the recipient experience jaime myers, rn, msn, cctc april 29, 2011
TRANSCRIPT
The Recipient ExperienceJaime Myers, RN, MSN, CCTC
April 29, 2011
Recipient Process
Referral Evaluation Work-up & Review Listing Getting the phone call
Step 1: Referral & Pre-screen
Physician or patient
Return call from Transplant Nurse Coordinator
Items to review for transplant
Age Cardiopulmonary health Malignancy Infection Technical and/or vascular
difficulty
Items to review for transplant
Substance Abuse Social Support Motivation Compliance
Step 2: Evaluation visit
Evaluation visit
Transplant Surgeon Hepatologist (liver) Clinical Transplant Coordinator Dietician Transplant Social Worker Financial Coordinator
Evaluation visit
Chest x-ray Labwork
Step 3: Work-up & Review
Testing is done to evaluate the risks of transplantation and to ensure the recipient is a good candidate.
Review panel
Transplant surgeons Nephrologists/Hepatologists Transplant
coordinators Social workers Pharmacy Dietician Other team
members
In order to proceed…
Patients must show commitment to follow-up care and the ability to follow the recommendations of the transplant team.
The Waiting List
Placed on waiting list.
Wait times are highly variable.
UNOS allocation
UNOS (United Network for Organ Sharing)
Established by the federal government to oversee all areas of transplantation.
Governs allocation of who will receive what donated organ.
UNOS point system: Factors
Differs depending on the organ:Kidney: Blood type Donor and recipient antigen matching Length of time on the wait list Antibody status Pediatric patients are given extra points
UNOS point system: Factors
Liver: Blood type MELD score (degree of illness)Pancreas: Blood type Time on waiting list Time on dialysis Antibody levels
How long will I wait?
For specific information on allocation rules and estimated
wait times visit: http://unos.org/
andhttp://www.uwhealth.org/
Source: United Network for Organ Sharing. Represents patients on waitlist list from 1/1/2004-6/30/2009. The graph illustrates the number of months it took for 50 percent of UW Health patients to receive a transplant after being placed on the waiting list, as well as how long it took regionally and nationally. The remaining 50 percent of patients were either still waiting or were removed from the waiting list. Data Published July, 2010.
Median Time to Transplant (50th Percentile)
2.7
3.2
10.9
9.6
13
33.2
18
14
46.7
0 10 20 30 40 50
Pancreas
Kidney/Pancreas
Kidney
Months to Transplant
National
Regional
UW
Source: United Network for Organ Sharing (UNOS. www.ustransplant.org. Represents patients on waitlist from 1/1/04 to 6/30/09. Fifty percent of UW Health patients received a liver transplant as of 2.8 months after being placed on the waiting list, while it took 7.3 months regionally and 11 months nationally. The remaining 50 percent of patients were either still waiting or were removed from the waiting list. Regional data includes transplant programs in WI, IL, MN, ND, SD. Data Published July, 2010.
Median Time to Transplant for Liver Waitlist Patients (50th Percentile)
2.8
7.3
11
0 2 4 6 8 10 12
UW
Regional
National
Months to Transplant
While waiting
Continued care with local medical providers. Visit with transplant team at least annually. Updated medical testing.
Organ offers
OPO contacts Transplant Coordinator.
Organs are allocated according to UNOS Match Runs.
Transplant coordinator reviews with surgeon and contacts the patient.
Getting the call
The call can come any time… day or night. We have one hour to contact the potential
recipient when an organ is available.
Getting the call
It is vital that the patient be readily accessible at all times and have a plan in place for how they will get to UWHC.
1 Year Kidney Transplant Graft Survival
94.72 94.67 93.47
0
20
40
60
80
100
UW (n=662) Expected National
Su
rviv
al P
erc
en
tag
e
Source: United Network for Organ Sharing. Represents patients transplanted from 01/01/2007 and 06/30/2009 for the 1 year Cohort. Data Published July, 2010.
1 Year Kidney Transplant Patient Survival
97.46 97.59 96.9
0
20
40
60
80
100
UW (n=545) Expected National
Su
rviv
al P
erce
nta
ge
Source: United Network for Organ Sharing. Represents patients transplanted from 01/01/2007 and 06/30/2009 for the 1 year Cohort. Data Published July, 2010.
3-Year Pancreas Transplant Graft Survival
74.7363.91
0102030405060708090
100
UW (n=40) National
Su
rviv
al
Perc
en
tag
e
Source: United Network for Organ Sharing. Represents patients transplanted from 7/1/2004 to 12/31/2006 for the 3 year Cohort. Data Published July, 2010.
3-Year Kidney/Pancreas Transplant Patient Survival
95.93 92.97 91.52
0102030405060708090
100
UW (n=123) Expected National
Su
rviv
al
Perc
en
tag
e
Source: United Network for Organ Sharing. Represents patients transplanted from 7/1/2004 to 12/31/2006 for the 3 year Cohort. Data Published July, 2010.
Source: United Network for Organ Sharing. Represents patients transplanted from 1/1/07 to 6/30/09 for the one month and 1 year Cohorts; between 7/1/04 and 12/31/06 for the 3 year Cohort. Data published July, 2010
Adult Liver Transplant Patient Survival
98.19
80.65
96.34
79.16
96.9688.79
78.55
91.7986.56
0
20
40
60
80
100
1 Month 1 Year 3 Year
Su
rviv
al P
erce
nta
ge
UW Expected National
Key Points:
Recipients undergo a very thorough process & review prior to being placed on the waiting list.
Recipients continue to follow-up with the transplant department while waiting for transplant.
Once wait-listed, recipients need to be accessible at all times.