Dysart



KIDNEY TRANSPLANT ACTIVITY

You have been assigned to a Medical Decisions Board for a university hospital. Today, your decision involves a very common dilemma; one kidney and four patients in complete renal failure, all in need of a kidney transplant. All of the following patients are compatible recipients for the kidney to be transplanted. The kidney donor was a 17-year-old male who was killed in a car crash. The parents have requested that the kidney be transplanted in a teenager.

|Name, Age, and Occupation|Renal Status |Other Medical Factors |Financial Status |Social Factors |

|Mary Greeves |Dialysis: 15 years |Arthritis (moderate) |$46,000/yr |Has 6 grown kids, all supportive |

| | | | |Husband is reformed alcoholic with stable |

|54 |Transplant waiting list: 7 |Post-menopausal hormone replacement|Medicaid |income and in good health, age 60 |

| |years | | | |

|Housewife | |Hypertension (moderate) | | |

| | | | | |

| | |Overall health: Fair | | |

|Michelle Mantle |Dialysis: 1 year |Multiple sclerosis: 2 years |Net worth – 20 million |High profile patient would bring much |

| | |(moderate) |dollars |media attention to the medical center |

|35 |Transplant waiting list: 6 | | |Potential exists for financial gain for |

| |months |Overall health: fair |No insurance |the medical center, publicity for organ |

|Former tennis pro | | | |donations |

|Gary Puckett |Dialysis: 2 years |Overall health: good |Parents: $120,00/yr |Parents are supportive |

| | |Regularly uses cocaine, other | |Patient resists medical regimen as |

|19 |Transplant waiting list: 9 |illegal substances have been |Blue Cross/Blue Shield |prescribed by physicians |

| |months |present in blood specimens | | |

|College student | | | | |

|Gerald Ford |Dialysis: 7 years |Overall health: excellent |$25,000/yr |Has 16 year old son in school who lives in|

| | | | |home |

|43 |Transplant waiting list: 2 | |Managed care – will |Wife died of leukemia in 1995 |

| |years | |cover 50% of costs | |

|Auto mechanic | | | | |

Questions to Consider (think of what our guest speaker, Ms. Stevenson, told you about organ transplants):

• How long can a person survive on dialysis?

• How does the patient’s overall health affect their ability to receive a transplanted organ?

• How does the patient’s financial status affect your decision?

• How do the different social factors affect your decision?

• Who has the best chance of successfully being treated with a kidney transplant?

Here are the necessary steps to get on the national waiting list:

1. Obtain a referral from a physician.

2. Contact a transplant hospital. Learn as much as possible about the 200 plus transplant hospitals in the United States and choose one based on individual needs, including insurance, location, finances, and support group availability.

3. Schedule an appointment for evaluation at the transplant hospital to determine if you are an appropriate candidate for a transplant.

4. During the evaluation, ask questions to learn as much as possible about the hospital and its transplant team.

5. Once the evaluation is completed, the hospital's transplant team will determine when it is appropriate to be added to the national waiting list.

The United Network for Organ Sharing (UNOS) maintains a centralized computer network, UNet sm , that links all organ procurement organizations (OPOs) and transplant centers. The national waiting list is maintained on UNet sm . This list is open only to transplant professionals who are members of the Organ Procurement and Transplantation Network. It cannot be accessed by the public.

Patients are not notified by UNOS when they are added to the waiting list. The transplant team that did the evaluation contacts the patient in writing within 10 days and notifies the patient of the date and time their name was added to the list. The patient then directs questions about their status on the waiting list to the transplant center’s transplant team.

Identifying Organ Recipients

There are more people on the organ donor waiting list than there are organ donors, so unless they can benefit from a living donation (e.g. kidney transplant) and have a living donor, people who need transplants must wait for an organ to become available. Because each candidate's situation is unique, waiting times can vary, depending on a number of factors described below.

When the person on the waiting list is offered an organ …

Many different factors determine who will be offered an organ. These include, but are not limited to:

• age

• blood and tissue type

• medical urgency

• waiting time

• the geographic distance between the donor and the recipient

• the size of the donor organ in relation to the size of the recipient (a lung from someone six feet tall would be too big for a child.)

• the type of organ needed

Who Gets a Kidney?

The average waiting time for a kidney is 1,121 days. When a UNOS team selects possible recipients for a donor kidney, they consider a variety of characteristics of both the donor and the recipient, including tissue match, blood type, blood antibody levels (which show how active the immune system is at the current time – too much activity increases the risk of rejection), length of time on the waiting list, whether the recipient is a child, whether the body sizes of the donor and recipient are a good match, and geographic factors. Kidneys can stay healthy outside the body for between 48 and 72 hours, so the UNOS kidney team can consider many more candidates than the heart or lung teams

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KIDNEY TRANSPLANT ACTIVITY

Group Names:

Rank the patient’s based on how your group thinks they should be placed on the waiting list, #1 -- #4. As a committee, you must agree on the ranking. Justify why you placed each patient in the ranking that you did.

|Patient & Information |Justification for Ranking |

|1. | |

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|2. | |

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|3. | |

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|4. | |

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