies (is sensitized) against. The higher the PRA, the more sensitized a patient is to the general donor pool, and thus the more difficult it is to find a suitable donor. A patient may become sensitized as a result of pregnancy, a blood transfusion, or a previous transplant.

Patient Survival

Patient survival refers to whether a transplant recipient is still alive at a certain time after transplantation. The time points used in the Annual Report tables include three months, one year, three years, and five years. Ten-year patient survival is also reported in Table 1.14.

Recipient

A transplant patient who receives an organ or tissue transplant.

Scientific Registry of Transplant Recipients (SRTR)

The SRTR provides analytic support for the ongoing evaluation of the scientific and clinical status of solid organ transplantation in the United States. With oversight and funding from the DoT, the SRTR is currently administered by University Renal Research and Education Association (URREA), in collaboration with the University of Michigan.

Sensitization

Potential recipients are sensitized if their immune system makes antibodies against potential donors. Sensitization usually occurs as a consequence of pregnancy, blood transfusions, or previous transplantation. The degree of sensitization is measured by PRA. Highly sensitized patients are more likely to reject an organ transplant than are unsensitized patients.

Time to Transplant (TT)

The time between when a patient is registered on a waiting list and when that patient receives a transplant. Annual Report tables show the median and other percentiles of time to transplant. The median time to transplant is the time by which 50% of a group of registrants have received a transplant. Among the factors affecting time to transplant are the shortage of organs; biologic issues such as blood type, body size of donors and recipients, PRA, immunological factors, and medical urgency status (for liver and heart); donation rates within an area; donation request and consent procedures at OPOs; and patient registration and organ acceptance practices at transplant centers. Table 1.6 presents an alternative measure, waiting time before transplant, in which inactive time on the waiting list is not counted and patients are censored at any removal from the waiting list.

University Renal Research and Education Association (URREA)

Located in Ann Arbor, Michigan, URREA is a private, nonprofit organization established for the purpose of collecting information and conducting worldwide epidemiological, clinical, and economic studies of organ failure and related diseases. URREA's mission is to conduct research, to distribute information focused on improving patient care, and to provide analysis and research training opportunities for medical professionals. URREA, in collaboration with the University of Michigan, is responsible for the administration of the Scientific Registry of Transplant Recipients (SRTR).

Utility

As applied to the medical ethics of transplantation, utility refers to allocating organs to those individuals who will make the best use of them. Issues of utility are balanced by concerns for justice that, in this context, refer to allocation of organs to those patients in the most immediate need. An example would be whether a potential recipient facing imminent death without a transplant but with a poorer chance of long-term survival should be given a transplant in preference to another individual with less immediate risk of death but a better long-term prognosis.

Waiting List

After evaluation by a team of transplant professionals, a patient is added to the national waiting list by the transplant center. Lists are specific to both geographic area and organ type: kidney, pancreas, kidney-pancreas, liver, intestine, heart, lung, and heart-lung. Each time a donor organ becomes available, a computer generates a list of potential recipients based on factors that may include genetic similarity, organ size, medical urgency, and time on the waiting list. Through this process, a new list that best matches a waiting patient to a donated organ is generated each time an organ becomes available.

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ABO Blood Type
Actual Donor
Additional Donor
Advisory Committee on Organ Transplantation (ACOT)
Allocation Policies
Allograft
Annual Death Rate
Antibody
Antigen
Cadaveric Donor
Cadaveric Transplant
Cardiomyopathy
Censoring
Centers for Medicare and Medicaid Services (CMS)
Chimerism
Cockcroft-Gault Formula
Cohort
Cold Ischemia Time (CIT)
Compliance
Confidence Interval
Congenital Heart Disease
Coronary Artery Disease
Creatinine
Crossmatch
Death Rate
Deceased Donor
Division of Transplantation (DoT)
Donation Rate
Donation Service Area
Donor
Donor Cardiac Death (DCD)
DSA
DSA
Eligible Donor
Emphysema
End-Stage Organ Failure
End-Stage Renal Disease (ESRD)
Ethnicity
Expanded Criteria Donor (ECD)
Expanded Criteria Donor (ECD) Kidneys
FEV1
Final Rule
Glomerular Filtration Rate (GFR)
Graft
Graft Survival
Haplotype
HCFA
Health Resources and Services Administration (HRSA)
Heterotopic Transplant
Histocompatibility Antigens
Human Leukocyte Antigen System (HLA System)
Immunogenicity
Immunosuppression
Induction Therapy
Informed Consent
Inotropes
Justice
Living Donor
Median Time to Transplant
Median Waiting Time
Medical Urgency Status Codes
Medical Urgency Status Codes for Heart Allocation (1999-2002)
Medical Urgency Status Codes for Heart Allocation (Pre-1999)
Medical Urgency Status Codes for Liver Allocation (1997)
Medical Urgency Status Codes for Liver Allocation (1997-2000)
Medical Urgency Status Codes for Liver Allocation (Pre-1997)
Mismatch
Model for End-Stage Liver Disease (MELD)
National Organ Transplant Act (NOTA)
Nonheartbeating Donor
OPO
Organ Preservation
Organ Procurement
Organ Procurement and Transplantation Network (OPTN)
Organ Procurement Organization (OPO)
Panel Reactive Antibody (PRA)
Patient Survival
Pediatric End Stage Liver Disease (PELD) Scoring System
Percentile
Procurement
Race
Recipient
Rejection
Scientific Registry of Transplant Recipients (SRTR)
Sensitization
Standard Error
Thoracic Organs
Time to Transplant (TT)
Tissue Type
Transplant Center
Transplant Program
Tumor
United Network for Organ Sharing (UNOS)
University Renal Research and Education Association (URREA)
Utility
Vascular
Ventricular Assist Device (VAD)
Waiting List
Waiting List (Active)
Waiting List (Inactive)
Waiting List (Removal)
Waiting Time