Whenever you talk to a transplant coordinator it may happen that you hear the word OPO. What the hell does it stand for and what do they do. OPO means Organ Procurement Organization and there are 62 of them in the country grouped in 11 regions(see map below). Their role is to promote organ donation in their respective area of responsibilities. They are also mandated by UNOS to organize public activity in order to get more people to sign their card to become organ donor.
Since some state, like Texas, mandates every hospital to report every death to their local OPO, they are getting thousands of calls for potential donors. One OPO in Texas gets over 30,000 calls a year! This is more than 3 calls every single hour 24h a day. The majority of those calls are turned down because the potential donor is too sick with too many infections or something else is wrong. Let me tell you that they screen the patients really good asking tons of questions.  Very few patients qualify as organ donor because for several reasons but a lot of them still can be tissue donor candidates.
Once the OPO coordinator decides that they have a potential donor they don’t want anybody, not even the physician, to talk to the family. They have highly trained professionals who will approach the family to discuss about donations. They use different tactics based on the religion or the race. They try very hard to have the family to consent because this is how they make money; by placing organs to patients in needs of transplant. Everybody’s got to make a living!  Once a donor becomes available, all the information is entered in the national “website” of UNOS (see the other 4/30/11 post) called Unet.  The donor information is then matched with potential patients on the wait list.

Basically the Organ Procurement Organization (OPO) only deals with potential donors and their family.  They don”t deal with the future transplanted patients.  Here is a link to check who is in charge of finding organ in your area:

(source:http://web.ics.purdue.edu/~nkong/Publication/IERC02 Region.pdf)

Almost every day we hear about human organ trafficking in other countries.  Here, in the US, we have several state and federal laws that regulate this business but we have one in particular whose sole mission is to regulate the organs allocations.

United Network for Organ Sharing (UNOS) is the private, non-profit organization that manages the nation’s organ transplant system under contract with the federal government.  Basically one of UNOS responsibilities is to make sure that organ transplantation is as safe as it can be by setting a national standard with rules that every single transplant center in this country must follow.  UNOS will survey every program every three years with a very comprehensive examination of practices and to make sure everybody follows the rules and its policies.  Trust me, when UNOS is in the house, people are nervous!  We just went through that at our center and a lot of people were anxious.  It is almost like the representatives are God!  As a matter of fact, they almost are because they have the power to shut a transplant program down.  They will go through charts after charts to make sure every single detail is present.  They mainly want to make sure that patients make an informed decision when signing in for transplant.

UNOS uses a portal named UNet that manages the wait list and organ offers from anywhere in the country.  This is the tool used to connect every transplant centers and organ procurement organization like LifeGift in Texas or OneLegacy in Los Angeles, Ca.  Offers can be sent from anywhere in the US, even Porto Rico and Hawaii!  Someone that lives in New York would not get a heart from California but could certainly get a kidney from Hawaii as the time an organ can spend outside a body varies.  But this is something I want to talk in a future blog.

Organ Transplants Resources mission is to provide an educational blog and resources about solid organ and tissue transplantation to increase understanding and knowledge for patients and their families or anybody else with an interest in this life saving medical advance.  Healthcare professionals working in the field of organ transplant will share their experiences with real everyday situations.  We will also review the actuality of organ transplantation in the news. The ultimate goal is to promote organ donation so more lives can be saved with these surgical miracles.  Once again, welcome aboard and get ready for an interesting ride!

Why Organ Transplant Resources? Organ Transplants Resources website was created to be a place where transplant patients along with their families and friends could easily find information about the whole process of transplantation. A blog written by healthcare professionals working in the field of transplant will share their daily life experiences in order to make things easier to understand for the public.

Early on when Facebook was created it was used to find old friends and stay in contact with people we care but didn’t necessarily have time to call or meet. Nowadays it is used to save peoples lives. Social media have expanded their role and now it goes beyond imagination. Patients waiting for organ transplant now turn toward Facebook in order to increase their pool of potential organ donors. Most of the living donors are giving one of their kidneys. The rest can give a piece of their liver or more rarely a lung in order to save somebody life.

Match on Facebook

Social media allow strangers to get in contact with each other and ask indirectly millions of people if they want to be organ donor. This has happened to a 38 years old man from Seattle who was desperately waiting for kidney transplant. He ended up creating a Facebook page named Damon Kidney, with the help of friends and family, which allowed him to find a perfect match. UNOS (United Network for Organ Sharing) acknowledges the existence of Social media uses from people looking for living organ donor.

Statistics

According to the federal government annual report, there is an average of 6,000 living donors who donates a kidney. This number has been steady for the past several years so this is why social media could play a significant role in finding more potential organ donors. The current waiting list for kidney transplant includes more than 90,000 patients and is growing every day. This show you to urge to find more living kidney donors.be surprised to find out that healthy sex life is more than great pleasure and ability to have children. It is the best and only way to guarantee natural training of the male heart, lungs, blood vessels and muscles. It is also the most efficient way of restoring male central nervous system. Normal sex life prevents the development of such severe diseases as stroke, heart attack, high blood pressure (hypertension), diabetes, cancer, neurosis, depression, dementia etc. Now you know that men think the worlds of their erectile function for a reason!

A transplant coordinator has a really important role in the transplant process. There are three types of coordinators: pre-transplant, inpatient and post-transplant. I will explain the role for all of them but will put an emphasis on the role of post-transplant coordinator since this is what I do.

Pre-Transplant

The pre-transplant coordinator is responsible for helping the process of putting patients on the wait list. They are usually responsible to enter patients info in the database (height, disease, labs, test results, medications, etc.) The purpose of that info is to build a packet with everything needed to present a patient to the patient selection committee. Once a patient has been cleared to be listed as a transplant candidate, they entered all info available into Unet (UNOS database) and the computer will rank the patient based on data entered and the type of organ needed.

They are also responsible to manage the wait list like updating new patients medical conditions in compliance with UNOS. Once a physician tells them to initiate a new patient evaluation, they are also responsible to make that everything that needs to be done is done.

Inpatient coordinator

The inpatient coordinator will round with the physician in the hospital and will plan discharge like coordinating teaching among other professionals such as pharmacist and dietitian. They will make sure the medication for home is approved by the insurance companies and do the prior-authorization as necessary. They will also provide updates to post-transplant coordinators about their current patients. They will write detailed notes to what happened to a patient while in the hospital to better facilitate follow up for the post-transplant coordinator.

Post-transplant coordinator

The role of the post-transplant coordinator is very important for the long term survival of the program. A short definition of the job description would read as is: The goal is to keep the patients alive. We are responsible for managing the post-transplant protocol that includes several tests, blood works and doctors visits. We have to make sure the patients stay on track with their protocol and all tests needed are scheduled. Once the tests are completed we help the physicians review the tests but they are ultimately responsible for making decisions.

We are the direct line of contact with physicians for the patients. They are instructed to call us with any issues they are experiencing at home and then we reviewed with the on-call physician. If tests or blood work are ordered, we have to make sure it is scheduled and then review the results with the medical team. This role is more clinical than the other coordinators.

We all have direct communication with the physicians and it is our duty to report any and all issues and our goal is to keep the patients free of complication (if possible) and alive as long as possible. We all have a bunch of reports to complete so we are in compliance with UNOS. It is a very stimulating but demanding job as our patients require constant monitoring and care. When we witness success story, it makes it worth it.

It is now proven that people over the age of 70 years old can safely become a living organ donor for kidney transplant.  A study that will come out in the Clinical Journal of the American Society Nephrology is showing there is no more risk for elderly to become organ donor than younger donors.  The investigators have studied more than 200 living kidney donor over the age of 70 and compared them with healthy people of the same age.  The outcome was quite surprising: the organ donors were living longer in general than the non-donor group.

Young Living Donor still Better

The only setback with older donor is that the kidney does not last as long as for younger living donor.  This is still a better option than the alternative for those patients who have received the gift of life.  If it was not for the elderly donor, they may have needed to be on dialysis for many more years.  The average wait time for deceased donor is in excess of 5 years in certain region of the US.

Many physicians are not aware that older people can become living organ donor and certainly not all transplant centers are willing to take a chance on an older patient.  Some claims the risk of complications is too high but you have to look at this: several thousand patients in their 70’s survive heart surgery every year in the US.  The operation for giving a kidney is much less traumatic.  There is still a lot of work to do to explore this group of potential donor, they only represent 1.5% of all living donor.  In numbers that means 89 donors only out of about 6000 kidney donors.

80 the new 70?

It is all about doing better education of not only the population but also for the healthcare professionals to promote what can be done safely as far as organ transplant go.  Every year limits of what was thought to be reached are pushed in the organ transplant world with the only goal of saving lives.  With the population living longer and healthier, will 80 become the new 70?

It is not recommended for a renal transplant patient to become pregnant after transplantation but it can be done successfully as long as the future mom is aware of the risks.  According to a study published in the American Journal of Transplantation, pregnancy after kidney transplant is associated to higher live birth rate, lower miscarriage but more complications than the general US population.  I would have never thought that kidney transplant patient could have babies with relatively good outcome.

Dark Side of the Story

Despite having relatively good outcome with pregnancy, renal transplant patients should discuss the risks with their nephrologists.  It is not all kidney transplant physician who will support their patients idea to have a baby.   They also need to find an OB/GYN willing to take high-risk pregnancy patients because the follow up will need to be tight.  Despite having more babies delivered by percentage than the general population, the complication rate is much higher.  These complications need to be addressed before the pregnancy to improve outcome.

Preeclampsia Risk

There is 6 times more chance for preeclampsia (high blood pressure and protein in urine) in women with history of kidney transplant.  Some of the risk factors of preeclampsia that are related to a post renal transplant patient are kidney disease and vitamin D deficiency.  This condition can lead to eclampsia if left untreated and can be fatal for both mom and baby.

Gestational Diabetes

Another complication that is not as bad but still need to be considered is gestational diabetes.  The chance of having this complication is double the rate of a pregnant woman with no history of renal transplant.  Because most transplant patients take prednisone as immune suppressant, diabetes rate is higher to begin with.  Like all transplant patients know, prednisone is well known to increase blood sugar level.  The complications for this kind of diabetes (it mostly affects baby)are: excessive birth weight, jaundice, respiratory distress, higher risk of diabetes type 2 later in life.

C-Sections

More than half of the renal transplant patients having babies have them through a C-section versus one third of all pregnant women.  Any surgery after organ transplant has more risk than for anybody else.  C-section brings its share of complications such as infection, blood clot in legs, bleeding.  If a transplant patient is taking rapamune, it will have to be stopped ahead of time because that drugs delay wound healing.  Anytime there is a change in a successful immune suppression regimen there are risks for rejections. The decision on how to have the baby should be discussed with the physicians ahead of time so the risks and benefits are well understood.

Pregnancy after organ transplantation should always be discussed with your transplant physician before the baby is conceived.  Having a baby is a lifelong commitment and that should always be kept in mind.