January 17, 2012

Transplant seminar #3

Since being accepted as a pre-transplant patient at Columbia, I've had to start attending educational seminars, designed to equip with patients and their caregivers with as much information about transplant as possible without resorting to throwing encyclopedias at us.  Each seminar is two talks, usually, and focus on one corner of the transplant world.

The first I attended was actually rather nice, as it was a panel discussion of post-tx patients.  (They generally have their own support meetings, so it is not common to meet post-tx people.)  It was great hearing their stories, seeing how healthy they've become, and listening to the complaints of their caregivers, who seem to have become accustomed to being bound to a *sick* person, rather than just a *person*.

The second set I attended had to do with the ex-vivo project.  Columbia is in a group of five transplant centers doing the very first ex-vivo lung transplants, using a machine that can keep lungs viable outside the body much longer and allow for treatment of those organs before implanting into the recipient.  Fascinating stuff.  So far, they've done two.  The study needs 42 before the FDA will consider it an approved method.

Today's session was a two-parter covering the donors themselves and pre-transplant testing.  I found it odd that Carmen Saunders was covering that topic (and she needs practice!) considering that every patient in that room had already gone through these tests.  But that's an assumption. And perhaps the caregivers aren't up to speed.  Or maybe we need a reminder why some tests get repeated so often.  I personally didn't find any of the tests too onerous, despite the gloom-and-doom rhetoric from other patients, except perhaps for the bicycle test, which I see the importance of and am glad to repeat anytime they want it.

The topic of "who are the donors" was new area for me, certainly.  I was shocked to find out that not every donor is an accident victim.  Or rather, that there are circumstances under which a person is considered a viable donor but is NOT DEAD YET.  Cadaveric donors were not covered, as they're pretty much no longer used for whole organ transplant, only certain tissues.  Of the remaining donors, where heartbeat and breathing has been maintained through brain death in one fashion or another, here's the breakdown:

1)  traditional brain death - typically an accident victim.  someone who is found still alive but who dies en route to the hospital, or is killed in a way that poses no trauma to the thoracic cavity, but damages the head AND life support begins immediately.  This is the ideal case and the one I certainly think of when pondering how I'll end up with lungs (if that should so happen).

2) DCD or Donation after Cardiac Death.  This is a NHBD Category III donor, who is still alive, but will die if life-support is withdrawn.  There are strictly controlled standards against which patients are judged.  The injuries must be fatal, the patient has no hope of recovery, and continued life-support or treatment is only prolonging the inevitable.  Etc.  (This would have been my dad.  He donated his corneas; and the transplant surgeons can be ready, but after his pulmonary embolism, it became only a waiting game.  Dad's fate was sealed at that point.  Unfortunately, since his lungs are what killed him, his other tissues were too damaged from poor oxygenation to be useful.)  ANYWAY.... this is a less-common category for donors.

3)  extended criteria donor.  This is the healthy old guy out mowing his lawn who takes a rock to the head and never wakes up again.  If you're over 65, you don't meet donation criteria.  But exceptions can be made.  I'll take a 65-year-old marathon runners lungs any day over a 20 year old basement-dwellers'.

4)  Finally, we learned about CDC high-risk donors.  These includes people who have been incarcerated, have a drug history, history of risky sexual behaviour, etc.  Not entirely off the eligible donor list, but a person would receive their organs only if in dire, dire need.

I also learned today that if there's a multiple organ transplant, it's the condition of the lungs that is the primary determiner of viability, as opposed to liver or heart.

And what exactly goes into a patient's LAS in the UNOS system?  PFTs, arterial blood gas results, and the number of feet walked during the 6-minute test.  There may be more, but those were mentioned.

I find these seminars mentally exhausting.  Not to mention my personal discomfort being in the same room with other people who may have bugs I might pick up or who might get my bugs.

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