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March 05, 2009

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Annie Dormant

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!

Anna Bennett

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.

Annie Dormant

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?

Anna Bennett

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."

Alison Hymes

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?

Anna Bennett

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)

Annie Dormant

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.

Mike

It's television

Monica

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.

Stacy Without An E

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.

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