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News and Trends

August 1, 1998
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UNOS Unites Patients and Organs

SIXTY THOUSAND PEOPLE IN THE UNITED STATESneed a replacement organ, and they trust the United Network for Organ Sharing’s (UNOS) computers to find them one. Considering that 4,000 people die each year while waiting for a compatible organ, UNOS’ 40-member IT department holds a major responsibility in keeping the network that unites patients and organs functioning properly.

UNOS manages the nation’s entire organ procurement and transplantation activities by administering the Organ Procurement and Transplantation Network (OPTN), under contract by Department of Health and Human Services’(HHS) Health Resources and Services Administration division. The organization maintains databases containing organ-specific "wait lists" of all patients needing organs in the United States, as well as the U.S. Scientific Registry, a colossal database that tracks the progress of all patients who have received solid organ transplants since October 1987.

Organ sharing begins with an organ procurement organization (OPO) locating an available organ. The OPO dials into UNOS’ proprietary donor management system via modem and the AT&T Interspan network service, enters characteristics about the organ and donor and launches the match program. Using sorting algorithms based on physical characteristics and the current procurement regulations, the match program, written entirely by UNOS’ IT staff, pulls potential recipients from an organ-specific "wait list" and produces a rank order list for the OPO to use in distributing the organ.

All patient data resides in an Oracle relational database running on Digital Alpha 2100 servers at UNOS’ Richmond, Va., headquarters. To ensure that the network is up at all times, UNOS maintains an exact replica of the system at a site 40 miles away on a different power grid. "The network must be extremely fault tolerant because it truly is a lifesaving function," UNOS IT director Berkeley Keck says.

Under current procurement and transplantation rules, when an organ becomes available, it is first given to a patient nearby--within the same HCFA-designated OPO. If the organ is not needed within that OPO area, it is made available to a patient in one of the other 62 areas. Recently, however, HHS has initiated a major policy change as to who should first receive an organ when it becomes available, complicating the organ matching process for those who are trying to expedite it.

HHS argues that the policy unfairly allocates organs based on "accidents of geography," and that organs should be assigned based on medical need, regardless of geographic location. The new rule is currently open for public comment until Aug. 31, and is scheduled to take effect on Oct. 1, 1998.

UNOS opposes the new regulations under the premise that sicker patients often need repeat transplants, ultimately limiting the number who receive transplants, UNOS spokesperson Bob Spieldenner says. "It literally could cause more people to die."

Fortunately, the new government regulations will not pose a problem for the IT department, Keck says. "The system is fairly dynamic because transplantation is dynamic. We are in the process of system revisions anyway, and if required, we could make the change with new implementation," he says.

The revision Keck refers to is actually a complete overhaul of the system that will make UNOS’ network Internet accessible. The new program, written in Visual Basic, will feature a Microsoft Access front end with an SQL Server database storing patient data. "It will allow wider access to a larger number of people," Keck says. "In turn, it will speed up the organ distribution process, which will improve the outcomes of transplantation."

Government Networking

IN CELEBRATION OF ITS TENTH ANNIVERSARY,Federal Computer Week magazine selected and featured the top 10 Federal Computer Systems. Including UNOS (United Network for Organ Sharing), other top systems included the FBI’s National Crime Information Center for catching wanted felons and the EPA’s Toxics Release Inventory database for identifying commercial polluters.

Though not on the list, there’s a new government network for the medical community to watch called PulseNet, a national network linking public health laboratories specifically for stopping "foodborn" illnesses--E. coli, for example. The network provides the laboratories with access to the Center for Disease Control’s (CDC) database containing DNA models of bacteria and pulsed-field gel electrophoresis, a molecular technology for identifying the food contaminants. When a foodborn illness is identified, epidemiologists share the information with their colleagues over the Internet to determine the outbreak’s scope and identify possible sources.

Administered by the CDC, PulseNet has also brought the U.S. Department of Agriculture and Food and Drug Administration laboratories online. Networking state public health laboratories to the CDC began in 1995 with Massachusetts, Minnesota, Texas and Washington. Each state is required to provide services to surrounding states. With the official launch of PulseNet, 12 states are now connected to the network.

--Jeffrey Elliott


Defining the CDR

"WHAT IS A CLINICAL DATA REPOSITORY?" THAT’Sone of the questions the Center for Healthcare Information Management (CHIM) intended to find out with its survey of 317 CIOs, physician executives and nurse executives on their perceptions of the CDR and current CDR activity in their organizations.