Q&A: Transplants at Carolinas Medical Center
Posted November 24, 2015
WRAL Investigates reporter Renee Chou reached out to the five transplant centers in the state for their explanations about the different waiting times and how new rules will impact the wait. Below is her Q&A with Carolinas Medical Center:
Why is the wait time at Carolinas double that of Vidant and Wake Forest?
The Scientific Registry of Transplant Recipients also gives us the % of transplants performed at each center from deceased organ donors vs. living organ donors.
When looking at the variability in waiting times, it is also relevant to look at the % of transplants performed at each center from deceased donors. As shown below, the US has a 67% deceased donor rate for all transplants performed. The higher deceased donor rates at both Vidant and Wake would explain the shorter waiting times. They are using organs that the other centers are not using.
|Location||% of deceased donor transplants||1-month survival||1-year survival||3-year-survival|
|Carolinas Medical Center||69%||99.22%||96.59%||85.31%|
|Duke University Hospital||69%||98.98%||96.78%||85.60%|
|Vidant Medical Center||84%||97%||95.13%||81.76%|
|Wake Forest Baptist Medical Center||81%||96.95%||91.17%||79.95%|
Each center has its own criteria for listing transplant candidates. What factors are considered in organ matching and allocation?
Transplant centers do have their own criteria for evaluating a transplant candidate to determine if transplant is the best option for them. These criteria do not match organs or impact allocation. It is related to the transplant recipient’s health issues and does not include any organ information.
Can a patient “list” at multiple centers? Do many choose to do that to increase chances of a match?
Every patient is educated on the potential to list at multiple centers. It is encouraged, so that their chances of matching in the national database are increased. However it is a burden to many patients to travel back and forth out of their area for testing and appointments. This can be prohibitive to being listed at multiple centers.
Please explain the process of how an organ that’s available in the region ends up at your hospital.
Every available organ is entered into the UNOS database. The system completes a “match run” to identify the most appropriate candidate for transplant. A list is generated by this system, ranking candidates by “best” match. The OPO then starts working the list beginning with the patient at the top and working down until a center accepts an organ for transplant with their patient.
It’s my understanding that UNOS has implemented new changes to organ allocations in order to make the process more “fair” and reduce discrepancy in wait times across the country (i.e., assigning scores to organs and recipients for better matching, giving back credit for dialysis) – what do you think of those changes?
The allocation changes from December of 2014 have negatively impacted some patients and benefited others. The criteria for being “on the list” longer was replaced with being on dialysis longer. It has been difficult for many patients who have been waiting on the list for several months. However, since dialysis takes such a toll on the body and patient’s health, it is relevant to consider the time on dialysis as a criteria for prioritizing candidates for transplant.
Advantages or disadvantages to the changes? Do you expect median wait time to go up or down as a result this year?
Wait time is often one thing patients consider when choosing a transplant hospital. What else should they keep in mind?
Wait time is important to patients, but type of organ for transplant and patient and graft survival rates are important to a patient’s outcome post-transplant.
Most recent public information on wait time is 2014. What is the current wait time for a kidney transplant for a patient at your hospital, according to your records?
Our wait time has not changed significantly since 2014.