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Under the National Organ Transplant Act, organ transplantation in the United States is overseen by the U.S. Department of Health and Human Services (DHHS). Specifically, the Division of Transplantation (DoT), which is part of the Health Resources and Services Administration (HRSA), is in charge of a federal contract that established and maintains the national waiting list and distributes cadaveric organs fairly. This organization is called the OPTN (Organ Procurement and Transplantation Network) and the contract is currently held by the United Network for Organ Sharing (UNOS).

Organs are allocated (given) according to strict rules that take into account physical matching, tissue and blood type matching, medical criteria, waiting time, severity of illness, etc. The allocation system is blind to name, race, sex, and wealth. The allocation rules have been developed over many years of deliberation by physicians and other transplant professionals, transplant candidates and recipients, donor families, and representatives of the federal government. (Source)