Transcript overview of solid organ transplantation

LIVING DONOR KIDNEY
TRANSPLANT
Kelli Willard West, MSSW, APSW
Living Donation Outreach Educator
End Stage Renal Disease
(ESRD) or Kidney Failure
 Can
occur at any age
 Requires renal replacement therapy
(dialysis) or kidney transplant to sustain
life
 Time varies between diagnosis and
need for dialysis or transplant,
depending upon disease
Common Causes of Kidney Failure


Diabetes Type I & II (diabetic nephropathy)
Hypertension
 Hereditary
 Polycystic Kidney Disease (PCKD)
 Auto-Immune
 Primary Glomerulonephritis
 Systemic Lupus Erythematosus (SLE)
 Renal Cell Carcinoma (RCC)
 Renal Artery Stenosis / Renal Vein
Thrombosis
 Urologic
 Reflux Nephropathy
 Stones
 Frequent chronic UTI’s
What is Transplant?

Definition:


The transfer of a tissue or organ from one part of
the body to another within the same person
The transfer of a tissue or organ from one
individual to another individual. This is usually
done surgically
Transplant is the treatment of choice for renal failure.
It offers the best opportunity for optimum medical,
social, psychological and vocational rehabilitation.
2 Basic Transplant Options

Deceased Donor Transplant

Brain Death (DBD)
• Determined by a neurologist
• Patient is on a ventilator at time of donation

Declared Cardiac Death (DCD)
• Ventilator support is withdrawn in the OR
• Determined by the patient’s critical care doctor
• Lack of blood flow can damage organs


Donor family provides consent to donate organs/ tissues
Living Donor Transplant

Patient receives kidney from a living related or non-related
donor
UNOS Wait List
As of 4/3/09  US - 109,294 waiting for organ transplant
 US - 83,913 waiting for kidneys

WI - 1,538 awaiting transplant
 WI - 1,115 waiting for kidneys
UWHC – 724 on transplant wait lists
 UWHC – 495 waiting for kidneys

Average Waiting List Time
 The
average waiting time at UW
Hospital depends on the recipient blood
type:
•
•
•
•
 Each
O=2-3 Years
B=2-2.5 Years
A=1-1.5 Years
AB=6 Months
center has a different waiting time
Blood Type Compatibility
Recipient Blood Type
Compatible Donors
O
O
B
B or O
A
A or O
AB
A, B, AB or O
The Operation

Transplanted
kidney’s artery &
vein attached to
recipient’s iliacs
 An incision is
made in bladder &
ureter is attached
UW Health Transplant Experience
1966
kidney transplant program established,
including deceased & live donor transplants
1997
OPO ranked most effective in the U.S.
2000
laparoscopic kidney donor nephrectomy began
2003
1st "humanitarian" live-donor kidney transplant
1st paired exchange transplant
2004
desensitization program started
donor mentor program developed
In various years since 1996, the UW Transplant Program has
been ranked the 1st or 2nd most active kidney transplant
center in the U.S. and has consistently performed in the top
five kidney transplant centers nationally.
Why is Living Donor Transplant
Recommended?

Longer Kidney Survival



8-12 years for deceased donor transplant
12-20 years for living donor transplant
Reduce Need for Future Re-Transplant
 Shorter Wait Times for Transplant
 Surgery Scheduled for Convenience
 Healthy Donor Kidney
Adult Kidney Graft Survival Rates 1995- 2005
Percentage
100%
90%
96%
90%
93%
90%
87%
86%
81%
80%
80%
76%
72%
70%
65%
60%
55%
50%
1 year
2 year
3 year
Living Donor
4 year
5 year
10 year
Deceased Donor
Source: UW Health Transplant database. Represents the total number of kidney transplants from 1/1/1995 through 12/31/2005. Includes all
kidneys transplanted, including multi-organ transplants.
01/24/2007
UW Kidney Transplant Graft Survival For
Patients Age 65+
100%
98.49%
91.35%
89.06%
90%
Survival Percentage
84.61%
84.61%
84.61%
82.23%
80%
71.98%
70%
64.70%
61.86%
60%
55.36%
55.36%
50%
40%
1
2
3
4
Years Post-Transplant
Living Donor
Source: UWHC Database Office, October 2008.
Deceased Donor
5
6
Benefits of Living Donor Transplant
(continued)






Able to Return to Work
Kidney Works Right Away
May Be a Closer Genetic Match
Lower Cost
Increase Kidneys Available for Transplants
Improve Quality of Life
Why Don’t More Patients Get A
Living Donor?
 Don’t
have enough information
 Fearful for the donor’s safety
 Don’t understand the donor’s experience
 Can’t bring themselves to ask
 Waiting for someone to offer
 Don’t want family/friends to feel obligated
 Don’t want to be a burden
 Refuse to accept kidney from adult children
Finding a Living Donor





The donor’s health is the goal in the screening. A
risky transplant doesn’t help anyone.
Don’t rule anyone out. Let the Transplant Team
decide if they are healthy enough.
Over 30% of donors screened are not approved. The
screening for risks is very careful.
All medical costs for kidney donor exam and surgery
are paid by the patient’s insurance or Medicare.
Donor pays only travel and hotel. Lost wages can be
a financial impact – depending upon employer
sick/vacation/disability leave policies.
Donors are given many chances to change mind.
Living Donor Criteria








18 years of age or older
Good physical & mental health
No chronic kidney stones
No diabetes
No current/recent cancer
Not a lot overweight
High blood pressure may be considered
Other medical issues checked case-by-case
Donor Evaluation Process
3 basic steps for the donor
 Review medical history with Transplant
Coordinator by phone
 Provide blood sample for compatibility
testing (done locally with mail-in test kit)
 Full medical evaluation at UWHC in
Madison
Donor’s Medical Exam













Complete medical history & Physical exam
Talk with a medical doctor about any medical issues
Talk with a surgeon about surgery and risks
Chest X-ray – checks for any lung or heart problems
EKG (electrocardiogram) – checks heart health
24-hour urine collection – checks kidney health
Urine test – checks kidney health
CT/CAT scan – looks at abdomen organs, kidneys, and kidney blood
vessels – checks to see if anatomy would work for surgery
Glucose test – screens for diabetes
Other blood tests – includes clotting study
Virus screening – checking for hepatitis, HIV, syphilis, or other virus
Social Work and/or Health Psychology visit – to see if mental health or
other stress might make it hard for a donor to make health choices or to
recover after surgery
Donor Advocate – to ensure donor is fully informed and consenting
Donor Selection Committee


Meets monthly
Includes:











transplant surgeons
medical doctors - nephrologists
transplant fellows
physician assistants
social workers
dietician
transplant coordinators
Head of in-patient transplant nurses
Living Donor Advocate
Prospective donors are presented & transplant candidacy is
determined
About 30 percent of possible donors ruled out
So What Are the
Kidney Donor’s Risks?

Many studies of have researched donor safety
 Long-term studies tracking kidney donors up to
40 years
 Many common fears about kidney donor safety
are not true
 Will discuss 3 basic areas of donor risks



Surgical risks
Long-term health impacts
Emotional/psychological impacts
Surgical Risks
Same complications as any other surgery - kidney
donors have fewer than typical surgery patient
because screening ensures they are healthy
Small issues:
 problems with anesthesia
 infection
 wound healing issues
 collapsed lung
 fluid in the lungs
(pneumonia)
 pain
Bigger problems:
 bleeding
 blood clots
 death
Less than 1% of all kidney donors have any
surgical problems
Long-Term Health Impacts
 Area
of biggest fears & most
misinformation in general public
 Common misconceptions



Donor will get kidney disease/failure
Donor’s lifespan will be shorter
Donor will need major lifestyle adjustments for
one kidney
Kidney Donor Health



Average person with 2 healthy kidneys has 8-10 times
kidney function body needs
Within 3-6 months of donation, remaining kidney adjusts
to being single kidney
Most recent study – University of Minnesota – published
January 2009




Kidney donor life expectancy same as general population
Lower rates of kidney disease/failure
No lifestyle changes expected
One area of concern – possible risk of high blood
pressure
Emotional/Psychological Impacts of
Kidney Donation





Common for recipients to fear that the donor
may have regrets
Most kidney donors have good experience
Most feel good about helping the kidney
patient & some feel more self-esteem
Over 90% of kidney donors say they would
make the same choice again
Emotional struggles are not common, but
possible; more likely if the transplant does not
go as planned
Open Nephrectomy
Laproscopic Nephrectomy
Donor Hospitalization

Laparoscopic procedure using scope and
cameras to remove kidney (utilized 95% of the
time)
• Stay about 3-4 days

Open donor nephrectomy; larger incision
• Stay about 4-5 days
Donor Recovery

Time to return to work



Laparoscopic: 3-6 weeks
Open nephrectomy: 6-8 weeks
First clinic visit with surgeon about 2-4 weeks
after discharge
 No additional medicines or diet changes
 Follow-up visit at month 4 and 1 year
 Annual physical with local physician thereafter
Donor Safety – What If
Worst Case Scenario?
If an organ donor (any “vital” organ including kidney,
liver segment, lung segment, partial pancreas, small
bowel segment) later needs a kidney transplant,
national policy provides priority on kidney wait list
 Cause of organ failure doesn’t matter
 Donor gets points equal to 4-years wait time
 Likely that others in family/community may volunteer
to help by donating
 Statistical chance of this scenario is very unlikely
 Safety-net provides peace of mind

Other Living Donation Terminology
 Desensitization
 Paired
Exchange or Kidney Swap
 Humanitarian (Non-Directed) Donors
 Living Donor Mentor Program
 Living Donor Advocate
 Donor Matching Websites or Services
So - How Do I Ask?
 Patients
often find it difficult to ask for
a kidney donor
 Many patients wait for someone to
offer
 Not all interested candidates will
automatically offer
Gaps of Communication
Role Play #1
 Situation
- Parent Talking to Teen
Gaps of Communication
Role Play #2
– Married Couple Has Different
Plans for the Night
 Situation
Gaps of Communication
Role Play #3
– Patient who can’t quite bring
themselves to ask the question
 Situation
Gaps of Communication
Role Play #4
– Patient with really poor
communication skills
 Situation
Filling In Communication Gaps

What Do These Patients Really Mean?






I’d like to talk to you about something very
personal. Do you have some time right now?
My health is failing because I have kidney
disease.
Dialysis is very difficult physically, and disrupts my
day-to-day life.
My doctor’s recommend living donation transplant
as the best treatment option for me.
Asking for a kidney donation is very difficult. This
conversation is awkward for both of us.
I would be honored if you would consider being
evaluated and possibly donating a kidney for my
transplant.
Continuing the Conversation





I want you to have time to think about this. I don’t
expect an answer right now.
I have some reading and video materials that can
provide more information for you to think about.
I don’t want you to feel pressured, so I will not
bring this up again – it is your choice if/when we
discuss this topic further.
If you don’t approach me about this in the future, I
will understand you don’t feel ready to pursue
kidney donation – and I will not pressure you.
It is OK to say no. I won’t be offended or hurt if
you choose not to pursue kidney donation.
Continuing the Conversation





I understand the sacrifice involved in kidney
donation and recognize that saying no doesn’t
mean you don’t care about me or love me.
Donating a kidney is a difficult decision – and you
may say no for reasons that have nothing to do with
your feelings about me.
Be assured I am pursuing other treatment options,
including the wait list for a deceased donor kidney.
I am also talking to other potential donors.
Living donation is the best treatment option, but is
not the only treatment available.
No matter what you decide, I will feel the same
about you and continue to value our relationship in
the same ways.
Internet Resources

UW Health Website




National Kidney Foundation




Health Facts for You
Patient Education Videos
www.uwhealth.org/transplant

Patient Education Videos
www.asts.org
UNOS (United Network for
Organ Sharing)



Patient Education & Advocacy
Living Donor Message Board
www.kidney.org
American Society of Transplant
Surgeons


Transplant Living



Transplant Data
www.unos.org
Patient Education project of
UNOS
www.transplantliving.org
Transplant Experience


Patient Education Materials &
Videos
www.transplantexperience.com
I expect to pass through life but
once. If therefore, there can be any
kindness I can show, or any good
thing I can do to any fellow being,
let me do it now and not defer or
neglect it, as I shall not pass this
way again.
- William Penn
Dottie the Dot