Intended audience: all

An organ recipient’s transplant journey refers to the entire process of managing an organ transplant, from the initial referral to post transplant follow-up. A recipient who needs several organs may be on more than one journey at a time.

A journey has multiple phases: Referral, Consultation, Medical Assessment, Waitlist, Allocation and Offer, Transplant Surgery, and Post Transplant Follow Up.

Each phase has decisions or outcomes that indicate the recipient's state in the journey. These decisions and outcomes determine whether the journey will continue to the next phase. For example,

  • A referral might have a decision of declined or accepted.

  • A consultation might have a decision of delayed or completed.

  • A medical assessment might have a decision of further treatment required or recipient to be listed.

  • A waitlisted journey might be active or on hold or suspended.

This article provides a brief overview of the transplant journey, outlining the most straightforward path a journey can take. Exceptions and complexities are described in the indicated help pages.

Referral

At the transplant program: A potential recipient is referred to a transplant program by their doctor or other specialist, by means of a referral package of documentation and medical information. The transplant program reviews the referral package, obtains additional information if required, and makes an initial referral decision whether to proceed with the requested transplant(s).

On the system: The recipient coordinator (or designate) enters information about the recipient to create a recipient profile. Once the profile is saved, the recipient coordinator specifies the organs the recipient requires and the referral decisions for each referral package received.

A decision of Referral Accepted allows the recipient to continue their journey. Other decisions can end the journey or put it on hold.

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Consultation

At the transplant program: Once the referral is accepted, the recipient meets with a transplant specialist regarding suitability for transplantation. The first consultation can cover:

On the system: The recipient coordinator (or designate) adds any new information to the recipient's profile and records that the consultation occurred.

An outcome of Consultation Completed allows the recipient to continue their journey. Other decisions can end the journey or put it on hold.

See: Manage consultation decisions

Medical assessment

At the transplant program: The transplant program completes a medical assessment for the recipient. This can happen before, during, or after the consultation. Based on the medical assessment, the transplant physician makes a decision on the next steps for the recipient.

On the system: The recipient coordinator or a transplant program administrator adds any new information to the recipient's profile and records the medical assessment decision.

A decision of Recipient to be waitlisted means the recipient is a suitable candidate for transplantation and can continue their journey. Other decisions can end the journey or put it on hold.

See: Manage medical assessment decisions

Waitlist

On the system: A recipient coordinator (or designate) adds the recipient to an organ waitlist and indicates the recipient's medical status. Over time, they add or change information on the recipient’s profile and organ journey(s) to maintain their active waitlist status.

The system sends reminders when important information must be updated (e.g., new NaMELD tests every 90 days).

Recipient coordinators can place a recipient on a temporary hold if they are not available for transplantation, or remove them from the waitlist if they withdraw, die, no longer meet listing criteria, or are ineligible for transplant.

See: Add recipient to waitlist

The quality of the recipient information in the system determines if and when a recipient can receive a transplant.

  • The system may suspend a recipient’s journey if mandatory information is missing.

  • The system will include the recipient in an allocation recommendation every time a required organ becomes available. The allocation algorithm will select, rank, and exclude recipients for organ offers based on their information.

  • For liver recipients, the system calculates exception points that impact their ranking.

  • The Special Case Committee (SCC) may enhance the recipient’s priority on the waitlist, based on recipient information.

  • The system will display recipient (and donor) information on offers, to help the transplant physician decide whether to accept or decline an offered organ.

Allocation and offer

At the Provincial Resource Centre (PRC): When a donated organ becomes available, a Clinical Services Coordinator (CSC) runs an allocation recommendation to identify possible recipients. The CSC makes offers to transplant programs, based on the recipients' rankings in the allocation recommendation.

At the transplant program: The transplant program chooses to accept or decline offers based on a clinical assessment of the recipient and organ match, the health of the recipient, and the recipient’s availability.

On the system: CSCs run an allocation recommendation. The resulting list of possible recipients becomes the working tool for making primary and backup offers to transplant programs.

Transplant physicians view donor and recipient information to make decisions.

Transplant programs respond to offers directly in the system.

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Surgery

At the transplant program: When a transplant coordinator accepts an organ offer and the PRC initiates the organ recovery, the recipient is considered to be in the surgery phase. The recipient is notified and travels to the transplant hospital. The transplant procedure is performed.

On the system: A transplant coordinator or CSC records the results of the transplant surgery, based on operating room data. An entry of Transplant Complete means that the recipient left the operating recovery room with a transplanted organ or organs.

See: Organ Recovery and Transplant

Post transplant

At the transplant program: The recipient travels to the transplant program for their annual transplant clinic appointment for ongoing follow-up care.

In other instances, the recipient receives ongoing follow-up care with their primary care provider in their community. In these cases, the recipient’s primary care provider provides and update on the recipient’s health and progression.

On the system: The recipient coordinator (or designate) captures the recipient’s post transplant status and any relevant contextual notes.

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