packaging and assurance that adequate material for tissue typing is procured, divided, and packaged (UNOS Policies as of March 7, 1997). OPOs also act as liaisons between individual hospitals and UNOS. Eligibility for reimbursement under Medicare requires that transplant centers be members of the OPTN. OPOs are responsible for identifying, evaluating, and maintaining the donor; obtaining consent from the patient or patient's family for the removal of organs; verifying pronouncement of death; and ensuring that information about the donor is entered into the UNOS national computer system, and that the approved UNOS organ allocation program is executed for each donor organ.
All 63 organ procurement organizations in the United States were identified by UNOS for an IOM survey of their NHBD protocols, carried out in May, June, and July 1997, which simply asked for a copy of OPO NHBD protocols and followed up all nonresponders to obtain a protocol or to confirm the absence of a protocol and elicit reasons for such an absence. (See Appendix C for the request letter, a listing of the OPOs, and a map.) Protocols were evaluated as described below using a checklist including: approved; draft; for controlled NHBDs; for uncontrolled NHBDs; cannula use; determination of death; use of heparin and regitine; OPO referral, life support withdrawal decision making, and donation discussions; and family contacts and location of withdrawal. Additional anecdotal information elicited during telephone follow-ups is included when judged to be worthwhile. The survey was performed to provide a basis of information on actual NHBD procurement practices. This information assisted in the analysis and preparation of conclusions and recommendations on issues identified earlier in this report. Fifty-four of the surveyed OPOs are independent. Nine are located in specific hospitals. According to UNOS data, 20 donor hospitals and OPOs recovered organs from NHBDs in 1996, and 36 recovered organs from NHBDs from 1993 to 1996.
All of the OPOs responded to the IOM request for a copy of their NHBD protocols, either by mail or via phone interview. Twenty-five OPOs have approved NHBD protocols in effect. Nine OPOs reported that they were in the process of drafting, approving, or reevaluating their NHBD protocols. A few OPOs reported that their NHBD protocols were being reevaluated by medical and ethics committees after the recent adverse national publicity and other negative reactions.