The New England Organ Bank--lessons from running a regional organ bank.

1. The NEOB is a very large organ procurement organization (OPO) recovering multiple organs and tissues on behalf of 15 transplant centers serving 11.5 million people scattered over 6 states. 2. The database maintained by the New England Organ Bank (NEOB) demonstrates a changing pattern of donors within our region. Trauma is decreasing as a cause of death and the age of donors is steadily increasing. 3. A flexible system for the allocation and distribution of kidneys is described. This system emphasizes waiting time as the primary criterion for allocation. This emphasis has not disadvantaged the highly sensitized patient and is equitable for minority recipients. The use of the longest waiting unsensitized patient to assign donors to transplant centers maintains the patient-based nature of the system, while allowing transplant centers to recover kidneys for their own patients and reducing ischemic time. The system is highly adaptable to a variety of local situations. 4. Extensive public education and research projects not feasible for small organizations are made possible through the resources available to a large OPO.