The Call is Made Rhonda Duggan, BSN, RN, CCTC August 29, 2014 Living Donor Coordinator Carolinas Medical Center

Kidney Matching Blood type HLA (tissue typing) Time Waiting Medical Urgency Antibody Level Geographic areas/Availability

Liver Matching Blood Type (A,B,O, AB) Percentage of blood groups in population: O = 46% A = 39% B = 11% AB = 4% MELD score Height/Weight Wait Time considered after ABO, MELD and Height/Weight Blood work to calculate MELD must be within 1-2 weeks Pt’s have the option to be multi-listed at other transplant centers, transfer primary waiting time, and the option to transfer care to a different transplant center without loss of accrued waiting time.

Heart Matching IA-highest priority ICU Swan ganz catheter One high dose inotrope or two lower dose inotropes Mechanical circulatory support/ Mechanical ventilation 30 days after VAD implant and device related complications None of the above, but life expectancy <7days These hospitalized patients will be seen daily by the heart transplant service

Heart Matching IB Continuous low dose inotropic support (home or hospitalized) As an outpatient, these patients will have office visits at least every month and lab work to include PT/INR (when applicable), CBC, and CMP and PRA at least every three months. II All patients waiting at home on oral heart failure therapy These patients will have office visits and lab at least every three months VII A patient who has been listed on the waiting list, but whose status is currently inactive If the patient’s status VII is not due to the patient being too sick to transplant, then the patient will have office visits and lab work at least every six months.

Organ Offers UNOS and/or the OPO notifies the transplant center of available organ Transplant Center has one hour to review the patient(s) that the organ is being offered for and whether to accept or decline the offer. If unable to reach patient within 1 hour, we will move to next patient on the list Transplant Center should have all phone numbers Questions for patient at time of organ offer Insurance (must match the insurance we received approval through) Recent illness, fevers, infections, etc. Most recent meal

Pre-op Surgical Work-up Admission to hospital room on transplant unit Labs (includes final crossmatch for kidney patients) Chest x-ray EKG Evaluation by Nurse & Physicians Shower with antimicrobial soap Dialysis (if needed for kidney patient) Other tests or procedures (if needed)

Liver Transplant Surgical Time: 6-12 hours May be placed on bypass during surgery Allows blood to flow through body while bypassing the liver Blood products will be administered during surgery

Kidney Transplant Surgical Time: 3-5 hours Blood products may be administered during surgery Foley catheter is inserted and remains for 3-4 days Ureteral stent placed and remains for several weeks Induction medication infused via central venous catheter

Questions?