Tuesday, January 5, 2010

How a set of lungs arrives at Duke

I was talking with Sharen on the phone the other day and we were talking about Lung Allocation Scores (LAS) and how the new lungs get to patients.  As we continued to talk I thought "gee...I should blog about this" so, here you are ;-)

For a patient to be "listed" - or placed on the nationwide lung transplant list, the patient has to be tested up one side and down the other.  The doctors determine if the patient needs a transplant and if the patient is in their "window of opportunity".  The window means the patient is sick enough to need a transplant but not too sick to survive a transplant.  That window can be pretty tricky and no one wants to reach the end of the window before transplant...that would be so sad.

Once the docs decide the patient is a good candidate for transplant they calculate a "Lung Allocation Score" or LAS for the patient and send that information to the United Network for Organ Sharing (UNOS).  The LAS is calculated based on different percentages for the following criteria:  Lung diagnosis; Date of birth; New York Heart Association Class; Assisted ventilation ; Height and weight; Diabetes; Supplemental oxygen; Percent predicted FVC; Six minute walk distance; Serum creatinine; Pulmonary artery systolic pressure; Mean pulmonary artery pressure; Pulmonary capillary wedge mean.

Some of these things are easy to figure out and some are a little more complicated.  They all factor into the LAS but some carry more weight than others.

So, now the patient is listed with UNOS and their specific data is stored in the UNOS database.

Now when donor lungs become available UNOS searchs the database looking for eligible patients based on blood type, distance from the donor hospital to the transplant center, and age group.  The closest hospital to the donor hospital receives the "offer" for the lungs first.  If they don't have a good candidate for the lungs then UNOS broadens its range and sends offers to more hospitals.  Duke receives a huge number of offers for two reasons...first because there are only two lung transplant centers in the state and Duke has a large number of patients on the list at all times so the center is "flagged" a lot.

Once Duke gets an offer for a set of lungs a team reviews all the information about the donor lungs.  They look at size, blood type, antibodies listing, etc.  Then, the transplant team will call one or more patients to come into the hospital for transplant.  They often call multiple patients because until the docs have actually looked at the lungs, they can't be sure which patient would be best served by them.

Duke has flown all over the country to retrieve lungs and, just like in the movies, they fly them back and the docs take a look at them to determine if they are usable (sadly they can deteriorate before they can be transplanted).  If usable, the team then decide which patient should receive them.

Then they transplant!

So the short list is:
  • get listed
  • be high enough on the list to receive calls for transplant
  • wait for the right donor lungs in the right geographic area
  • wait for the right antibody match
  •  then it will be a go!
My LAS is still relatively low and I'm still at the first part of my window. There are a lot of patients that are way sicker than me with a much higher LAS. They will, and should, be transplanted before me! At some point my score will be that high and I pray that I'll get my lungs at that point.

My friend Susan had a LAS of 64 (that is really really high) and she just got transplanted Sunday night! That was such great news because Susan was so sick but she, like me, had a lot of antibodies that they needed to try and get rid of. I was worried about Susan because of how sick she was. Duke's normal LAS score for transplant patients is between 30 & 40.

Oh, one other piece of info...

Five years ago no hospital would transplant a patient with antibodies.  I would have died instead of receiving new lungs.  Duke has one of the most high-tech, state-of-the-art HLA labs in the country and they can identify and measure antibodies to the point that they can be dealt with.  Apparently Duke provides this lab service to most of the hospitals on the East coast.  There are still very few hospitals that will transplant a patient with antibodies and I have a slew of them.  We still don't have the results of the chemo treatments on my antibodies.

I'll keep you posted.

Love to all,
Lee, Wendy and Missy

No comments:

Post a Comment