Help!

[Sandra28678]

My nephew needs a liver and a kidney transplant.  He was trying to meet the criteria for Mayo Clinic to put him on the list for the transplants, before he could fulfill the requirements, he fell ill with sepsis, etc.  He is suffering brain damage from the toxins, and the hospital has released him to hospice because Mayo has now denied him for the transplant because he has not been able to fulfill all the requirements and that his body is not healthy enough to be a candidate.  We are wracking or brains on what to do next.  Does anybody have any idea what further avenues we can take?  Are there facilities out there that are willing to take on patients at risk for transplants?

[Thomas D Schiano, MD]

it sounds to me like he will need a private ambulance transport him.  If he has a DNR order signed they may not agree to take him.  please doublecheck whether he could potentially lose his hospice benefits if he makes the trip.  he probably needs a therapeutic paracentesis so may need to be hospitalized when he reaches the transplant center.  good luck.

[Sandra28678]

Thanks for the tips on centers.  My niece is going to call the Cal Pacific office in Las Vegas.  The biggest issue right now is transport. The hospital and the hospice center are both not agreeing to provide or pay for transport.  Traveling with him in a car for 5 hours to california is of course risky.  he does have some bladder function.  He seems to be holding his own right now.  His blood pressure is very low and they have him on medication for that.  His stomach is very, very extended from all the fluid, but he won't let them put a needle back in his stomach to drain it.  He does not comprehend the seriousness of the situation right now, he's under the delusion that he will get better on his own.  We're hoping that he can be convinced soon that he will not.  Do you have any ideas on transport?

[Thomas D Schiano, MD]

the ER cannot turn him down.  Stanford has a liver transplant program as does california pacific, both of which i think may be geographically close to loma linda.

[Sandra28678]

Is there any place in california that you know of?  He has some kidney function without the dialysis.  The hospital suggested they go into the hospice, now hospice is suggesting home hospice.  They are considering driving him from vegas to loma linda hospital ER...they can't turn him away correct?

[Thomas D Schiano, MD]

its important to know whether dialysis was stopped because his kidneys are getting better or because they are giving up on him.  Its a good sign that he is walking--if he has renal failure and dialysis is stopped he may not make it to be evaluated I am sorry to say.

[Sandra28678]

They are not sure.  And he also has kidney failure,  He was in a hospital in Las Vegas for almost 3 months with dialysis 3 times a week, now they have released him to a hospice center, so he's not on any dialysis at the moment, and we are desperately trying to find someplace that will accept him and keep him well enough for a living donor transplant from family.  Hopefully, in California where his sister lives.  So he needs a liver AND a kidney.  He can walk with a walker and his cognitive ability is very diminished, he can converse ok, but his short term memory. He's adamant about no more needles or treatments, and he can't accept the fact he will die if he does not continue treatment.

[Thomas D Schiano, MD]

there are many liver transplant programs that accept high risk pts but he would need to be seen there to be evaluated.  Is his neuro problem irreversible and will he convalesce enough to go home?