Dr. Marios Prikis, medical director of transplant at the UVM Medical Center and Rich Padula, manager of transplant services at the UVM Medical Center discuss the many ways in which lives are saved by organ donation and what they do to make the process as easy as possible for those on the waiting list.
Listen to the radio interview below, or read the transcript that follows.
Learn more about Organ Transplant Surgery Program at the University of Vermont Medical Center.
The UVM Medical Center: Say you’re badly injured in a car accident on the highway. There you are, stranded at the side of the road, desperately hoping that someone will stop to help you. Instead, thousands of cars pass by. You only need one to stop, but none of them do.
This is roughly similar to the situation faced by people in need of an organ transplant. Day after day they wait for an organ to become available from someone who decides to give so a life can be saved. There are, unfortunately, a lot of people in this situation, hundreds in Vermont and more than 120,000 in the United States. Every 10 minutes someone new is added to this list, and every day 22 die waiting. There’s even more reason to give than people might be aware of. You can actually save up to eight lives and enhance the lives of 50 others as an organ donor.
We’ll tell you how that’s possible and explore other aspects of this issue today with two guests. Dr. Marios Prikis is a nephrologist, also medical director of the transplant program at the UVM Medical Center, and an assistant professor at the Larner College of Medicine. We’re also joined by Rich Padula, who is manager of transplant services at the Medical Center. Thanks for coming.
Marios Prikis: Thanks so much for having us here.
Rich Padula: Thank you for the opportunity.
The UVM Medical Center Organ Transplant Program
The UVM Medical Center: Overall, why don’t we describe the program here, what kind of transplants we do, the team and all of that? Do you want to start, Rich?
Rich Padula: Sure, I’ll start. The transplant program here at the University of Vermont Medical Center currently provides kidney transplants for patients. We have roughly 68 patients on our waiting list currently. We have two surgeons and two transplant nephrologists. There is an incredible team of three transplant coordinators as well as nurses. We have a social worker who is dedicated to our program and our patients. Also, we have nutritionists, a pharmacist, and a financial coordinator, who are all dedicated to our program as well.
The UVM Medical Center: That’s a big group, and probably more than people realized, but there’s so much that goes into the prep. Why don’t you talk, Dr. Prikis, about that from a medical standpoint? This is quite a long process, right?
Marios Prikis: First of all I would like to say that we do know that organ transplantation, and especially kidney transplantation, is the way to go when the kidney fails. It’s the best way of replacing kidney loss and it’s certainly not an easy task to prepare patients like this. The process of getting to the day of transplantation, but also the post-transplant period is long as well.
As you have heard from my colleague, Mr. Padula, there is a big group of people who are involved in preparing kidney disease patients for the day of transplantation, and also many other people are involved in their care after they receive a kidney or another organ. It’s certainly teamwork and we are very proud to say that here in Vermont we do have a great team.
The UVM Medical Center: How many visits might there be before the actual surgery?
Marios Prikis: It depends on the patient, but usually we have a specific day that we bring the patients here so that they can meet the team, they can get as much information as they can about transplantation so they are more aware of what the process is and what they should expect after the kidney transplant, so this is a long day. They meet everyone, and then of course we can bring them maybe another one or two times. But it’s not just the visits. It’s also there are several tests that they have to go through, so the process may take one, up to three months many times. Again, this is for the benefit of the patient, so that we make sure they are ready to undergo such a procedure and to benefit the most from this.
The Role of the Social Worker in Organ Transplant
The UVM Medical Center: You mentioned social worker. How come?
Rich Padula: A social worker is important in helping determine the psychosocial status of the patient. Transplantation is more than just the physical component. We’ve sort of developed a mantra, if you will, here that we want patients to be physically ready, and that’s where the medical team certainly comes in. We want them to be psychosocially ready and financially ready for transplant.
That’s where the social worker plays a key role. Currently Mary is our social worker. She performs an assessment and provides information to us as to whether or not a person really is mentally ready and socially supported to get through transplantation. It takes a village, as you just sort of heard, on the list, and it takes a village afterwards of support for a patient to have a successful outcome. Social work plays a key component in that.
Then long term, there are multiple phases. There’s the pre-transplant phase, there’s the transplant phase, and post. We’re sort of wedded to these patients, if you will, for their life, and the social worker plays a key support in making sure there’s community resources. Sometimes just an ear, you know, just somebody to talk to, like why this is harder than I thought, so social work is a key component to success.
How Organ Transplants Happen and How Often
The UVM Medical Center: How many people get transplanted here every year?
Marios Prikis: Usually the number of kidney transplants that the center is performing depends on the population that it’s actually serving. Here in Vermont, in the greater area, usually it’s about 50 to 60 kidney transplants, even though at our center at the current moment we’re doing about between 20 to 30. One of our major goals for the future, and we believe that this is a feasible target, is to reach that level of 50 to 60, which is what our population can withstand. Over the years it varies because of different changes of the program and the team members and so on, and I think about 40 to 50 is something I think is allowable.
Rich Padula: I think one of the other things we’re finding in the couple years that we’ve worked together as a team, patients can get university medicine here and they still get the small town feel. I think that is something that we’re starting to learn from our patients, as we continue to see patients travel from outside of Vermont to come here, to be listed. From the time you’re listed to receiving a transplant is right around 36 to 39 months, where in places, as you mentioned in the Massachusetts area, you can wait up to seven years before you get a transplant.
The UVM Medical Center: Tell me how that works. If I’m in New England and donate an organ, do they stay in this region or is there a national list where they could end up … My organ could end up in California?
Rich Padula: That’s a great question. Historically it was sort of regional, as you mentioned, where if there was an organ donor recovered within your donation service area, is what they called it, typically the kidneys stayed local. In 2014, they made a change to the national allocation, which is basically the way that kidneys are allocated across the country, to where patients who have higher risk, meaning they’ve had previous kidney transplants or sensitizing events … Sometimes it could be a woman who has had a few childbirths that have changed her immune system, and so they’re more sensitized. Those patients in the past could wait years, or possibly never get a transplant.
The allocation sequence changed to allow those patients to go to the top of the list. In addition to that, they also looked at change in the structure to look for the length of the kidney over time. Nowadays the way the allocation sequence works is it’s not unlikely for a kidney that would be recovered here at the University of Vermont to be transplanted somewhere else in the country, but the vast majority of organs stay within your donation service area.
The UVM Medical Center: That’s Rich Padula. He is manager of transplant services at the UVM Medical Center. We’re also joined by Dr. Marios Prikis, who is a nephrologist, medical director of the transplant program, and an assistant professor at the Larner College of Medicine. We’re doing an overview of transplant services here and the issue in general. Before I go too much farther, I did want to let people know that there is a very easy way to register to donate your organs, and we’ll talk a little bit more about that later in the interview, but for now I want you to remember donatelifevt.org. That’s all run together as one sequence, donatelifevt.org.
The Opioid Crisis and Its Effect on Organ Transplants
The UVM Medical Center: One sort of hot topic right now is opioids, and that’s from opioid overdose, then there’s this trend that makes more organs available, but they are compromised I guess you would say in a way. How does that get handled and what do you talk to the patient about in terms of accepting an organ like that?
Marios Prikis: These are the so called high risk patients, as we call them. These are donors who have been carrying out actions that are considered high risk, either intravenous opioid use or even sexual intercourse that can potentially expose them to sexually transmitted diseases that can be transmitted to the recipients.
When a donor such as this is available, certainly the organs that are allocated to people that are aware of such kind of available organs and they have accepted to receive an organ like that, so when we evaluate patients during our pre-transplant evaluation process we do provide them with this information of high risk donors and they have to sign a consent that is supported to United Network of Organ Sharing, UNOS, which is the organization that manages and overlooks transplantation in the United States. This way, whenever there is a donor like that, then if our recipient matches with that donor, then we’ll accept that organ.
The UVM Medical Center: I know from talking to other folks in your program that we’ve done this for years and there’s never been a major medical problem as a result of it, right?
Rich Padula: Not here at the University of Vermont Medical Center. I mean the testing now continues to improve and the likelihood is almost zero that you would get a conversion. Unfortunately, due to this crisis, with the opioid crisis, there has been for the first time in well over 10 years an increase across the country in the number of organs transplanted. That’s the sad outcome, but the positive benefits those waiting on the list.
How You Can Become an Organ Donor
The UVM Medical Center: I said in the introduction that people can save eight lives and enhance the lives of 50 others. The reason I mentioned that is I think a lot of people just think donate a kidney, or maybe the pancreas or something, but you can donate tissue, you can donate your corneas. There’s a lot more that can be offered to folks.
Marios Prikis: We have to make sure we distinguish the different types of donations. We’re talking about donation of an organ when a person is living and he wants to donate to one of his blood relatives or one of his friends, or many, many times even altruistically to someone he doesn’t even know. In this case, you can donate only your kidney, as long as there’s going to be no impact on his general health, no impact on his kidney function, and so on and so on. This is the living donation. You can also donate in some centers a part of your liver, so it can be living liver donation. That’s probably what it is in living donation.
Now there is the deceased donor donation, which anyone can register, which means that in case that we die, then we can donate any of our organs and many other tissues like corneas and several other parts. That’s why many people can be saved and many other people can be affected because of that. Of course this is a different way of registering. People can register any time in their life. When you get your license, the driver’s license, there’s a registry, where you put your name there so when something unfortunate happens the providers know that your wish was to be a donor. Of course the other best way is also to let your immediate family know about it.
Rich Padula: Speaking from experience, it’s very relieving to the family to not have to make that decision and it starts to help the healing process, because in these terrible situations that is the one thing they can control, and that is they can ensure that their loved one’s wish is carried out. And you know what? No is okay, too.
The UVM Medical Center: That’s right. I want to emphasize that the registration process is very quick in easy, in case people think it’s complicated. Vermonters, I will just say, are very generous people. As soon as we had the online registry the donation percentages went way up, so I think it’s an indication that it is easy and accessible and just takes a couple minutes. I’m afraid we’re going to have to leave it there, but thank you very much gentlemen for joining me.
We’ve been talking to Dr. Marios Prikis. He’s the medical director of the transplant program here at the UVM Medical Center, also an nephrologist and assistant professor at the Larner College of Medicine. And we’ve been joined by Rich Padula, manager of transplant services at the Medical Center. Thanks very much for coming.
Rich Padula: Thank you for having us.
Marios Prikis: Thank you so much for having us here.
The UVM Medical Center: Again, that website if you want to register to donate your organs is donatelifevt.org, donatelifevt.org.