Q&A: Transplants at UNC Hospitals
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 UNC Hospitals:
Why is the wait time at UNC double that of Vidant and Wake Forest? According to the same data for 2014, UNC had 658 on the waiting list and performed transplants. Vidant had 432 on waiting list and performed 107 transplants. WF had 742 on waiting list and performed 158 transplants.
Prior to the changes in the kidney allocation system, patient wait time was driven by how early they were placed on the list (whether the patient was active or inactive on the waitlist). Many patients have conflicting issues (such as health, socioeconomic, access to the transplant center, etc.) that impact the timing of when transplant is a viable option. As our center advocated for our patients we have felt it was important to get them on to the list while we help them work through those issues that would prevent them from having a positive transplant outcome. Therefore, in our history there were times when as many as 65 percent of the patients on our wait list were classified as “inactive.” These patients push the median wait time for the center. Our center’s philosophy has always emphasized supporting the individual patient as our first priority.
Each center has its own criteria for listing transplant candidates. What factors are considered in organ matching and allocation?
Organ matching is currently performed through blood type—the new allocation model looks at all deceased donors and based on medical testing compares them with each other. The allocation model takes the top 20 percent of donors and allocates them to those patients who have the greatest benefit from these kidneys. In addition, those patients who are most difficult to match (because the potential recipient has numerous antibodies) are given higher priority when the rank list comes out.
Can a patient “list” at multiple centers? Do many choose to do that to increase chances of a match?
Yes to both of those questions. There is limited benefit if you are listing in the same donor service area (DSA) managed by the same Organ Procurement Organization (OPO), but there may be more benefit if you list in another service area.
Please explain the process of how an organ that’s available in the region ends up at your hospital.
Every time there is a deceased donor a candidate list is generated via the processes established by NOTA and currently implemented by UNOS. Once the list is generated, centers are contacted that their potential patient has an organ offer. With the new allocation system approximately 25 to 30 percent of kidneys are being allocated nationally with the majority of the remaining offers being allocated to the local centers.
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 new system has only been in place since December 2014 and it is premature to assess the impact of these changes. Preliminarily we have seen an increase in the number of organs being allocated nationally and a decrease in the number of pediatric recipients receiving deceased donor transplants.
Advantages or disadvantages to the changes? Do you expect median wait time to go up or down as a result this year?
It is impossible to predict what will happen to median wait time at specific centers due to the new allocation system. The current publically posted information for wait time looks at patients registered between 01/01/2009 and 06/30/2014. We won’t have the data we need to know the full impact of the new system until July 2019 — almost five years from now.
Wait time is often one thing patients consider when choosing a transplant hospital. What else should they keep in mind?
Patients should also be focusing on a center’s 1-year and 3-year outcomes (patient survival and organ (graft) survival). Getting a kidney quicker that only lasts 18 months doesn’t benefit the patient. UNC has the highest 3-year graft survival rate in NC (85.9 percent). UNC also has the largest living donor program in North Carolina, and is the only program to offer both desensitization and Blood type incompatible transplants for kidney.
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?
The current publicly posted information for wait time looks at patients registered between 01/01/2009 and 06/30/2014. Our actual wait time when looking at patients transplanted over the last 1-2 years is much lower than the published data.
For transplants that have occurred in the last 2 years, the median days between listing and transplant is 1,240 days (41.3 months) for deceased donor recipients and 259 days (8.63 months) for living donor recipients. The combined median is 580.5 days or (19.3 months. The combined total # of transplants is 154 for the last two years.