Cadaveric vs Living Donation; Comparing Options

1. Cadaveric vs Living Donation; Comparing Options Donna Ferchill, RN, BSN Clinical Nurse Manager, Liver Transplant Program Living Donor Coordinator

2. At a Glance: 117,589 people need a lifesaving organ transplant 14,073 organ transplants performed so far in 20176,611donors(Total Transplants and Donors from January - May 2017 as of 06/18/2017) *data from OPTN websiteThe discrepancy between organ supply and demand has reached its highest level, resulting in increased waiting times and higher death rates. Living donor liver transplantation (LDLT) is a well-established strategy to decrease the mortality in the waiting list and recent studies have demonstrated its value in patients with low MELD score.

3. Living donor over deceased donor transplantation; advantages and disadvantagesTRANSPLANT TIMING Deceased - MELD allocation rules make transplant unlikely at low MELD scoresLiving – scheduled surgery, transplanted with lower MELD scoreRECIPIENT OUTCOMESDeceased - Estimated probability of surviving with a functioning graft at 1 year is 88.48% (OHCC), 89.52% (US)*Living – Estimated probability of surviving with a functioning graft at 1 year is 90.32% (OHCC), 87.15% (US)**SRTR data as of January 5, 2017

4. Liver Transplant Evaluation Patient is referred for liver transplant Insurance authorization is obtained Intake coordinator calls patient and sets up evaluation Evaluation is scheduled and patient notified Evaluation takes place over 4-5 days or longer if additional consultations required (i.e. Cardiology, Pulmonary) Once evaluation has been completed the patient will be formally discussed at the Liver Transplant Selection Committee Meeting using a multidisciplinary approach If patient is approved for liver transplant the transplant coordinator will obtain approval from the Ohio Solid Organ Transplant Consortium at the same time financial approval is obtained for listing Once OSOTC approval and financial approval is obtained then the patient is listed for liver transplant Patient is notified of their listing status and a listing letter is sent

5. Cleveland Clinic Living Donor Program LDLT program performed first Living Donor Liver Transplant in 1999 Total number of LDLT performed to date - 115

6. Living Donor Evaluation Evaluation phase – will evaluate one donor at a time

7. Living Donor Evaluation Evaluation phase – will evaluate one donor at a time Age requirements – Donors must be 18-55 years old or can be up to the age of 60 if donating to a pediatric patient

8. Living Donor Evaluation Evaluation phase – will evaluate one donor at a time Age requirements – Donors must be 18-55 years old or can be up to the age of 60 if donating to a pediatric patient Recipient has to be APPROVED for transplant

9. Living Donor Evaluation Evaluation phase – will evaluate one donor at a time Age requirements – Donors must be 18-55 years old or can be up to the age of 60 if donating to a pediatric patient Recipient has to be APPROVED for transplant Donor evaluation/surgery/post operative care is covered under the recipients insurance

10. Living Donor Evaluation Evaluation phase – will evaluate one donor at a time Age requirements – Donors must be 18-55 years old or can be up to the age of 60 if donating to a pediatric patient Recipient has to be APPROVED for transplant Donor evaluation/surgery/post operative care is covered under the recipients insurance Directed/Non-directed (Anonymous)

11. Living Donor Evaluation Evaluation phase – will evaluate one donor at a time Age requirements – Donors must be 18-55 years old or can be up to the age of 60 if donating to a pediatric patient Recipient has to be APPROVED for transplant Donor evaluation/surgery/post operative care is covered under the recipients insurance Directed/Non-directed (Anonymous) Ht/Wt, BMI, no major medical conditions

12. Living Donor Evaluation Evaluation phase – will evaluate one donor at a time Age requirements 18-55 (60 if donating LLS) Recipient has to be approved for transplant Donor evaluation/surgery/follow up submitted to recipients insurance (must carry LDLT benefits) Directed/Non-directed (Anonymous) Weight, BMI, no major medical conditions 3 full days of testing (Medical, Surgical, Psychosocial)

13. Living Donor Evaluation Evaluation phase – will evaluate one donor at a time Age requirements 18-55 (60 if donating LLS) Recipient has to be approved for transplant Donor evaluation/surgery/follow up submitted to recipients insurance (must carry LDLT benefits) Directed/Non-directed (Anonymous) Weight, BMI, no major medical conditions 3 full days of testing (medical, surgical, Psychosocial) Donor approval at committee meetings

14. Living Donor Evaluation Evaluation phase – will evaluate one donor at a time Age requirements 18-55 (60 if donating LLS) Recipient has to be approved for transplant Donor evaluation/surgery/follow up submitted to recipients insurance (must carry LDLT benefits) Directed/Non-directed (Anonymous) Weight, BMI, no major medical conditions 3 full days of testing (medical, surgical, Psychosocial) Donor approval at committee meetings Surgery date (mutually agreed upon date)

15. Living Donor Informed Consent for Evaluation includes: 1. Document entitled “Informed Consent for Living Liver Donation.” 2. Donor consenting to proceed with the transplant evaluation process. 3. Donor willing to donate. 4. Free from inducement and coercion. 5. Donor may decline to donate at any time. 6. The Transplant Center must offer donor an opportunity to discontinue the organ donation consent or evaluation process in a way that is protected and confidential. 7. The Transplant Center must provide an independent living donor advocate (ILDA) to assist a potential organ donor during the entire process. 8. The Transplant Center is required to report living donor follow-up information at 6 months, 1 year, and 2 years following organ donation. Donor commits to undergo the post-operative follow-up testing as coordinated by the Transplant Center.

16. If interested in learning more about the LDLT program please call 216-444-1976.Thank you!