Transcript Is Your Patient a Transplant Candidate?

Jennifer Mize, LCSW
UNC Center for Transplant Care
Kidney Transplant Clinical Social Worker
Amy Woodard, RN, BSN, CNN, CCTC
UNC Center for Transplant Care
Lead Transplant Coordinator
Objectives
 Review national/regional kidney transplant allocation
system
 Review the transplant criteria and evaluation protocol
 Discuss common barriers and absolute contraindications
to transplant
 Review and discuss how dialysis staff can assist their
patients before, during and after transplant
As of April 5, 2013
• 127,966 people nationwide are waiting for transplant.
• 102,566 of those people are waiting for kidney
transplant.
• Every 10 minutes, a new patient is added to the wait
list for an organ
• 77 transplants take place daily, but 18 people die each
day while waiting for an organ transplant—one person
every 80 minutes.
In North Carolina…….
 There are 3 OPOs (organ procurement organizations/regions):
 Carolina Donor Services—Greenville, NC (serves 78 counties in northwest, central,
and eastern areas of NC and Danville, VA)
 Lifeshare of the Carolinas—Charlotte, NC (serves 22 counties in southwest area of
NC)
 LifeNet Health—Virginia Beach, VA (serves most of VA and Currituck County, NC)
 There are 5 transplant centers:
 UNC Hospitals—Chapel Hill, NC
 North Carolina Baptist Hospital—Winston-Salem, NC
 Duke University Hospital—Durham, NC
 Pitt County Memorial Hospital (now Vidant Medical Center)—Greenville, NC
 Carolinas Medical Center—Charlotte, NC
Kidney transplant centers in NC
When a kidney is available..
 OPO notifies transplant
 First person on match
center/centers if they
have a pt. on the match
list
 Patients at top of match
list are brought into their
transplant center for
testing, cross match, and
are seen by physicians
list that has clearance
from physicians AND
has negative cross match
gets kidney
 A deceased donor has
TWO kidneys so 2
patients can get
transplanted from 1
donor
Referrals/Evaluation process
 Begins with a referral from the dialysis unit or from the patient’s
neprhologist.
 Patients are screened for any contraindications to transplant. These can
vary from center to center. These can be made available to you upon
request from any transplant center.
 Some are absolute contraindications, meaning patient is not eligible for
consideration (i.e. Active TB, Advanced heart/lung disease,
malignancy, active drug abuse, etc.)
 Some are relative contraindications, meaning once these
contraindications are resolved or controlled, the patient may again be
eligible for consideration (i.e. vascular disease, lack of social support,
uncontrolled HIV, active lupus/auto-immune disease, lack of interest
in transplant, etc.)
If an acceptable referral……
• Evaluation begins and includes (but is not limited to): Labs,
EKG, CXR, Renal U/S, Echocardiogram, Health maintenance
screening (Pap, Mammogram, PSA, Colonoscopy, Dental),
Psychosocial evaluation, Financial coordinator consultation,
Transplant Nephrologist, Cardiologist, and Transplant Surgeon
• After the evaluation is complete and the patient is determined to
be a suitable candidate by the multidisciplinary team (“Selection
Committee”), then his/her name is placed on the kidney
transplant wait list.
On “the” list!!
 Patients are notified by phone and in writing after listing.
 REMEMBER… being “listed” is an ongoing process!
 It does NOT start with a referral
 It does NOT end with being approved by the selection committee
 Patients who are on the wait list are re-evaluated annually.
 Patients need to know that their status on the wait list could change, if their
medical and/or social circumstances change after listing.
 Once listed, patients can often change between “active” and “on hold” status.
 For example:


If someone is admitted to a hospital, then they would likely be placed on
“hold” until they are well again.
If someone needs to have their testing updated, they could be placed on
“hold” until it is completed.
What makes a “good” transplant
candidate?
 Do they understand the transplant process, including the long term
responsibilities?
 A transplant does not last a lifetime.
 Yes, you will have to take medication for as long as that kidney is
working.
 Do they have an adequate financial plan and/or insurance coverage to
cover their needs before, during & after transplant?
 Do they understand that SSDI, Medicare, etc… may not last after
transplant?
 Do they need encouragement to finish a GED or learn new job skills
so that they can return to work following transplant (and have
insurance benefits)?
What makes a “good” transplant
candidate?
 Do they have reliable transportation?
 Can they get to UNC if they get an organ offer at 2am?
 Are they dependent on Medicaid transportation?
If Medicaid is their only source of transportation, a
patient will need a “Plan B”.
 Have they been compliant with their dialysis
recommendations?
 This includes attendance, early sign offs, history of noshows, fluid overload, medication compliance, and/or
behavior.
 Think of dialysis as “practice” for transplant…

What makes a “good” transplant
candidate?
 Is there a history of Substance Abuse?
 “Anything” in the last 5 years will require something, e.g. random
tox screens
 More significant histories of SA abuse could require up to 6 months
of SA counseling and random tox screens, all of which must be
negative
 Is there a history of Mental Illness or Developmental Disability?
 Are they under the appropriate psychiatric care?
 Do they have responsible support people/caregivers?
 Are they living in supportive housing, e.g. ALF, group home?
 Have they been “stable” in the last few years?
What makes a “good” transplant
candidate?
 Do they have an “appropriate” caregiving
plan?
 Do they have people who can stay with them & help
them out during their recovery?
 Drive them to appointments? Or bring them to UNC for
emergent issues?
 Help them remember their new medications?
 Patients will need a plan for the first 4-6 weeks following
transplant surgery

Any potential complications could add to this recovery period!
How can the dialysis center help?
 Report the following to the Transplant Center:
1. Up-to-date contact information
2. Recent hospitalization, infection, or illness
3. Non-compliance with dialysis, medications, or
diet
4. Suspicion of substance abuse
5. Changes in social support system
7. Changes in insurance coverage
How can the dialysis center help?
7. Is the patient going out of town?
8. Send monthly PRA, even if patient is waitlist
9.
10.
11.
12.
hold
Up-to-date health maintenance (e.g.
mammogram, PPD, dental, colonoscopy)
Patient received a transplant at another center
Death
Educate your patients about the above before
referral
Sometimes, it takes a village…….
 Get education materials from your
local transplant center
 Have patient support groups – invite
past patients that have been
transplanted
 Ask staff from local transplant
center to speak at your unit (to staff
or patients)
 On line education materials
 DVD’s that can be shown on TV’s at
your unit
 Post information on bulletin board
in your unit
Resources
 UNC Center for Transplant Care: www.unctransplant.org
 United Network for Organ Sharing (UNOS): www.unos.org
 National Kidney Foundation (NKF): www.kidney.org
 Carolina Donor Services (CDS): www.carolinadonorservices.org
THANK
YOU!
Amy & Jen