[Born2BAnurse]

what would be a reason that a person would be refused a spot on a transplant recipient list?

[caroladybelle]

There are many reasons...we would need more info.

- Age
- Health
- Psychosocial situation
- Economic factors
- Ability to commit to followup care
- Cause of organ failure

Organs (especially heart and/or lungs) are scarce, therefore they must go to whomever can use them best and take care to not "waste" them. People that are in poor overall health (in regards to other systems), do not have the capacity to get/afford/maintain proper aftercare, or have habits/conditions that have caused initial failure, and have not adequately resolved those issues are going to be lower on the list, if considered at all.

[Erin RN]

Current drug use, current tobacco use, history of noncompliance, too old, not meeting cardiac output/ SV criteria, malignancy. Since there is a shortage of Organs prior to being considered medical, psychological, sociological and funding resources are looked at and assessed.

The reference I have dates back to 1996 at which time the charge for a heart transplant during the 1 st year was 254,000.00 the following 4 years usually cost 316,000.00 . Having a transplant is considered to be basically changing one chronic illness (heart disease) for another (transplantation) since it requires a life long comittment to medication, follow ups, biopsies etc. Hope this helps? Erin

[Born2BAnurse]

what woukd be a psychological reason?

[Erin RN]

Anything that would indicate that the patient might not be able to handle transplant life...uncontrolled mental illness, not being certain whether you actually want a transplant or going through with it because your family or spouse wants it but ethically not wanting it yourself. The active drug use would also fall under this category. Sociologically it has to be determined that a stong support system exists that clear arrangements have been made for the post transplant phase.
When I used to do home IV infusion our company provided all of the IV post transplant drugs for our areas transplant center. The families were required to live at the "transplant " apartments, if they were not from our city for 3-5 months postop. They had daily activities they HAD to attend and weekly MD appts..If I remember correctly they had biopsies every few weeks to determine that no rejection was taking place. The initial IV drugs destroyed their immune system, they had to wear masks everywhere they went and were not to go anyplace where there were younger children or larger crowds. Having a transplant, although lifesaving, is a HUGE responsibility to the patient and the family. Since so many people die waiting the protocols that determine who gets on the list are very stringent to help determine the probability of success. It is a real commitment..regular MD appts and daily medications which cost upwards to 1000.00-2000.00 a month just so the person doesn't reject..this is for the pts lifetime

I remember one gentleman that I was maintaining his picc line while he was awaiting a liver transplant since he had destroyed his liver using IV drugs. He went on a binge and used his Picc line to use illegal drugs..this happened twice and he was removed from the list and would not ever be reconsidered..it is much like playing god I suppose but if it were your organ or your childs organ would you not want it to go the person who would benefit most and take care of it?? I would. Erin

[caroladybelle]

Mental illness/retardation to the extent that they might not be able to maintain post transplant regimens with lack of social support to help them do so.

Drug/alcohol abuse without complete and extensive rehabilitation.

Previous transplant with organ failure due not maintaining post transplant regimen.

Suididal Ideation, not under control.

[RNCENCCRNNREMTP]

Originally Posted by caroladybelle

There are many reasons...we would need more info.

- Cause of organ failure

, or have habits/conditions that have caused initial failure, and have not adequately resolved those issues are going to be lower on the list, if considered at all.

What about Mickey mantle?
Big drinker and had cancer and got a new liver.

and

David crosby (love his music) but big drinker and drug abuser and got a new liver.

Money and sentiment talks.

[Havin' A Party!]

Originally Posted by RNCENCCRNNREMTP

... Money and sentiment talks.

Think it's mostly the moolah.

[elkpark]

What about Mickey mantle?
Big drinker and had cancer and got a new liver.

and

David crosby (love his music) but big drinker and drug abuser and got a new liver.

Money and sentiment talks.

I don't know enough details of either case to speak to them directly, but having a HISTORY of drug/ETOH abuse does not necessarily rule you out for transplant if you have a more recent solid record of staying sober/in recovery. There are many, many considerations taken into account.

[caroladybelle]

Those who are wealthy or have connections (private planes available at minute's notice) can be listed on several transplant lists, instead of one list.

Even if they are low on the list (due to history of ETOH abuse, health status), if an orgen comes in that cannot go to another patient (due to type, health status, fever, distance) higher up, it may go to the individual.

As such, you may have people on several lists, get an organ much sooner. And some facility may have more "relaxed" attitudes than others.

So more money/connections does translate into a bit better chance of getting an organ.