How the US organ transplant system works and what to ask to improve your
chances
[October 21, 2026]
By LAURAN NEERGAARD
It’s not always patience and luck that get patients off the organ
transplant waiting list and into the operating room.
Unlike in many areas of medicine, experts say there’s a lot of variation
in the U.S. transplant system. Knowing there are differences and what to
ask might help.
“I had to ask a lot of questions to figure out what it was that I could
do to move the needle,” said Katherine Screws of Phoenix, who got a rare
intestine transplant after she decided to get on the waiting list at
more than one hospital to increase her chances.
It can be difficult to learn how to navigate that search, but there's
publicly available information about which hospitals perform the most of
each type of transplant, plus their waiting times and outcomes. Long
used by experts analyzing the transplant system, the Scientific Registry
of Transplant Recipients, or SRTR, database has new patient-friendly
tools developed in the hopes that more would-be transplant recipients
will use it.
“People are making these really high-stakes decisions without
understanding the options,” said Dr. Allyson Hart of Minnesota’s
Hennepin Healthcare Research Institute, who helped design the tools.
Here are some things to know.
Different transplant centers have different criteria
There are about 100,000 people on the U.S. transplant list at any given
time, the vast majority of whom need a kidney. With just over 49,000
transplants performed in the U.S last year, more people than ever are
getting new organs. It’s mostly thanks to over a decade of increases in
donations from the deceased, which are recovered by organ procurement
organizations, or OPOs.
But more organs are needed to meet the demand, and different transplant
hospitals have different criteria for who they'll accept on their
waiting list.
Sometimes, “if a patient receives a ‘no’ at one place, they can go
somewhere else and be successfully transplanted,” said Dr. Syed Ali
Husain, a kidney specialist at NYU Langone Health.
Each transplant program's waiting list is linked to a national automated
matching system. OPOs enter information about viable organs into that
system, which generates lists of possible matches at multiple hospitals
in order of priority. When the OPO offers an organ, the transplant team
must quickly decide if it's a good choice for that patient or the offer
moves to the hospital with the next-in-line candidate.
Some hospitals are more conservative than others about which organs
they’ll accept, said Husain, who studies such differences.
One large study of kidney transplants found “there’s about a 16-fold
variation in how quickly a patient will get transplanted at one center
versus another,” he said. That's partly because some surgeons have more
experience than others using kidneys with complex anatomy such as extra
arteries, or those from older, sicker donors that still may be better
than dialysis for the right patient.
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Dr. Cal Matsumoto, a MedStar Georgetown University Hospital
transplant surgeon, gestures to a chart on the digestive system on
March 4, 2026, in Washington. (AP Photo/Shelby Lum)
 How to find data about transplant
centers
Typically, a doctor or other health worker points patients to the
nearest hospital offering the kind of transplant they need. But the
SRTR database allows people to compare transplant centers around the
country in multiple ways.
Search for a particular organ and a list of the
highest-to-lowest-volume centers pops up, with dials to show how
they perform on such measures as getting a transplant faster,
survival on the waiting list and the new organ's survival. Click on
those of interest for more data.
For certain organs, there's a “personalized decision guide” to
customize the search a little more with demographic and medical
information that compares outcomes for patients similar to you. It
may be important to know, for example, if hospitals you’re
considering perform transplants for a lot of older adults or people
with certain chronic illnesses, Hart said.
There's more data about kidneys, the most-transplanted organ, and a
kidney decision aid also allows adding factors such as blood type
and diabetes that play a particular role in those transplants. That
tool shows the chances of getting a transplant in the first five
years after joining the waiting list, or the alternatives — still
waiting or having died or become too sick to get a transplant.
It's OK to quiz the transplant team
Like Screws, the Phoenix patient, some people choose to “double
list” at a hospital closer to home and another higher-volume
transplant program further away.
While not everyone is able to travel, the search tools can also help
inform discussions with your chosen transplant program.
It's OK to come to a transplant program to say, “'Hey, there are
other centers that do this faster. Help me understand why,'” Hart
said. “Sometimes, that conversation is really enough to prompt maybe
more aggressive offer acceptance than that center might otherwise do
on their own.”
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