Concern about competition with other candidates enters the mind of many transplant candidates at some time or another.
Lawrence: After waiting almost two years for a lung transplant, Lawrence was worried. The move to the transplant hospital had separated him from his family. And it concerned him to see his health deteriorate. Earlier, Lawrence disagreed about how the transplant team treated him for his lung condition. They had a very different approach from his usual doctors. Now he wondered if they had passed him over for transplant because of this disagreement. So many others had waited a much shorter time.
Transplant teams usually strive to follow fair guidelines regarding the priority of candidates for transplant. Typically these guidelines are available to read. But you will not always know exactly where you stand in relation to other candidates. The team does not wish to arouse competitiveness. And the priority of candidates for transplant can change rapidly.
Many teams will try to transplant those candidates in most urgent need. But many factors influence the decision of whom to transplant. For example, there must be an acceptable match (e.g., in blood type) between the donor and recipient. For lung transplant, the size of the donor lung must approximate the size of the candidate's chest. Candidates with unusually large or small lung cavities often wait longer for an appropriate donor. This factor is not so important with other types of transplants.
Finally, most teams try to minimize the number of people on their list who are in direct competition for donor organs. For example, a lung transplant team would try to not have several people with similar sized lungs and blood type waiting simultaneously. Obviously this is unavoidable at times. When competition for a donor organ does occur, those who have waited the longest or who are the most severely ill would usually be ranked highest for transplant.