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Presentation on theme: "THE PATIENT’S JOURNEY TO TRANSPLANT AND BEYOND"— Presentation transcript:

Chris Lillesand, RN, MSN, CCTC Kidney Transplant Coordinator Don Hawes, RN Lung Transplant Coordinator Polly Boynton, RN, BSN, CPTC Heart Transplant Coordinator 1


3 Evaluation Referral to UWHC Talk with organ specific coordinator
Lab testing Surgeon, coordinator, social work, nutrition, dental, financial consults Arrange for organ specific testing - specialty coordinators for each organ divided by the diaphragm (thoracic and abdominal) - 2.5 heart following 210 patients, 2.5 lung following 151 patients, - Lab testing: HLA typing (genetic markers), ABO x 2, PRA (panel of reactive antibodies), basic organ function, infectious disease - each organ will have specific testing but all patients have to have basic testing regardless of organ

4 Heart Evaluation Support person Radiology testing
Age based preventive screening Cardiac function testing Vascular screening Pulmonary function testing Radiology: Chest CT, Chest x-ray, panorex, bone density, gallbladder ultrasound Age based:mammogram, colonoscopy, pap & pelvic, opth Heart function testing: Echo, Heart Cath, EKG, Exercise Stress Test Vascular Screening: Carotid dopplers and ABIs


6 Lung Evaluation Support person Radiology testing Lung function testing
GI testing Cardiac testing Radiology Testing: CXR 2 view, CXR single, Chest CT, Panorex, Bone mineral density, Sinus CT for CF pts Lung Function: PFTs, Lung Perfusion Scan, 6 minute walk GI testing: Manometry, PH Impedance Cardiac testing: Echo, Heart Cath, EKG


8 Case Specific Additional Testing
Urine cotinine screening for former smokers AODA counseling Psychiatrist Referrals to other specialties based on abnormal results nicotine alcohol/cocaine

9 Listing for Transplant
Have insurance coverage verified Approval by a multi-disciplinary committee Listed with UNOS (United Network of Organ Sharing) multi-disciplinary committee: surgeon, MD, NP/PA, coordinator, social work, nutrition, pharmacy, health psych, financial


11 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) Cancer w/in 5 months Heart and Lung require 6 months of documented abstinence Obesity: (Kidney-BMI 35 or less; Lung-BMI 18-30; Heart-140% of IBW

12 Organ Specific Listing Status
Kidney – HLA & wait time Liver – Model for End-Stage Liver Disease (MELD) & Pediatric End-Stage Liver Disease (PELD) Pancreas – HLA & wait time Heart – 1A, 1B, 2, 7 Lung – Lung Allocation Score (LAS)


14 Average Wait Time for Thoracic Organs
Heart – 161 days Lung – 176 days Heart: 264 days O, 82.5 days AB, 119 days A, 206 days B (shortest time in days) Lung: 187 days A, 7.5 days AB, 148 days B, 181 days O (shortest time in days)

15 Average Waiting Time for Kidneys
Depends on the recipient blood type and antibody levels O - 3 Years B Years A - weeks to months AB - weeks to months 15

16 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 Heart: A goes to A & AB, B goes to B, O goes to O & B


18 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

19 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? -Sheriff (Chris), snow storm (Don) -Status 7 if patient refuses for heart & lung and consider de-list


21 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

22 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 -all donors over 60 yrs are expanded criteria and have to have 2 of the other criteria -for each of the special circumstances the patient has to sign a special consent except for kidney

23 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


25 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 Lung: Insuring adequate oxygen and supplies for round-trip Heart: Have VAD batteries and supplies

26 Post-Transplant Encourage contact with donor family
initially anonymous Patient followed by transplant program for life monitor for rejection/infection biopsies lab work testing


28 Questions or Comments?


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