THE PATIENT’S JOURNEY TO TRANSPLANT AND BEYOND

1. THE PATIENT’S JOURNEY TO TRANSPLANT AND BEYOND Chris Lillesand, RN, MSN, CCTC Kidney Transplant Coordinator Don Hawes, RN Lung Transplant Coordinator Polly Boynton, RN, BSN, CPTC Heart Transplant Coordinator

3. Evaluation • Referral to UWHC • Talk with organ specific coordinator • Lab testing • Surgeon, coordinator, social work, nutrition, dental, financial consults • Arrange for organ specific testing

4. Heart Evaluation • Support person • Radiology testing • Age based preventive screening • Cardiac function testing • Vascular screening • Pulmonary function testing

6. Lung Evaluation • Support person • Radiology testing • Lung function testing • GI testing • Cardiac testing

8. Case Specific Additional Testing • Urine cotinine screening for former smokers • AODA counseling • Psychiatrist • Referrals to other specialties based on abnormal results

9. Listing for Transplant • Have insurance coverage verified • Approval by a multi-disciplinary committee • Listed with UNOS (United Network of Organ Sharing)

11. Absolute Contraindications • Recent or active cancer • Active smoking (heart & lung) • Obesity • Current alcohol use (liver) • Irreversible pulmonary HTN (heart) • Uncontrolled DM • No support person • HIV (heart & lung) • Iliac disease (kidney)

12. Organ Specific Listing Status • Kidney – HLA & wait time • Liver – Model for End-Stage Liver Disease (MELD) & Pediatric End-Stage Liver Disease (PELD) • Pancreas – HLA & wait time • Heart – 1A, 1B, 2, 7 • Lung – Lung Allocation Score (LAS)

14. Average Wait Time for Thoracic Organs Heart – 161 days Lung – 176 days

15. Average Waiting Time for Kidneys • Depends on the recipient blood type and antibody levels • O - 3 Years • B - 3-4 Years • A - weeks to months • AB - weeks to months

16. Organ Allocation UNOS matches donors with recipients based upon (differs depending on organ) blood type height & weight medical urgency tissue typing time on wait list Generates a list of potential recipients

18. Organ Allocation • Organ Procurement Organization (OPO) coordinator calls transplant coordinator with offer • Transplant coordinator calls • surgeon • patient • admissions • surgery fellow • blood bank • inpatient unit • tissue typing for crossmatch • attending physician • clinical trials

19. The Recipient • Recipients need to be available 24/7 • Transplant coordinator has 1 hour to locate patient • At time of offer transplant coordinator provides instruction • timing for travel • arranging ambulance/flight • NPO status • What if the patient refuses?

21. Special Circumstances • CDC High Risk Donor • men who have sex with men, prostitution, hemophiliacs, potential HIV exposure, non-medicinal needle use, inmates • specific risk information is confidential and not released to the recipient • will require additional infectious disease testing after transplant

22. Special Circumstances • Expanded Criteria Donors (ECD) • based upon age, mechanism of death, history of hypertension and creatinine • only applies to kidney • Donation after Cardiac Death (DCD) • patients that do not meet brain death criteria but are still able to donate • applies to all organs but heart

23. Preparation for Transplant • The patient arrives and has typical pre-surgical prep • CXR, EKG, labs • Anesthesiology • Transplant Fellow • PA/Resident • Transplant Surgeon • Pharmacy • Nursing • Clinical Trials

25. A Dry Run • Patient is aware that there is always a possibility that the transplant will not occur • change in donor condition • organ not suitable for transplant • recipient condition • No change in patient’s waitlist status

26. Post-Transplant • Encourage contact with donor family • initially anonymous • Patient followed by transplant program for life • monitor for rejection/infection • biopsies • lab work • testing

28. Questions or Comments?