Liver Transplant:
What is best place inside/outside US to get liver transplant based on:
fastest time to get a liver (shortest wait times), highest success
rate and survivor rate (quality), and accessibility for foreign
patients (US citizens).

More specifically for a patient with:
A MELD score of 28 or 29;
Hemochromatosis - Liver produces too much iron
Cancer of liver which is isolated in liver;
Has been waiting for 10 months (since May 2005);
Other than liver cancer, the patient is healthy and has a high chance
for successful transplant (according to Mayo Clinc in Rochester);

More specifically:
What is the best place (shortest speed, best quality, accessible) for
a patient to persue a liver transplant today
A) Mayo Clinic Rochester
B) Mayo Clinic Jacksonville
C) Other location inside US
D) Other location outside the US

---

Request for Question Clarification by hummer-ga on 08 Mar 2006 06:00 PST

Hi adamhicks,

I'm sure you are anxiously waiting for a response to your question so
I thought I'd let you know that I am working on it and will have an
answer for you, hopefully by the end of the day.

Till later,
hummer

Hi adamhicks,

The Scientific Registry of Transplant Recipients will, I'm sure,
provide you with more information than you want to know. We can,
however, extract the data that you have requested (waiting periods and
survival rates), plus one other important aspect, the number of
transplants done.  That last piece is important because a center could
have a 100% survival rate, but if they only did one transplant, the
rating is less significant.  Another statistic that makes a difference
in the survival rate is the proportion of those patients who were
listed as Status 1 (very urgent). Ofcourse having fewer listed in this
group will increase the survival rate.

First, a couple of websites which talk about how to choose a transplant center.

Liver transplant: Intervention for end-stage liver disease
"When selecting a liver transplant center, take into account the
number of liver transplants the center performs each year and the
recipient survival rates. You can compare liver transplant center
statistics through a database maintained by the Scientific Registry of
Transplant Recipients.
You should also consider additional services provided by a transplant
center. Many centers coordinate support groups, assist you with travel
arrangements, help you find local housing for your recovery period, or
direct you to organizations that can help with these concerns."
http://www.mayoclinic.com/health/liver-transplant/DG00037

Selecting a Hospital
Which Hospital Is Best for You?
When choosing a transplant center, patients should carefully consider
these factors:
    * The experience of the transplant team and support personnel... 
    * The cost of the procedure and related items...
    * Insurance coverage...
    * Geographical proximity to the program...
    * The quality and availability of pre- and post-transplant services...
    * A commitment to keeping up with technologic advances...
    * Multicultural sensitivity...
    * Availability of friends and family for assistance...
http://www.transplantliving.org/beforethetransplant/hospital/hospital.aspx

Selecting a Hospital
Other Options to Consider
Multiple Listing
"As addressed in the OPTN/UNOS Policy 3.2.2, patients may be listed at
more than one transplant center. Being listed at more than one
transplant center does not guarantee that an organ will become
available faster than if you are listed at one transplant center. If
you choose to multiple list, your primary care physician should
contact your centers of choice so that you may be evaluated as a
transplant candidate, as you did with your primary evaluation." [link
to brochure]
Transferal of Waiting Time
"As addressed in the OPTN/UNOS Policy 3.2.2.1, patients may transfer
their primary waiting time from one transplant center to another
center. This transfer may be necessary for a number of reasons, such
as a change in the transplant candidate's health insurance or if the
candidate has moved." [link to brochure]
http://www.transplantliving.org/beforethetransplant/hospital/otherOptions.aspx

Questions to Ask Your Transplant Team
http://www.transplantliving.org/beforethetransplant/list/questions.aspx


>>> The Reports
[click on the pdf link which is under the drop-down menu to view the
entire report of each transplant center]


A) MAYO CLINIC: Rochester Methodist Hospital, Rochester, MN
     Summary: 
         Number:   Very high (349)
         Speed:    Lower than average (31.4% transplanted within 6 months)
         Survival: Very high (3.8% had died by 6 months)
"At this center, 5 of 156 of these patients were listed at Status 1.
For these most urgent patients, 80.0 percent had received a transplant
by 6 months after listing, compared with 54.6 in the nation (Table
4S1). At 6 months, 0.0 percent had died (14.9 nationally) and 0.0 were
still on the waiting list (7.4 nationally)."

"Rochester Methodist Hospital (Mayo Clinic) (MNMC) had 379 patients on
its waiting list on 07/01/2003 and 349 patients on 06/30/2005. During
these two years, 326 patients were added to the list and 356 patients
were removed. Of the removals, 26 were for transplant from a living
donor and 171 were for transplant from a deceased donor. Rochester
Methodist Hospital (Mayo Clinic) (MNMC) performed 110 liver
transplants (Table 7) during the last year (07/01/2004-06/30/2005). "
"Overall, at Rochester Methodist Hospital (Mayo Clinic) (MNMC), 31.4
percent of patients placed on the waiting list had received a
transplant by 6 months after listing, compared with 37.9 in the nation
(Table 4). At 6 months, 3.8 percent had died (compared to 7.8
nationally) and 59.6 were still on the waiting list (48.9 nationally).
These numbers are strongly influenced by the proportion of patients
who are listed at a high medical urgency status. At this center, 5 of
156 of these patients were listed at Status 1. For these most urgent
patients, 80.0 percent had received a transplant by 6 months after
listing, compared with 54.6 in the nation (Table 4S1). At 6 months,
0.0 percent had died (14.9 nationally) and 0.0 were still on the
waiting list (7.4 nationally)."
[SEE TABLES]
http://www.ustransplant.org/csr/current/publicData.aspx?facilityID=MNMCTX1LI&t=G


B) MAYO CLINIC: Saint Marys Hospital, Rochester, MN
     Summary: 
         Number:   Very Low (9)
         Speed:    The best (100% transplanted within 6 months)
         Survival: The best (0% had died by 6 months)
"At this center, 1 of 3 of these patients were listed at Status 1. For
these most urgent patients, 100.0 percent had received a transplant by
6 months after listing, compared with 54.6 in the nation (Table 4S1).
At 6 months, 0.0 percent had died (14.9 nationally) and 0.0 were still
on the waiting list (7.4 nationally)."

"Saint Marys Hospital (Mayo Clinic) (MNSM) had 12 patients on its
waiting list on 07/01/2003 and 15 patients on 06/30/2005. During these
two years, 20 patients were added to the list and 17 patients were
removed. Of the removals, 13 were for transplant from a deceased
donor. Saint Marys Hospital (Mayo Clinic) (MNSM) performed 9 liver
transplants (Table 7) during the last year (07/01/2004-06/30/2005).
Typical liver programs currently operating in the United States
transplanted between 15 and 75 people in that same period."
"Overall, at Saint Marys Hospital (Mayo Clinic) (MNSM), 100.0 percent
of patients placed on the waiting list had received a transplant by 6
months after listing, compared with 37.9 in the nation (Table 4). At 6
months, 0.0 percent had died (compared to 7.8 nationally) and 0.0 were
still on the waiting list (48.9 nationally). These numbers are
strongly influenced by the proportion of patients who are listed at a
high medical urgency status. At this center, 1 of 3 of these patients
were listed at Status 1. For these most urgent patients, 100.0 percent
had received a transplant by 6 months after listing, compared with
54.6 in the nation (Table 4S1). At 6 months, 0.0 percent had died
(14.9 nationally) and 0.0 were still on the waiting list (7.4
nationally)."
[SEE TABLES]
http://www.ustransplant.org/csr/current/publicData.aspx?facilityID=MNSMTX1LI&t=G


C) MAYO CLINIC: St. Luke's Hospital, Jacksonville, FL
     Summary: 
         Number:   High (253)
         Speed:    Very high (89.7% transplanted within 6 months)
         Survival: Very high (1.6% had died by 6 months)
"At this center, 8 of 184 of these patients were listed at Status 1.
For these most urgent patients, 50.0 percent had received a transplant
by 6 months after listing, compared with 54.6 in the nation (Table
4S1). At 6 months, 0.0 percent had died (14.9 nationally) and 0.0 were
still on the waiting list (7.4 nationally)."

"Overall, at St. Luke's Hospital (Mayo Clinic) (FLSL), 89.7 percent of
patients placed on the waiting list had received a transplant by 6
months after listing, compared with 37.9 in the nation (Table 4). At 6
months, 1.6 percent had died (compared to 7.8 nationally) and 4.3 were
still on the waiting list (48.9 nationally). These numbers are
strongly influenced by the proportion of patients who are listed at a
high medical urgency status. At this center, 8 of 184 of these
patients were listed at Status 1. For these most urgent patients, 50.0
percent had received a transplant by 6 months after listing, compared
with 54.6 in the nation (Table 4S1). At 6 months, 0.0 percent had died
(14.9 nationally) and 0.0 were still on the waiting list (7.4
nationally).
At St. Luke's Hospital (Mayo Clinic) (FLSL), 89.25 percent of adult
patients were alive one year after transplant, compared to the 84.63
percent that would be expected based on the characteristics of these
patients. Moreover, the p-value of 0.005 indicates that this
difference is statistically significant. Similar comparisons may be
made for shorter- (1 month) and longer-term (3 year) survival, also in
Table 11, as well as for graft survival (Table 10). Further discussion
of actual, expected, and national survival rates may be found in the
Table Details section below.
The above results reflect survival for both deceased and living donor
transplants combined. Of these 421 adult transplants performed by St.
Luke's Hospital (Mayo Clinic) (FLSL), 420 were deceased donor
transplants, and 89.23 percent of these recipients remained alive one
year later. This center also performed 1 adult living donor
transplants in this period with 100.00 percent of these recipients
alive one year later."
[SEE TABLES]
http://www.ustransplant.org/csr/current/publicData.aspx?facilityID=FLSLTX1LI&t=G


D) University of Pittsburgh Medical Center
     Summary: 
         Number:   High (230)
         Speed:    High (65.6 transplanted within 6 months)
         Survival: Lower than average (8.5% had died by 6 months)
"At this center, 27 of 390 of these patients were listed at Status 1.
For these most urgent patients, 66.7 percent had received a transplant
by 6 months after listing, compared with 54.6 in the nation (Table
4S1). At 6 months, 22.2 percent had died (14.9 nationally) and 3.7
were still on the waiting list (7.4 nationally)."

"Table 1 provides a picture of the volume and type of waiting list and
transplant activity at this center. University of Pittsburgh Medical
Center (PAPT) had 289 patients on its waiting list on 07/01/2003 and
346 patients on 06/30/2005. During these two years, 684 patients were
added to the list and 627 patients were removed. Of the removals, 59
were for transplant from a living donor and 436 were for transplant
from a deceased donor. University of Pittsburgh Medical Center (PAPT)
performed 230 liver transplants (Table 7) during the last year
(07/01/2004-06/30/2005). Typical liver programs currently operating in
the United States transplanted between 15 and 75 people in that same
period. More about the activity at this center and the types of
patients served is found in the Table Details section below and in
Tables 1 and 2 (waiting list) and Tables 7, 8, and 9 (transplant).
The likelihood of receiving a liver transplant differs from facility
to facility and also from person to person depending upon the medical
condition of the candidate. Overall, at University of Pittsburgh
Medical Center (PAPT), 65.6 percent of patients placed on the waiting
list had received a transplant by 6 months after listing, compared
with 37.9 in the nation (Table 4). At 6 months, 8.5 percent had died
(compared to 7.8 nationally) and 24.6 were still on the waiting list
(48.9 nationally). These numbers are strongly influenced by the
proportion of patients who are listed at a high medical urgency
status. At this center, 27 of 390 of these patients were listed at
Status 1. For these most urgent patients, 66.7 percent had received a
transplant by 6 months after listing, compared with 54.6 in the nation
(Table 4S1). At 6 months, 22.2 percent had died (14.9 nationally) and
3.7 were still on the waiting list (7.4 nationally)."
[SEE TABLES]
http://www.ustransplant.org/csr/current/publicData.aspx?facilityID=PAPTTX1LI&t=G


E) University of Washington Medical Center 
     Summary: 
         Number:   Medium (127)
         Speed:    High (54.5 transplanted within 6 months)
         Survival: Very High (1.5% had died by 6 months)
"At this center, 4 of 132 of these patients were listed at Status 1.
For these most urgent patients, 50.0 percent had received a transplant
by 6 months after listing, compared with 54.6 in the nation (Table
4S1). At 6 months, 25.0 percent had died (14.9 nationally) and 0.0
were still on the waiting list (7.4 nationally)."

"University of Washington Medical Center (WAUW) had 118 patients on
its waiting list on 07/01/2003 and 191 patients on 06/30/2005. During
these two years, 373 patients were added to the list and 300 patients
were removed. Of the removals, 249 were for transplant from a deceased
donor. University of Washington Medical Center (WAUW) performed 127
liver transplants (Table 7) during the last year
(07/01/2004-06/30/2005). Typical liver programs currently operating in
the United States transplanted between 15 and 75 people in that same
period."
"Overall, at University of Washington Medical Center (WAUW), 54.5
percent of patients placed on the waiting list had received a
transplant by 6 months after listing, compared with 37.9 in the nation
(Table 4). At 6 months, 1.5 percent had died (compared to 7.8
nationally) and 39.4 were still on the waiting list (48.9 nationally).
These numbers are strongly influenced by the proportion of patients
who are listed at a high medical urgency status. At this center, 4 of
132 of these patients were listed at Status 1. For these most urgent
patients, 50.0 percent had received a transplant by 6 months after
listing, compared with 54.6 in the nation (Table 4S1). At 6 months,
25.0 percent had died (14.9 nationally) and 0.0 were still on the
waiting list (7.4 nationally)."
http://www.ustransplant.org/csr/current/publicData.aspx?facilityID=WAUWTX1LI&t=G


F) Stanford University Medical Center, Stanford, CA

"The Stanford Liver Transplant Program is a well-known center for
referral of very high-risk patients. Table 7 shows that 37.2% of our
recipients were Status 1 (very high risk patients) compared with 14.9%
for the region and 9.2% for the U.S. Moreover, 29.1% of our patients
were children under 2 years of age compared with 6.1% for the region
and 3.7% for the U.S. Lastly, 31.4% of our patients had malignancy
compared with 10.7% for the region and 8.2% for the U.S.
In summary, the transplant team at Stanford has a cumulative
experience of more than 2000 liver transplants, is willing to take on
high-risk patients, and has a strong commitment to excellence. "
http://www.ustransplant.org/csr/current/viewComments.aspx?facilityID=CASUTX1LI&t=0


>>> International centers

I really can't, with good conscience, recommend seeking treatment
abroad. There are several reasons for this, e.g.,  the low
availability of donated organs and local restrictions making organs
mostly unavailable to foreigners. An American has a far better chance
of being treated quickly in the United States versus elsewhere.

Committee for Promoting German Medicine in Foreign Countries
Transplantation
"Transplantation in Germany, however, is strictly regulated by law.
These regulations make it impossible for a non-European patient to
receive an organ from a deceased donor except in a few limited cases.
Quotas have been set throughout Europe stating that a maximum of 15%
of organs from deceased donors can be transplanted into non-European
patients. Considering the variety of medical factors that must
correspond between the organ offered by the donor and the potential
recipient, it becomes clear that the chances of receiving such an
organ are very slight.
For this reason, situations in which the donated organ comes from a
living donor (especially kidney and liver transplants) are the more
common focus of treatment for international patients..."
http://www.committee-german-medicine.de/cms/front_content.php?idcat=190

It is also important to remember the importance of being near family
and the logistics of being prepared for surgery (a person would have
to live in the foreign country for an unknown length of time during
the waiting period). Also, there is no chance of transferring the
waiting time to a foreign country that has already spent in the U.S.

Preparing for a Transplant
Waiting for Your Transplant
# Take care of your health...
# Keep your scheduled appointments with your physicians...
# Participate in support groups...
# Follow the dietary and exercise guidelines...
# Occupy yourself by staying involved...
# Maintain contact with family and friends...
# Make sure you are available...
# Be prepared with transportation...
# Make sure you are available. It is important for your transplant
team to know how to get in touch with you at all times. Pagers, cell
phones or remote answering machines may be required by your transplant
center. Your transplant coordinator may recommend that you stay within
a certain geographic range.
# Be prepared with transportation. When you are placed on the organ
waiting list, your first responsibility is to plan how to get to the
transplant center as soon as you are notified that an organ is
available. Prepare yourself for this call by making the necessary
arrangements for transportation well in advance.
# Be prepared by packing your bags in advance. You'll need to be ready
to leave as soon as you get the call that an organ is available. Be
sure to take your insurance information, an extra 24-hour supply of
medication and all other necessities."
http://www.transplantliving.org/beforethetransplant/prepare_tx.aspx?prep=wait

The Cromwell Liver Centre 
"It is the only private facility in Europe carrying out liver transplantation"
http://www.cromwell-hospital.co.uk/htmlpages/sp_centre.asp?ID=12

The Cromwell Liver Centre 
"A biologically compatible donor will need to be found and
unfortunately there is usually a long wait for donor organs to become
available."
http://www.cromwell-hospital.co.uk/htmlpages/specialties.asp?ID=125


>>> Additional Links of Interest:

Center and OPO-Specific Reports, January 2006
Select a state of interest on the map:
http://www.ustransplant.org/csr/current/csrDefault.aspx

Transplants by State and Transplant Center, 1995 to 2004
http://www.ustransplant.org/annual_reports/current/915_li.htm

Chapter VI
Liver and Intestine Transplantation in the United States, 1995-2004 
http://www.ustransplant.org/annual_reports/current/Chapter_VI_AR_CD.htm?cp=7

The Transplantation Society
http://www.transplantation-soc.org/

Transplantation Journals
http://www.transplantation-soc.org/journals.php

Links (UK)
http://body.orpheusweb.co.uk/lnks.html


So, there you have it, that should keep you busy for awhile! I think
you will find that the Mayo Clinic in Jacksonville, FL is hard to
beat. If you have any questions, please post a clarification request
and wait for me to respond before closing/rating my answer.

Thank you,
hummer

Search strategy:
I spent most of my time searching through the SRTR website.

---

Request for Answer Clarification by adamhicks-ga on 08 Mar 2006 15:35 PST

Hummer, I greatly appreciate the answer and timing related to US
Domestic options. However, I was pretty certain Mayo at either
Rochester or more likely Jacksonville were best domestic options. Your
consolidation of facts was useful and I am pleased.

One area I would like a bit more information is the conclusion of
difficulties of foreign patients in countries outside the US. This is
obviously regulated in Europe, but it is my understanding that India,
Thailand, Philippines, and China are opportunities. As an example see:
http://yeson.com/new/index.htm www.yeson.com.tw

Any clarification you can offer related to additional sites outside US
in comparison?

---

Clarification of Answer by hummer-ga on 08 Mar 2006 19:43 PST

Hi adamhicks,

Just a note to let you know that I will respond to your clarification
tomorrow, when I'll have more time to work on it.

Regards,
hummer

---

Clarification of Answer by hummer-ga on 09 Mar 2006 11:52 PST

Hi adamhicks,

What you are proposing is called "medical tourism" and I don't think
it would satisfy your original question, i.e., the best place to get a
liver transplant based on shortest wait times (there is a shortage of
donors there too) and highest survival rates (it's too bad the SRTR
reports aren't worldwide).  The link you gave me says it all:
"survival rates approaching those of the US". That doesn't sound like
"the best" to me, and their unfinished sentence does not give me a
sense of confidence.

Why China?
Here are the main reasons to chose China:
"China has made great strides with transplant surgery in recent years,
with survival rates approaching those of the US. They are even
pioneering new drugs and new techniques that are being tried in the
US. Many of the doctors there were trained in the best transplant
centers in the US. It was affordable in compare to the over priced
medical expense in US. It is possible to get an match transplant in
relatively"
http://yeson.com/new/english/Why_China_4.1.htm

Successful transplants are dependent on a wide range of up-to-date
medical procedures, requiring the latest equipment and well trained
personel. In other words, the best results are found at 'transplant
centers" where the procedure is a speciality.

Complications and long-term outcome of living liver donors: a survey
of 1,508 cases in five Asian centers.
http://www.transplantjournal.com/pt/re/transplantation/abstract.00007890-200302151-00005.htm;jsessionid=EQCfp2HfJMs1ARU58PSjV07XiK9NV63cv2a08RBeAB2qBHI9Lbdf!-1070481199!-949856145!9001!-1

China:
China to 'tidy up' trade in executed prisoners' organs
From Jane Macartney in Beijing
"CHINA broke its silence yesterday to admit for the first time that
the organs of executed prisoners were sold to foreigners for
transplant."
"The one-year survival rate for a liver transplant in China is about
50 per cent, compared with 81 per cent in the US."
http://www.timesonline.co.uk/article/0,,25689-1901558,00.html

India:
Why is the success rate in liver transplant low in India? What are
your suggestions for improvement?
"The experience of carrying out liver transplants in India is vastly
different from that in the US..."
http://www.expresshealthcaremgmt.com/20040930/interview01.shtml

Where to have liver transplant
"At the authors center at New Delhi more than 25 successful liver
transplants have been carried out, making it the only successful,
ongoing liver transplant programme in India till date (January 2003)."
http://www.liverindia.com/wheretohave.htm

World Health Organization
Ethics, access and safety in tissue and organ transplantation Issues
of global concern
Madrid, Spain, 6-9 October 2003
Session 7 - Quality and safety in the transplantation process
Basic requirements for organ transplantation - Dr Ryota Shirakura
"Dr Shirakura reported that Japan has performed 15 113 renal
transplants since 1964, 2411 liver transplants since 1989, but only 17
heart and 39 lung transplants since 1998. The organs have largely been
obtained from living and to some extent from non-heart beating donors.
There still remains an extreme donor shortage from brain dead
donors..."
http://www.who.int/ethics/topics/en/madrid_report_final.pdf

Thailand
"Liver transplantation is one of the best treatments for advanced
liver disease since it can prolong the patient's survival. In
Thailand, the first liver transplantation was performed in 1987 at
King Chulalongkorn Memorial Hospital. Up till now the authors have
transplanted the most in Thailand, having done more than 30 cases.
From 1997 to 2002, there were 20 cases of liver transplantation and
this is the result presented."
"The authors classified the patients into 2 groups, according to
primary indications for transplantation. Patients with cirrhosis were
included in group I and patients with hepatocellular carcinoma were
included in group II. The one year survival in group I and II was 64
per cent and 29 per cent respectively.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12930023&dopt=Abstract

Ok, adamhicks, I finally found an Asian website that might be worth a
look.  I've no idea of survival rates or waiting times.

Taiwan
Liver Transplant Center
Linkou Chang Gung Memorial Hospital 
Read this page and then click on the link at the bottom of the page:
<more information for Liver Transplant Center>
http://www.cgmh.com.tw/eng2002/ci06.htm

Liver Transplant Center
Kaohsiung Chang Gung Memorial Hospital
"Living donor liver transplantation has also become a routine
operation in our center, being performed on a weekly basis for
elective cases. The number of cases that have been performed amount to
nearly eighty percent of total number in the whole country to date,
and our survival record remains among the highest in the world."
http://www.clchen.org.tw/english/e_team_intro.htm

Liver Transplant Center
Kaohsiung Chang Gung Memorial Hospital
LIVER TRANSPLANTATION SERVICES FOR INTERNATIONAL PATIENTS
http://www.clchen.org.tw/english/e_International_Patients.htm

Philippines
"Liver transplant has not been done here in the Philippines"
"Unfortunately Liver transplant is not yet available here in the Philippines"
http://www.cgmh.com.tw/eng2002/contact_qa.asp

I hope that helps. Please let me know if you have any other questions.
hummer

Hummer. I've passed the information on to the patient. 
You have given us a tremendous amount of information in a very
expedient manner. This is the first time using Google Answers and it
has been a very useful experience. I hope we never have to consider
options outside the US but considering all options when faced with the
situation of liver cancer is necessary. At this stage, the patient is
likely to live 10+ years if they could get the transplant, without it
is just like waiting for the liver cancer to spread and take its toll.
Again, thank you for looking at the data and helping reinforce we're
heading in the best direction. Appreciate it.

hummer- You've put together an amazing consolidation of vast amounts
of circuitous information into an understandable format. My hat's off
to your expertise. I agree that Mayo Jacksonville presents best in the
literature.

adamhicks,
 
Best wishes to you in your search and decision regarding a transplant
facility to work with.

Is there a specific reason that you are still considering facilities
outside the US?  For example, I can think of a blood type issue that
wasn't in your original criteria, that causes people to strongly
consider going outside the US.  Cost of living is also an issue if you
must live in the area awaiting transplant and for follow-up care. 
There are several US Centers that also look quite good on paper in
smaller metropolitan areas of the country if that is a major
consideration (Univ Alabama at B'ham for example).  Perhaps a bit more
information would help in finding a center that will not only give you
the best medical care, but also peace of mind in your decision.

I have fond memories of a friend who's liver is in Chicago, and I play
darts with a friend who's liver is from Miami. I don't know you, but I
know domestic livers are pretty darn good! :)

The only reason to consider alternatives outside the US is speed to
receive a liver. The patient in reference has been on the waiting list
almost one year with Mayo Clinic in Rochester. His MELD score has gone
up 2 points since registering, he is aware of at least 2 other
patients with lower MELD scores who have received transplants. Now
they are suggesting he go down to Jacksonville (after a year in
Rochester). So, when you are in this position and are told to make a
switch you start to ask yourself questions and this is as you can
guess, an important one to feel good about the answer. Overall, the
transplant process is NOT very transparent for the patients and
getting a straight answer is not very easy nor diffinitive. The
patient in question can accept death as it is inevitable. But is the
type that will not die for a stupid reason like not checking the
alternatives and persuing every possible one. At this point, the
process leaves you feeling like you could just be lost in a shuffle
and end up dying as a result. Thanks again to hummer for the
assistance in weighing this information. Well done hummer.

Dear adamhicks,

Thank you for your kind words and for your elaboration of the
situation. I agree wholeheartedly that more often than not, the maze
of our medical system is a difficult one to traverse, especially when
one is ailing. To complicate things, so much depends on who you ask,
you may get one answer one day but receive a different answer from
someone else the next day. The Scientific Registry of Transplant
Recipients is really a terrific site and hopefully your friend will be
eased by feeling that he has some real facts in hand.

I would like to wish your friend well and if you think of me after his
recovery, I would appreciate hearing when and where he had his
transplant.

Sincerely,
hummer

Onenonblonde, thank you for your comments also, it was very nice of
you to take the time to write.  Regards, hummer

Go to India and the city is Chinai also called Madras.Hospital chains
which do the transplant job. Apollo and Dr. Reddy these are two names
of the hospital services.
Good Luck !
Pradeep

Greetings ALL,

I just want to shout out that the patient related to my inquiry has
received his transplant from Mayo Clinic Rochester. As of a few days
after, he is doing remarkably well both physically and mentally. It
all happened so fast and went so smoothly it was/is astounding. As you
know we are keen on statistics, things are looking good and we are (as
you also know) doing all we can to contribute to the process. We are
greatful for all the input we received to help us in this process and
thank you all for your expertise, concern, and participation in this
processs. Light and love to you all.


1. To Hummer: Again, please let me thank you for the excellent
assistance you offered when I realized there was a bounty of
statistical information and significantly less, but potentially
extremely relevant available on the web (or more specifically from
Google products). I know I'm good at research, and web research, but
you did your job...finding out and classifying better than I could
myself. Worth every penny. You even went above and beyond by sharing a
moral intelligence to the direct inquiry. I don't begrudge and thank
you again. Options come with consequences always, you offered opinion
and expertise for both.

You are a text book case (worthy of an advertisting campaign, or at
least a testimonial) for how Google Answers really works. (Might help
them combat the stupid commercials being put out by "ask.com" right
now.) Tools that make people communicate and share expertise is what
it means to be evolved. I digress. You rock. Please send me a list of
other things you're expert in. Your research is a blessing. Many
thanks.

2. Onenonblonde:
Thank you for your well wishing to the patient and hummer. 
I hope you understood that people whose liver's are trying to kill
them with cancer brought on from an unrealted situation, but other
than that they are healthy, can be left out of the "my liver failed
please help me up" category; and the injustice or pointlessness that
the one facing the fuzzy end of the lollipop can feel in that
circumstance can go through. I know a lot of livers all over the world
some better at darts than others and just thank you for your
observations and well wishes.

Pradeep1965 -
I am greatful for the followup after the fact and besides thanking the
"immediate responders" of hummer and onenonblonde, your response has
validated that I needed to come back and clarify things for this post.

I challenge you to qualify your comments about Liver Translplant in India.

I just want to be clear on what I found out (on my own and with
Hummer's assistance) in case anyone searching a similar transplant
finds their way here. From what I have found out is that of all the
places outside of the US, India is not in TOP 3 Globally and in fact
may still have many questions about the competency of India to provide
for people of its own nation much less those from foreign lands. If
you have any information to the contrary, I invite you to add it to
the resource this may be for patients seeking this kind of treatment
as of March 28, 2006.

Additonally, so that my above comments not be unclear about US vs.
Non-US transplants and if someone is seeking outside the US boundaries
as per necessity...I will offer the following:

1. There is a very large moral dilemma in accepting organ transplants.
2. If you have the necessity for an organ transplant that has a good
to high likelihood of success there are other moral dilemmas to face.
Which is availability of willing donors. Medically speaking, there is
the ability to transfer a healthy liver to a healthy donor with great
success.
3. The reality of transplant is that there is a scarcity of donors for
many reasons, none of which or some of which may or may not matter to
the person when faced with certain death as a result of not receiving
a transplant.
4. No one can be judged immoral by researching all their available
options when faced with their own mortality or the mortality of those
they care for or are assigned to give the best available information
to.
5. Google Answers, has proven one of the best options to gain valuable
intelligence on all levels.
6. For full information disclosure if have heard of in my process:
China, India, Taiwan (via China), Canary Islands as possible resources
for liver transplants. Europe has very tight "regulatory" controls on
transplants to ensure a supply for EU citizens or native EU country
citizens first. Asian countries have a more "liberal" or "lax" or
"immoral" position. I do not judge here, only comment.
7. Before things become unclear. I don't support exploitation. I just
want the best alternatives to be communicated clearly.
8. My next step is to advocate global awareness of organ donor
advocacy and participation.

Many thanks to you all.
NAMASTE.

Dear Namaste,

Thank you so much for the good news, and I'm so glad that your friend
is at the Mayo - that is terrific!  You know, it is so seldom that I
hear about outcomes to questions that I have worked on, that I really
appreciate it when I do.  I can't help but think about the family who
gave such a wonderful gift to your friend, I hope that it has brought
them some comfort.

I'm touched by your evident enthusiasm with my research, I am looking
forward to answering my 1000th question (currently 994) but can't
believe I've done so many. I've "met" many interesting people along
the way and feel fortunate to have participated in this little GA
experiment.  By the way, it is possible to view any researcher's past
questions by typing their id (e.g., hummer-ga) into GA's search field.

You asked about my research expertise (probably more interests than
expertise), here are some off of the top of my head.

Immigration
Nature/wildflowers/birds, particularly Hummingbirds
Canada
Books
Shipping/postage/packaging
Finding options to help people make informed decisions
MS Word/Excel (not an expert but I enjoy finding solutions)

Please give your friend a big hummer-hug when he's up to it, tell him
I'm rooting for him.

Take care,
hummer

adamhicks,

I just checked back to see if there were any updates to your question
and I am thrilled to find that your friend has received a liver and is
on the road to recovery without having to change programs.

When Friend is feeling like it, I hope you two will check out that
liver and see if it can play darts! ;)

ONB