Urgent heart cases take priority. If there are no suitable urgent cases on the national database, the heart and lungs are offered to the nearest transplant centre so they can be transported there as quickly as possible.
If this centre cannot use the heart or lungs, the organs are offered in turn to the other transplant centres in the UK and Republic of Ireland. The order is determined according to the length of time each centre has waited for these particular organs.
First option goes to the centre that has waited longest. If this centre can make use of the organs, it will be at the bottom of the list the next time heart and lungs are offered from outside its own area.
The heart and lungs can be offered as a heart/lung block or separately. A patient waiting for an urgent heart transplant may not need the lungs. These are then offered to other centres, either as a pair or singly, on the rotational basis just described.