By Anna Bennett
Even though March 12th is World Kidney Day, March really is World Kidney Month. We are seeing mainstream press write about dialysis, kidney failure and transplant. CKD5 is in in prime time, watched by millions of people who are emotionally attached to the character played by Noah Wyle, Dr. John Carter. In tonight's third episode "What we do" of the Carter is sick story line, he is back, has revealed that he is in kidney failure due to prior trauma and amyloidosis secondary to chronic inflammation from Schistosomiasis. He is back in Chicago, and waiting on the UNOS list for a deceased donor kidney. We covered all of this is our prior posts. (3/7 episode SPOILERS after the jump)
Tonight, Carter passed out while treating patients in the ER. As his coworkers treat him, more people are now aware of his condition. His incenter runs are 3x a week for 4 hours. (he would have been so much healthier at home on NxStage) Wow, while he is being treated, Carter tells Gates to summon his Nephrologist from another hospital (Northwestern). (Now that can only be on TV)
The John Stamos character, Dr. Tony Gates covers transplant options, questioning the length of the UNOS wait time, offering County's paired donor program in which a non matching donor is matched to another recipient, and that recipient's donor is matched to Dr. Carter - the first of these transplant chains was done in NY.
Dr. Carter could not tell his wife what was going on with him medically. His withdrawal and fear of rejection is common, but it cost him the love and support of the woman he loves. Dialysis is depressing, scary, and some people choose to be scared in silence. But the depression can be treated.
ER is really doing transplant a favor. They are trying to cover a lifetime of disease and waiting in a few episodes. Tonight, the character of Sam Taggert (Linda Cardellini) is waiting for a transplant flight (a heart).
Carter was not able to summon his nephrologist (hah a bit of real life there!) and he is in the stretcher being transferred to NorthWestern.
The show ends with Carter turning off an alarm, and speaking to the camera. I have a feeling that we'll have him around for a while.
In the promo clip for next week episode, we see a doctor telling Dr. Carter that they found a kidney for him. My question is: is he incredibly lucky to get one so fast, or does there exist a medical condition that can put him top of the list?
My (very little) knowledge about UNOS list and priority for kidneys was that the priority was given to the person with the best match, and if there are two matches, then to the person having been on the list the longest. Is that true, is that the only rule, or are there other priority rules and from what we saw on the show ER, could Dr.Carter look like he needs such a priority?
Thanks!
Posted by: Annie Dormant | March 06, 2009 at 07:19 AM
Hi Annie,
You are right to question the speediness if Dr. Carter does get a kidney. It could happen very quickly - depending on the area, and his blood type, but, the average wait in Chicago for a UNOS kidney is fairly long.
According to UNOS, there are 1,114 people waiting for a kidney at Northwestern as of today's data http://www.unos.org/Data/. My take on Dr. Carter getting a kidney so quickly is that it seems to be some television magic.
Right now, the matching process is wait and antigen match based. From UNOS http://www.optn.org/about/transplantation/matchingprocess.asp
"For each organ that becomes available, the computer program generates a list of potential recipients ranked according to objective criteria (i.e. blood type, tissue type, size of the organ, medical urgency of the patient, time on the waiting list, and distance between donor and recipient). Each organ has its own specific criteria. Ethnicity, gender, religion, and financial status are not part of the computer matching system.
After printing the list of potential recipients, the procurement coordinator contacts the transplant surgeon caring for the top-ranked patient (i.e. patient whose organ characteristics best match the donor organ and whose time on the waiting list, urgency status, and distance from the donor organ adhere to allocation policy) to offer the organ. Depending on various factors, such as the donor's medical history and the current health of the potential recipient, the transplant surgeon determines if the organ is suitable for the patient. If the organ is turned down, the next listed individual's transplant center is contacted, and so on, until the organ is placed."
I was listed in NYC for 3.5 years before I received my kidney, and I have a very common blood type A+. There are states that have a quicker turn over on the list, which is why people who are really motivated multi list at several centers for a transplant.
I was one of the lucky ones, I was able to perform high dose hemodialysis at home while waiting, and data shows that high dose dialysis can rival the outcomes of a deceased donor transplant.
Posted by: Anna Bennett | March 06, 2009 at 07:41 AM
Thank you very much for this very precise answer!
May I dare another question? It's been told several times on the show in the past (many years ago...) that Carter has blood type O-. Do you know if that makes him more or less likely to get a kidney fast?
Posted by: Annie Dormant | March 06, 2009 at 08:35 AM
According to UNOS Data, http://www.unos.org/Data/
There are 1,916 people with type O blood currently waiting for a kidney in Illinois. If Dr. Carter were just listed he would be one of many waiting for a type O kidney.
As far as matching by blood type,from aakp http://www.aakp.org/aakp-library/Kidney-Transplant-Matching/
"Looking at this from the recipient's point of view, a recipient with blood type O can receive a kidney only from a donor with blood type O. A recipient with blood type A may receive a kidney from a recipient with blood type O or A and a recipient with blood type B can receive a kidney from a donor with blood type O or B. Obviously, a recipient with blood type AB can receive a kidney from a person of any blood type."
Posted by: Anna Bennett | March 06, 2009 at 10:14 AM
Someone correct me if I am out of date, but I thought that kidneys were the only organ in which medical urgency is not one of the factors considered. I think this is under debate/discussion now though. Anyone else know if I am out of date on this?
Posted by: Alison Hymes | March 06, 2009 at 03:32 PM
Alison, I think that you are right. I lifted a lot of my response from UNOS and didn't put in quotes. (I'm going to fix that now)
Posted by: Anna Bennett | March 06, 2009 at 04:58 PM
Thank you very much for your answers Anna and Alison.
So I guess it'll be pure TV magic that Carter gets a kidney so fast!
I'm always a bit bothered on medical TV shows that doctors seem to get special treatment. There was a scene in the last episode where one of the doctors taking care of Carter kicks out a med student coming for a renal consult, and wants an attending from nephrology to come down. Would he have done the same if the patient had been anonymous to him? probably not.
I'm glad that this show is addressing kidney failure and transplant and tries to bring awareness, through one of its main character, which usually is more touching for the audience vis-à-vis any patient, but the story is of course a bit rushed. It would have been good to see this story developed along the course of several seasons. But the actor Noah Wyle was signed for a few episodes only.
Posted by: Annie Dormant | March 07, 2009 at 01:15 AM
It's television
Posted by: Mike | March 08, 2009 at 11:53 AM
As for the kicking the med student out I see two main reasons:
1) He's a good friend of their's (it's hard to not fight for the best for our friends and family)
2) He provides a very important societal function. If he dies there is one less doctor vs someone who is not effecting the world in the ERverse like Carter is.
Posted by: Monica | March 08, 2009 at 02:31 PM
If he gets a kidney before the end of ER's run I'm going to be VERY DISAPPOINTED. But it depends on how they handle it. If one of his friends is a match, fine, that makes sense and can happen.
But if he's on the list for only a few weeks and gets a kidney, that distorts the truth for the public. If a novice about kidney disease were watching, they would think kidney's are available left and right, which is highly inaccurate.
I've been on for five years and have never been called.
To the producers of ER I say: stay true to your nature at depicting real medical conditions and take your time with his storyline.
Posted by: Stacy Without An E | March 15, 2009 at 07:56 PM