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Tue, Aug 7 9:50am · Countdown to Living Donor Surgery: Key Steps

We love keeping up with the transplant discussion group to see what topics are top of mind for recipients. When possible, we use our transplant blog to provide information and fill gaps based on feedback from the group – which led to the development of this post. In this case, we saw a comment from a living donor who wished for a timeline of events leading up to living donor surgery, and then got busy developing one!

As we got started, we realized it’s difficult to provide a detailed timeline because every living donor and recipient’s situation is so different. In general, the recipient’s condition is most often what drives the timeline – but in any case, here are the key steps that must take place before surgery.

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9. Assessment of Recipient. Before a living donor can be identified, the recipient will undergo an extensive evaluation to be sure transplant is the right option for them, and that they’re medically eligible for surgery. This process could take just a few days or it could take weeks, depending on their condition and tests needed for the recipient.

8. Research and Learn. At the same time the recipient is being evaluated, anyone interested in being a living donor can read, research and learn about the process, risks and benefits of living organ donation. Our living donor toolkit is a good resource for someone at this stage in the process.

7. Fill out the Health History Questionnaire. After becoming comfortable with the donation process and making the decision to proceed, the next step for donors is to fill out the online Health History Questionnaire. Potential donors should complete the form when they have adequate time and space to concentrate on each question.

6. Medical and Social Interview with Living Donor Nurse. Once the online form is submitted, a confirmation email is sent that it’s been received by our team. If there aren’t any initial health issues that disqualify the donor, you’ll be contacted by one of our nurses in the transplant center. If you do not qualify for donation, the form will either provide you with a notice on the screen, not letting you proceed with the questions, or you receive an email letting you know that medical criteria is not met. If you’re contacted by a nurse, the next step is a medical and social phone interview, which will take approximately one hour. The nurse team will go over your form and collect more details about your history and review any medical conditions you listed. They will also answer your questions about donation, so be sure to have those ready to ask.

5. Follow-Up with Opportunities Identified in Interview. Once a nurse has contacted you, they might have asked you to follow-up on medical or social issues that were identified in the interview or on the form. You may need to lose weight, stop smoking, or take care of family situations before you can be considered as a donor. This could take days to weeks, depending upon your situation and how serious those issues are.

4. Schedule and Proceed with Evaluation. Once you’ve been deemed a donor candidate, you’ll undergo a donor evaluation. The timing of this evaluation is determined by your schedule and the condition of the donor. If the donor is ready for transplant and you’re able to come to the transplant center soon, this evaluation process can be completed quickly. Learn more about the donor evaluation here.

3. Schedule Surgery. Once you’ve been cleared by our team to be the living donor, and the recipient is ready to proceed, surgery can be scheduled. The timing of surgery is typically dependent on the donor and recipient’s choice. If we have an operating room and surgeon available, the surgery can happen any time everyone is ready to proceed.

2. Surgery and Hospital Stay. At Mayo Clinic, surgery to donate a kidney is usually done using several small incisions instead of one larger one. This surgery is called laparoscopic surgery, which reduces the time needed to recover following surgery.

During a living-donor liver transplant, a surgeon places the part of your liver that is removed into the recipient after all of his or her liver is removed. It usually takes several weeks to several months for the liver to return to its normal size in both the recipient and the donor.

1. Recovery. Liver donors usually stay in the hospital for four to seven days after surgery, while kidney donors typically stay two to three days. Most people can resume normal activity within six weeks and can return to work within six to eight weeks, depending on the type of work. Ask your donor team what you can expect with recovery and follow-up care.

As you can see, donation is an involved process, and it takes time to determine who should be the donor and time for them to prepare for donation. If you have questions about donation, leave us a comment!

HELPFUL LINKS

Tue, Jun 12 12:46pm · New Transplant Blog Posts in Transplants

Hello everyone,
I hope everyone is enjoying this beginning of summer. Here in Minnesota we have beautiful weather mixed with some needed rain. I hope you all are finding time to enjoy the outdoors where you live.
Our blog today is about innovations in transplant at Mayo Clinic. We have given just a brief description of a few things that have already happened and some that are in the works. Our hope is to inspire you to learn more about transplant, but also to keep the faith that new ideas and treatments are coming every day that could help people who are waiting for an organ.

Learn more from our blog this week!

https://mayocl.in/2Mlje0C

-Kristin

Tue, Jun 12 12:30pm · Mayo Clinic Transplant Innovations

Transplant medicine has made amazing progress in the last 50 years, with new research and surgical techniques saving thousands of lives worldwide. In 2017, a record number of more than 34,000 transplant surgeries were performed in the U.S. I have worked in the Transplant Center at Mayo Clinic’s campus in Rochester, Minnesota, for nearly 20 years. Just during the time that I have been with Mayo, processes and procedures have changed the way we care for patients and have allowed us to perform more transplants than ever before.2018-05-29 Innovations Blog Post

In 1963, Mayo Clinic officially entered the field of transplantation with a bone marrow and kidney transplant. Today Mayo is the largest integrated transplant provider in the U.S. performing more than 2,000 transplants each year. While some innovations are still in clinical trials, some of these transplants were made possible by innovative transplant procedures, research and medical advances pioneered by Mayo Clinic. Here are just a few transplant-related innovations that have occurred in the last few years at Mayo Clinic.

Laryngotracheal Transplant

Dr. David Lott came to Mayo Clinic’s campus in Phoenix, Arizona in 2011 on a mission – to start a laryngotracheal transplant program – the first in the U.S. Dr. Lott is embarking on a five-year clinical trial of 10 laryngotracheal transplant patients. “We have a handful of patients waiting for the trial to commence,” he says. “Mayo wants to be at the forefront of transplant medicine, and this will be the world’s first full-fledged laryngotracheal transplant program. We’re excited to change the lives of these patients.” In addition to the laryngotracheal transplant program, which will use cadaver larynges, Dr. Lott and his team are working on a bioengineered larynx program. They’ll use a patient’s own stem cells to create tissue to replace the damaged areas of the larynx and trachea. Over several weeks of special treatment, the stem cells will grow new tissue on a patient-specific scaffold made on a 3-D printer in a new cell therapy laboratory at Mayo Clinic.

Regenerative Medicine

Due to a nationwide organ shortage and never-ending quest to find the best answers, medical science can provide, Mayo Clinic researchers are studying alternatives to transplant including using stem cells to repair, replace or regenerate diseased cells. Researchers study and test how reprogrammed stem cells may be turned into specialized cells that can repair or regenerate cells in the heart, blood, nerves and other parts of the body. These stem cells have the potential to treat many conditions and could eliminate many of the long waits on the transplant waiting lists.

Liver Ex Vivo Perfusion

When a liver is removed from a donor for transplant, surgeons typically have less than 12 hours to transplant that liver into the recipient. Current practice is to place the liver in cold storage in a preservation solution at 4 degrees Celsius. Dr. Andrew Singer of Mayo Clinic’s campus in Phoenix, Arizona is the principal investigator for a clinical trial to increase that preservation time for as long as 24 hours, using a perfusion system that keeps the liver at a temperature that simulates the human body. Dr. Singer believes this new system will give surgeons longer time to transport livers over longer distances – which could minimize deaths on the waiting list by allowing the sickest patients to have those organs regardless of where they are located around the country.

Liver Regeneration

We talked above a little bit about regenerative medicine, but what if liver disease could be cured by using a patient’s own cells to correct their liver disease? Dr. Scott Nyberg of Mayo Clinic’s campus in Rochester, Minnesota has spent his professional life perfecting such a system. Dr. Nyberg is trained as a transplant surgeon and biomedical engineer, and his vision for the future is to engineer livers to address the organ shortage. Sometimes livers are donated that are not able to be used for transplant. Dr. Nyberg uses these livers in his research. He removes all the cells from the liver and replaces those cells with cells from a patient, creating a whole new organ. He and his colleagues hope to someday help eradicate the waiting list and eliminate the need for more deceased organ donors for patients with liver failure.

Even with the high transplant volumes, the rising number of organ donors, and the medical and surgical innovations that continue to be discovered, twenty people in the U.S. still die each day waiting for an organ. There’s more work for us all to do – more medical and surgical innovations to research, more opportunities to promote organ donation and more advances to put to use for our patients.

What do you think will be the next big transplant innovation?

HELPFUL LINKS

 

 

Tue, Apr 17 9:05am · New Transplant Blog Posts in Transplants

Happy Tuesday!
We know that April showers bring May flowers, but what does April snow bring? We'd like to know, since we are about to get a half foot more in the Rochester area tonight. 🙂
If you love the Minnesota snow, the Florida beach or the Arizona warmth, you will love today's blog post about patients who travel to a transplant center that's out of their home state. Thousands of people travel to Mayo Clinic from all 50 states and countries around the world, and they ask great questions about how to manage their care far from home. We hope this blog post will answer some of those questions you might have. Traveling for transplant is more common than you might think, and we do everything we can to make your time at Mayo Clinic comfortable, efficient and worth every minute you spend with us. No matter where you are from, this post can help you better understand the questions you will face when choosing a transplant center far from home. Did you have transplant care away from your home state? Comment below with your ideas to help others who might need to travel.
Have a great week!

https://connect.mayoclinic.org/newsfeed-post/qa-for-out-of-state-patients/

Mon, Mar 26 7:32am · staging for liver transplant in Transplants

@jerrydrennan, Welcome to Mayo Clinic Connect! I am one of the moderators, and I work in the clinical area with the physicians and nurses. I spoke to our surgical director this morning about your question. Staging is an operation to explore your abdomen. The surgery is done either as a regular open surgery or as a laparoscopic surgery (small incisions). The purpose of the surgery is to rule out progression or spreading of the tumor, as sometimes that can't be seen clearly enough on imaging. The doctors will definitely explain this further to you at your appointment, and you are welcome to bring a list of questions for them as well. They are always willing to take the time to answer your questions before you undergo any surgery.
I hope this helps a little bit. All my best to you for your appointments in May.

Tue, Mar 20 9:33am · New Transplant Blog Posts in Transplants

Good morning friends,
I hope this first day of spring finds you in good spirits. We might have snow in Minnesota today, so our good spirits might have to wait until tomorrow. 🙂
In today's blog post, we celebrate National Kidney Month. This month, pay some extra attention to your kidneys and learn about their function and how to keep them healthy. If you are in need of a kidney transplant, have you taken advantage of the National Kidney Month hype to talk to your friends and family about kidney donation?

https://connect.mayoclinic.org/newsfeed-post/celebrate-national-kidney-month/

Tue, Mar 13 11:35am · UNOS changing how HCC scores are tabulated? in Transplants

@rosemarya and @jodeej,
HCC and exception points is always a difficult process to understand. When changes are made to the policy, UNOS doesn’t typically print a “patient friendly” version of those changes, so it’s important to check with your physician when you have questions regarding a change. When you brought up this discussion a few days ago, we actually had one of our physicians speaking to a group about these changes that very evening – what a coincidence! We were able to ask her for some clarification, and she said the biggest change is inclusion of the AFP blood test in the listing requirements for the patient. Previously, UNOS didn’t require the AFP level. Now the level must be below 1000ng/mL. If the level is above this, it must fall below 500ng/mL with treatment in order for the patient to be listed. While there are some other changes, this is the primary difference in the new policy. It also sounds like the Regional Review Boards will be reviewing cases more often than they have done in the past.

This is a link to the actual policy, in case you want to review any parts of this with your physician next time you visit with them.

https://optn.transplant.hrsa.gov/media/2411/modification-to-hcc-auto-approval-criteria_policy-notice.pdf

Mon, Mar 12 10:31am · Wanted: Organ Transplant Recipients Who Have Been Hit By a Car in Transplants

@glinda, @rosemarya, @andtridd63, @rose999, @contentandwell,
This is an interesting exchange on the importance of seatbelts. I asked our abdominal transplant surgeons if there's anything special they would recommend considering seatbelts and transplant recipients. They didn't have any special recommendations other than to say that they strongly recommend wearing your seatbelt even if you are concerned about damaging your new organ in an accident. The damage caused by not wearing one could be much, much worse. If you use one of the sheepskin covers or anything else to cushion your seatbelt, just be sure they don't interfere with proper use and fit of the seatbelt.
Stay safe everyone!
-Kristin