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View Diary: Update: "That is when the Transplant Coordinator Nurse told me that they are Republicans." (143 comments)

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  •  Without reference to the current situation (0+ / 0-)

    Caveats:
    I am not commenting in any way on the current situation.
    I am not the patient's doctor.
    I do not have sufficient information to be able to offer even a glimpse of an opinion.

    What does someone's mental state have to do with whether or not they need a kidney?
    It doesn't have anything to do with whether or not they NEED a kidney. It has everything to do with whether or not they will currently be put on a transplant list.

    We have a huge shortage of transplantable organs in this country. Huge. Demand far exceeds supply. [PSA: Please fill out your donor card AND let your loved ones know that you've done so.]

    Therefore, we have to prioritize in some way. Transplants involve the need for conscientious medical follow up. The medication regimens require to prevent transplant rejection are frequently fairly exacting. Current uncontrolled psychiatric diagnoses are considered as reasons to exclude someone from being put on the list. This is a decision we have made as a consensus medical/societal opinion. History of such a diagnosis, or current diagnosis considered in remission or well-controlled are NOT contraindications.

    Transfolk are more likely to have depression (including major depressive disorder) and anxiety (including seriously debilitating disease) when compared to their cis counterparts. My personal belief is that this is largely (if not fully) explained by the situational factors that complicate the lives of transfolk. Situational pressures can turn a milder form of psychiatric disorder into a more serious one. (Compare a trans and a cis who have dysthmia, the blahs if you will. The transperson is more likely to experience craptastic treatment than the cisperson is. Social/work situations can drive someone from a bit of the blues to a deep melancholy. The transperson is more likely to experience that stressor, on average.) Note well, I'm not a psychiatrist, and I have no idea whether or not there is a credible current competing theory as to why the incidence of depression and anxiety are higher in transfolk.

    Doing a thorough psychiatric assessment is straightforwardly standard of care before putting someone on a transplant list. Zero transplant centers would list someone without doing this. If sie were MY patient, I'm pretty sure I'd ask for a psychiatric consult. (Some transplant centers REQUIRE it, full stop.) This isn't because sie is trans. It's because sie is about to be put on the transplant list. (I'm currently mostly a geriatrician, taking care of older patients. It's been years since I've tried to get anyone on a transplant list, since 60 tends to be an age cutoff. When I was seeing younger patients in a primary care setting, any of my patients who were possible transplant candidates ALWAYS got psychiatric consults...either from my order or that of the transplant center.)

    As I said earlier. I'm not addressing the current case at all. I am loathe to ever comment on cases that aren't my patients because 1) I'm not sure that the information is accurate and complete; 2) I consider it to be unethical to give medical advice to people who aren't under my care. But a psychiatric evaluation is standard here, and not discriminatory. (They might have ALSO been discriminatory, which wouldn't be remotely shocking, but a psych eval is not evidence for discrimination.)

    The plural of anecdote is not data.

    by Skipbidder on Mon Nov 11, 2013 at 03:08:48 PM PST

    [ Parent ]

    •  On further review... (0+ / 0-)

      Reading the comments, especially by Horace Boothroyd III, it looks like the belief is that the psychiatric assessment was already done.

      If that is the case, then my comment is largely moot.

      The plural of anecdote is not data.

      by Skipbidder on Mon Nov 11, 2013 at 03:21:13 PM PST

      [ Parent ]

    •  Mika says sie in NOT transgender!!! (0+ / 0-)

      I don't usually do this, but I know some people at UNMC so I did some clicking around and found there is some additional information out there.

      1. UNMC is where hir condition of Cystinosis was first diagnosed. This is when other testing centers were baffled by her early condition. They saved hir life.
      2. Mika received a referral to an NIH study that enabled hir to have an experimental treatment that certainly extended hir life as hir original prognosis was only for 6 years. This was because of staff at UNMC. This was still as a child before any gender identification changes.
      3.UNMC accepted Mika and did all the workups for Mika for a  cadaver donor and put hir on the appropriate lists. They were concerned about mental health issues and mandated an evaluation and then therapy because of issues (severe depression and others). The evaluation and required follow-up therapy were quite proper as you iterated.
      4. When it became apparent that Mika had found a live donor, there was a bit of an issue because the donor also needed to be evaluated and to undergo some psychotherapy to determine his or her fitness. This seems to be about the time that Mika claims that things changed and there was a slowdown. Mika claims that when sie first told the transplant team sie was genderqueer, there weren't any issues except much confusion and lack of cooperation in using her requested identifiers (sie/hir). Mika reports the problems became real after sie informed the team she worked for anti-bullying issues, LGBT issues and was an Obama supporter and wanted to help his re-election effort which she later did in Iowa.
      5. Even though UNMC had some issues with Mika cooperating with her dialysis team and with her psychotherapy appointments, they scheduled two separate dates for her transplant after her live doner completed his various evaluations and psych sessions. The first date was cancelled after Mika failed to have a Crohn's test and evaluation completed in time for the transplant to go forward. A second date was then scheduled. This one was cancelled when she was taken by ambulence from a dialysis center to an ER because of severe tacachardia. It seems that with the two failed transplant attempts and the other issues the team was worried about, they decided that Mika was not a good patient for their facility (this actually happens more often that you might think in transplant programs).
      6. The good news is that Mika did get a successful transplant this past May at the University of Iowa Medical Center. That center also had concerns with the mental health state of Mika, but her therapy apparently stabilized her to the point that they were able to proceed. She was able to use the same live doner as previously planned. This center seemed to have less confusion about Mika not being transgender but rather being genderqueer and she's seems happier because of it.
      7. Mika continues to take Zoloft for depression which seemed to be an area of concern for both transplant teams.

      I really can't figure out what the whole story is here. In another story, the claim is made that Mika wants UNMC to just come out and tell the whole story. They claim they can't until she signs a HIPAA release. She claims she wants to. They claim they have sent her several. She claims she never got any. Who knows. I think it is just good that she did get a transplant and life goes on. I do believe that the issue here is much more than...

      Me Republican...
      You genderqueer...
      Scram!

      Whether some discrimination had something to do with the issues here, I don't know. It is he says sie says. However, there do certainly seem to be some very valid medical concerns that were raised at UNMC as to whether or not a transplant there would be successful and efficacious.

      •  I've had multiple experiences of being denied (1+ / 0-)
        Recommended by:
        Silina

        Medical care due to being gender queer. I don't doubt any of what she wrote.

        •  I apologize for my profession (1+ / 0-)
          Recommended by:
          Horace Boothroyd III

          I am so sorry that you were denied care, it is completely unprofessional for an educated RN to treat a patient with disrespect. You are worthy of the same treatment, care, and compassion that any human being would expect. I am saddened and disappointed that someone who is in the healing field would discriminate due to race, gender orientation, or ethnicity.  People needing care, are just that, people needing care. It was drilled into me, as a student nurse, back in early 1950s, yes, before civil rights were on "the books" that we, as nurses, were to treat every person under our care with the same compassion, using our knowledge and expertise to be sure that person received optimum care. The same care that we would want our sister, brother, father, mother or any loved one to receive.  

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