1. The Recipient Experience Jaime Myers, RN, MSN, CCTC April 29, 2011

2. Recipient Process  Referral  Evaluation  Work-up & Review  Listing  Getting the phone call

3. Step 1: Referral & Pre-screen  Physician or patient  Return call from Transplant Nurse Coordinator

4. Items to review for transplant  Age  Cardiopulmonary health  Malignancy  Infection  Technical and/or vascular difficulty

5. Items to review for transplant  Substance Abuse  Social Support  Motivation  Compliance

6. Step 2: Evaluation visit

7. Evaluation visit  Transplant Surgeon  Hepatologist (liver)  Clinical Transplant Coordinator  Dietician  Transplant Social Worker  Financial Coordinator

8. Evaluation visit Chest x-ray Labwork

9. Step 3: Work-up & Review Testing is done to evaluate the risks of transplantation and to ensure the recipient is a good candidate.

10. Review panel  Transplant surgeons  Nephrologists/ Hepatologists  Transplant coordinators  Social workers  Pharmacy  Dietician  Other team members

11. In order to proceed… Patients must show commitment to follow-up care and the ability to follow the recommendations of the transplant team.

12. The Waiting List  Placed on waiting list.  Wait times are highly variable.

13. 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.

14. 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

15. UNOS point system: Factors Liver:  Blood type  MELD score (degree of illness) Pancreas:  Blood type  Time on waiting list  Time on dialysis  Antibody levels

16. How long will I wait? For specific information on allocation rules and estimated wait times visit: http://unos.org/ and http://www.uwhealth.org/

17. 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.

18. 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.www.ustransplant.org Median Time to Transplant for Liver Waitlist Patients (50th Percentile)

19. While waiting  Continued care with local medical providers.  Visit with transplant team at least annually.  Updated medical testing.

20. Organ offers  OPO contacts Transplant Coordinator.  Organs are allocated according to UNOS Match Runs.  Transplant coordinator reviews with surgeon and contacts the patient.

21. 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.

22. 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.

23. 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.

25. 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.

27. 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 Adult Liver Transplant Patient Survival

28. 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.