Transcript The Patient`s Journey to Transplant and Beyond

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
Evaluation
•
•
•
•
Referral to UWHC
Talk with organ specific coordinator
Lab testing
Surgeon, coordinator, social work,
nutrition, dental, financial consults
• Arrange for organ specific testing
Heart Evaluation
•
•
•
•
•
•
Support person
Radiology testing
Age based preventive screening
Cardiac function testing
Vascular screening
Pulmonary function testing
Lung Evaluation
•
•
•
•
•
Support person
Radiology testing
Lung function testing
GI testing
Cardiac testing
Case Specific Additional
Testing
• Urine cotinine screening for former
smokers
• AODA counseling
• Psychiatrist
• Referrals to other specialties based
on abnormal results
Listing for Transplant
• Have insurance coverage verified
• Approval by a multi-disciplinary
committee
• Listed with UNOS (United Network of
Organ Sharing)
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)
Organ Specific Listing Status
• Kidney – HLA & wait time
• Liver – Model for End-Stage Liver
Disease (MELD) & Pediatric EndStage Liver Disease (PELD)
• Pancreas – HLA & wait time
• Heart – 1A, 1B, 2, 7
• Lung – Lung Allocation Score (LAS)
Average Wait Time for
Thoracic Organs
Heart – 161 days
Lung – 176 days
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
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
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
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?
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
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
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
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
Post-Transplant
• Encourage contact with donor family
– initially anonymous
• Patient followed by transplant
program for life
– monitor for rejection/infection
– biopsies
– lab work
– testing
Questions or Comments?