the recipient experience jaime myers, rn, msn, cctc april 29, 2011

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.