The Recipient Experience
Jaime 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/
and
http://www.uwhealth.org/
Median Time to Transplant (50th Percentile)
10.9
3.2
2.7
0
National
14
13
Kidney/Pancreas
Pancreas
46.7
33.2
Kidney
Regional
UW
9.6
10
18
20
30
40
50
Months to Transplant
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 for Liver
Waitlist Patients (50th Percentile)
National
11
Regional
7.3
UW
2.8
0
2
4
6
8
10
12
Months to Transplant
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.
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
Survival Percentage
100
94.72
94.67
93.47
UW (n=662)
Expected
National
80
60
40
20
0
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
Survival Percentage
100
97.46
97.59
96.9
UW (n=545)
Expected
National
80
60
40
20
0
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.
Survival Percentage
3-Year Pancreas Transplant
Graft Survival
100
90
80
70
60
50
40
30
20
10
0
74.73
63.91
UW (n=40)
National
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.
Survival Percentage
3-Year Kidney/Pancreas Transplant
Patient Survival
100
90
80
70
60
50
40
30
20
10
0
95.93
92.97
91.52
UW (n=123)
Expected
National
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.
Adult Liver Transplant Patient Survival
Survival Percentage
100
98.19 96.34 96.96
91.79
86.56
88.79
80.65 79.16 78.55
80
60
40
20
0
3 Year
1 Year
1 Month
UW
Expected
National
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
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.