While many hospitals won’t transplant patients as sick as Thompson was, the doctors at Duke are very experienced working with critically ill patients in dire need of liver transplants. In fact, with three transplant teams on call 24/7, they are prepared for every medical issue -- no matter how serious or complicated.
When presented with a patient as sick as Thompson, they don’t waste a second when there isn’t one to lose.
“We get everything assessed in a few days,” said Deepak Vikraman, MD, Thompson’s transplant surgeon. “ We have an emergency meeting so we can get them listed and the patient doesn’t lose the opportunity for an organ.”
Doctors use the MELD (Model for End-State Liver Disease) score, which is based on lab tests, to determine how sick patients are. The higher the number, the more urgent the need for a transplant. Thompson’s initial MELD score was 37, near the high end of the range. Thompson’s MELD score then spiked to 45. It bumped him up to the first position on the transplant list in the Duke region. Within one day, a liver became available. But Thompson’s body wasn’t ready.
“They had to reject the first liver because I had an infection,” he said.
The infection was treated, but his problems continued. His kidney function plummeted and he went on dialysis. He became delirious and his MELD score soared to 52. Thompson later learned he had a 1 percent chance for survival.