Q&A: Transplants at Wake Forest Baptist Medical Center
Posted November 24, 2015 5:45 p.m. EST
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 Wake Forest Baptist Medical Center:
Why is the wait time at Wake Forest half that of Duke, UNC and Carolinas Medical Center? According to the same data for 2014, WF Baptist MC had 742 on the waiting list and performed 158 transplants. Duke had 490 on waiting list; 126 transplants. Carolinas MC had 629 on waiting list, 103 transplants, and UNC 658 on waiting list, 86 transplants.
Wake Forest Baptist Medical Center accepts more organs on average than other centers. Our experienced surgeons have a level of confidence in accepting some organs that may not be as readily accepted by others. It is also having a list that includes recipients that would be appropriate for a given organ. For example, we try to avoid having large age disparities between the donor and the recipient.
Each center has its own criteria for listing transplant candidates. What factors are considered in organ matching and allocation?
Time on the waitlist is by far the greatest determinant for organ allocation and in the new allocation system, time on the wait list is largely determined by when the patient initiated dialysis. Other factors include age, blood type and to some extent tissue type, and ability/willingness on the part of the recipient to accept organs that may be from either older age or higher risk donors.
Can a patient “list” at multiple centers? Do many choose to do that to increase chances of a match?
Yes, patients may list at more than one center. That is not a very common practice because it involves more travel and tests for the patient. However, we have a number of patients who are on multiple lists and our center encourages this practice.
Please explain the process of how an organ that’s available in the region ends up at your hospital.
Organ allocation is determined by the computer system at UNOS located in Richmond. The computer considers the characteristics of the donor/donor organ and the characteristics of all the recipients who match blood type and creates what is called a match run. That match run determines the order of recipients who are offered the organ. Allocation in general happens within the local donation service area, then regionally, then nationally, at least for kidneys. There are some exceptions to that but that is the general way that it works.
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 biggest change in the allocation system that took place last December is that patients who are on dialysis accrue waiting time from the time they started dialysis even if that is years before they were referred and evaluated for transplant. The reason for that change is to reduce the disadvantage that patients may experience if they for whatever reason, are not referred for transplant when they first develop kidney failure.
Advantages or disadvantages to the changes? Do you expect median wait time to go up or down as a result this year?
In the first few months of the new allocation system, we have seen those patients who have been on dialysis a long time and those who are sensitized or have antibodies to lots of potential donors get transplanted more quickly. We believe that after the new system level sets, we will generally see a less dramatic change in the patients being transplanted. However, there is some preliminary data to suggest that older patients may have a longer waiting time than younger patients.
Wait time is often one thing patients consider when choosing a transplant hospital. What else should they keep in mind?
Patients should consider a lot of things. First of all, the team with whom they would be working. It is important that a patient is able to relate to the team members so that together they can work toward a positive outcome. Secondly, the patient should consider the outcomes of the center at which they are looking. Thirdly, proximity and the ability of the patient to travel and have close monitoring and follow up.
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?
It has not changed significantly from what is published.