What is multiple listing?
Multiple listing involves registering at two or more transplant centers. Since candidates at centers local to the donor hospital are usually considered ahead of those who are more distant, multiple listing may increase your chances of receiving a local organ offer.
UNOS’ patient services assistant, Ruth Henson, explains what multiple listing is and how it works
What is involved in multiple listing?
As with any transplant listing, you must be considered and accepted by a transplant center. This involves completing an evaluation and agreeing to meet any conditions set by the program (for example, ability to come to the hospital within a certain time if you are called for an organ offer).
Check with your insurance provider to see if they will reimburse the cost of additional evaluations. You should also consider other costs associated with listing that insurance may not cover. For example, you may need to pay for travel and lodging if the center is further from your home. You should also find out whether your post-transplant medical care will be provided at the center or can be transferred to a facility closer to your home. In addition, you need to maintain current lab results and contact information for each transplant program where you list. Each program will need current information should they receive an organ offer for you. Through the OPTN database your center can know if you are multiple-listed but may not know the other hospital(s) where you are listed.
I listed myself in five transplant centers. I researched success rates at one year and five years post-transplant, and made my plan as to where I would feel comfortable listing within a four hour drive from home.
Could multiple listing shorten my waiting time for a transplant?
Some studies suggest multiple listing can shorten the average waiting times of kidney transplant candidates by several months. This does not guarantee that every multiple-listed patient will have a shorter waiting time.
Many factors affect how long you might wait for a transplant. Of course, not enough organs are donated each year to meet everyone’s needs. Everyone in the transplant community shares the goal of increasing organ donation to save and enhance more lives.
Other waiting time factors include how urgent the patient is and how closely the donor and candidate match on body size and blood type. Some kidney and pancreas candidates have a “highly sensitized” immune system because of earlier transplants, pregnancy or multiple blood transfusions. Highly sensitized patients will only be good matches for a limited number of organ offers, so they often wait longer than non-sensitized candidates.
Are there any restrictions?
OPTN policy allows multiple listing. It will still be up to the individual center to decide whether to accept you as a candidate. You probably would not benefit from listing at multiple centers in the same local allocation area. This is because waiting time priority is first calculated among candidates at all hospitals within the local donation area, not for each hospital individually.
Some transplant programs may not accept multiple-listed patients. Others may set their own requirements for multiple-listed candidates. If you are considering multiple listing, you should ask the transplant team how they handle such requests.
If I list at more than one center, how is my waiting time considered?
Depending on the organ you need, waiting time may be a factor in matching you for an organ offer. Waiting time is a more important factor for certain organ types such as kidney and pancreas. It is less of a factor with heart, liver, and intestinal organs. For these organs more priority is given for factors such as medical urgency.
If you are a lung transplant candidate age 12 or older, waiting time will not be used at all in matching you with organ offers. Lung transplant priority is given for a combination of medical urgency and expected post-transplant survival. Waiting time is a factor for lung transplant candidates age 11 and younger.
The longest amount of time you have waited at any center is called your primary waiting time. If you list at multiple centers, your waiting time at each center will start from the date that center listed you. OPTN policy allows you to transfer your primary waiting time to another center where you are listed, or switch time waited at different programs. (For example, if you have waited 9 months at Center A and 6 months at Center B, you could switch your time to have 6 months at Center A and 9 months at Center B.)
You are not allowed to add up or split your total waiting time among multiple centers. (Again, assume you have waited 9 months at Center A and 6 months
at Center B. You could not assume you have 15 total months of waiting time and assign 5 months to Center A and 10 months to Center B.)
Any request to transfer or switch waiting time must be approved by the transplant center(s) involved. Most transplant programs require a written
request to swap or transfer waiting time, which will then be considered by the transplant team.