Q&A: Transplants at Vidant Medical Center

Posted 10:45 p.m. Nov 24, 2015 — Updated 10:45 p.m. Nov 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 Vidant Medical Center:

Why is the wait time at Vidant half that of Duke or UNC?

Geography plays part, and our surgeons utilize well thought out criteria specific to the organs offered. We tailor the criteria to the specific recipient for the best possible patient outcome.

Each center has its own criteria for listing transplant candidates. What factors are considered in organ matching and allocation?

The criteria that Vidant & UNOS include, but are not limited to:

Donor organ must be compatible blood type with the potential recipient’s blood type
Tissue Typing Match Quality: a zero antigen mismatch is ideal
Percent of reactive antibodies (a pre-test to identify what organs will be rejected by the new host despite being ABO compatible. The higher the PRA, the less likely to have a successful crossmatch to determine compatibility).
Donor age as compared to recipient age
Size of the donor v. size of the recipient (will the kidney fit? Is the kidney big enough to work for the size of the recipient?)
Condition of the kidney
Social/familiar support after surgery for care and follow-up visits
Donor disease history (known high risk donors such as IV drug abusers only match to those willing to accept a high risk kidney).

Can a patient “list” at multiple centers? Do many choose to do that to increase chances of a match?

Yes, a patient can list at multiple centers. However, the patient must be able to demonstrate to the individual transplant center they can meet their requirements (e.g., able to reach hospital in ___hours). We have found that very few patients opt to list at multiple centers.

Can you explain the process of how an organ that’s available in the region ends up at your hospital?

As noted above, it is driven by data. (ABO blood group compatible, tissue typing match quality, donor age, body size of donor and recipient, condition of kidney etc.)

Ultimately we do not choose how or when a kidney ends up here at VMC. UNOS (United Network for Organ Sharing) is the contracted agency that handles organ distribution. UNOS has implemented a comprehensive suite of computer driven algorithm’s that computes where the organ should be offered. This utilizes a revised organ allocation system implemented last fall.

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 and how is that affecting what you’re doing at Vidant?

Yes, the new organ allocation system was done in an attempt to further improve the equitability of how organs are shared around the country. One of the major benefits of this change is that younger donor organs are shared with younger recipients regardless of geographic location v. going to a recipient who may only have a five year life expectancy. Per UNOS, the organ allocation system is doing what the models predicted. We have not seen a significant change in the impact here at VMC.

Advantages or disadvantages to the changes? Do you expect median wait time to go up or down as a result this year?

It’s still too early to tell. Theoretically, there is not as big a benefit to adding patients to the waiting list to gain time since most patients gain time based on dialysis start date. As to median wait time going up or down…. Yes, it’s too early to tell. We live in an area with high rates of hypertension and diabetes and we know that these are key risk factors for renal impairment or end-stage kidney disease.

Wait time is often one thing a patient considers when choosing a transplant hospital. What else should they keep in mind?

Access to care, both pre and post-transplant is critical in the decision-making process. Also, quality outcomes data will paint a very clear picture of how well a center is truly performing. Finally, we have to remember that transplant is both an art and science. For the patient in need of a transplant, he or she will look for the best outcomes data BUT they will also look for how they were treated at a given center. Competent care is expected. At Vidant, we believe that our pre and post patient care are the differentiators.

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