Post Transplant Flying

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IF they ever get the 3rd class issue cleared, this should be a moot point. Here goes anyway: If a person were to have a splenectomy and a liver transplant (due to collapsed portal vein), would it be reasonable to resume GA flying after the transplant team approves it?

I currently am not flying even as a passenger. I have obviously self grounded due to hepatic encephalopathy. I am super cautious even driving to the mailbox, and when I don't feel right, it is a no go. I offer the info above to demonstrate the level of caution I am at/willing to go to in order to protect family, friends and the public.

Thanks,

The Anonymous Grounded One.
 
Yes, transplant surgery itself is not insurmountable, although that may not carry over to the underlying disease. Bruce Chien would be a good resource to run your exact case by.
 
I know Dr. C. is a busy guy, but I am in no rush, so I will wait and see. Been on the transplant list for 5 months and no donor will cooperate (sad joke).

Had a couple of pretty good deals lined up until this hit me. Now its just time for saving more cash. Better to pay cash if I can, and I know there are quite a few $50,000.00 fly away planes out there.

Thanks to the respondents. I appreciate it.

Red Board? Was ist?

Same grounded guy who asked first.
 
Unregistered said:
I know Dr. C. is a busy guy, but I am in no rush, so I will wait and see. Been on the transplant list for 5 months and no donor will cooperate (sad joke).

Had a couple of pretty good deals lined up until this hit me. Now its just time for saving more cash. Better to pay cash if I can, and I know there are quite a few $50,000.00 fly away planes out there.

Thanks to the respondents. I appreciate it.

Red Board? Was ist?

Same grounded guy who asked first.
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The AOPA board. You have to be a member to access it. I was once, but am not any more. I left shortly after the "Anthony's Bicycle Scandal."

It seems caustic to extend my wishes that you get a liver soon in view of what has to happen for you to get one; but people die every day, so let's just hope that one who has signed an organ donor card will be a good match for you.

Rich
 
Bad deal, good luck. Must suck waiting for a biker to die.

Now for the good news. We are on the fore front of the most amazing technology I've seen in a lifetime of amazing technology. We can take any cell of your body and reprogram it to be a copy of an embryonic stem cell. A cell that can make any cell in your body. Once this technology is mature your doctor will be able to take a skin cell or anything else, have it reprogrammed and differentiated into hepatocytic cells. Marry that to the advancements in materials science and we'll grow you a new liver that's immunocompatible with your body.

This will happen. We're not there yet, right now you get to wait for a motorcycle to crash. But it will.
 
Unregistered said:
IF they ever get the 3rd class issue cleared, this should be a moot point. Here goes anyway: If a person were to have a splenectomy and a liver transplant (due to collapsed portal vein), would it be reasonable to resume GA flying after the transplant team approves it?

I currently am not flying even as a passenger. I have obviously self grounded due to hepatic encephalopathy. I am super cautious even driving to the mailbox, and when I don't feel right, it is a no go. I offer the info above to demonstrate the level of caution I am at/willing to go to in order to protect family, friends and the public.

Thanks,

The Anonymous Grounded One.
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Being in a holding pattern anyway, I'd recommend calling your region's Flight Surgeon's office and having a conversation with them. Most guys consider the FAA the "enemy" and are reluctant to contact them. Personally I don't classify them as the enemy, just the authority, so understanding their position has been helpful. They aren't out to get you as many would have you believe. At least that's been my experience through the years. When it comes time to get your status back you might look to AOPA's Pilot Protection Services for assistance. They helped me navigate the process when it was time to submit for my SI. I appreciated the validation that I had a good case and a very small potential for a denial, which was the single most important detail to me.

Good luck with your health and your pilot status.
 
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A couple of points:

1. I personally do not WANT anyone to die on my behalf. I guess I have it a little better than many, living in a "no helmet" state. Prime organ donor country. What I don't quite get is the MELD (Model for End Stage Liver Disease) number, which is a major decision point when it comes to recipient selection along with the standard match criteria. In my locale, a number like 35 gets things hopping. But I am told that in TN (for example), hospitals treat a number in the 20s similarly. I bounce around between 25 and 35, but for the most part, just sit and wait. Boring as hell!!! And all the technology advances are great, but they are certainly down the road.

2. As regards the FAA, I don't necessarily think they are the enemy. A well funded and focused adversary? Yes they are. Can they stop you from flying? Yes they can. Can they intimidate you into doing things that you don't think that need to be done? Yes they can. Can they be petty and overzealous Yes they can. Sometimes you can wave your license at them; then they break out the people and money that most of us can't compete with. At a minimum, it takes time. When I went for an SI (was issued), it took 7 months. That left 17 months to fly legally, and less, knowing that I would have to start the process again before expiration. (I have heard the AME can now speed that up so there is a little progress.)

When my medical expired, I did some Sport Flying, but finding those planes are not easy. And since I went on this list, I have self grounded. No desire to be a headline.

In any case, thanks for the words of wisdom, advice and guidance.

Original Self Grounded Anonymous.
 
Unregistered said:
A couple of points:

1. I personally do not WANT anyone to die on my behalf. I guess I have it a little better than many, living in a "no helmet" state. Prime organ donor country. What I don't quite get is the MELD (Model for End Stage Liver Disease) number, which is a major decision point when it comes to recipient selection along with the standard match criteria. In my locale, a number like 35 gets things hopping. But I am told that in TN (for example), hospitals treat a number in the 20s similarly. I bounce around between 25 and 35, but for the most part, just sit and wait. Boring as hell!!! And all the technology advances are great, but they are certainly down the road.

2. As regards the FAA, I don't necessarily think they are the enemy. A well funded and focused adversary? Yes they are. Can they stop you from flying? Yes they can. Can they intimidate you into doing things that you don't think that need to be done? Yes they can. Can they be petty and overzealous Yes they can. Sometimes you can wave your license at them; then they break out the people and money that most of us can't compete with. At a minimum, it takes time. When I went for an SI (was issued), it took 7 months. That left 17 months to fly legally, and less, knowing that I would have to start the process again before expiration. (I have heard the AME can now speed that up so there is a little progress.)

When my medical expired, I did some Sport Flying, but finding those planes are not easy. And since I went on this list, I have self grounded. No desire to be a headline.

In any case, thanks for the words of wisdom, advice and guidance.

Original Self Grounded Anonymous.
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Really and truly, that are not your adversary if you don't make them one. I just went through a post accident 709 ride with the Feds and they went above and beyond in getting everything squared away. I can't figure where they could have been more helpful in the process. They will be for you the resource you make them.
 
Stewartb said:
Being in a holding pattern anyway, I'd recommend calling your region's Flight Surgeon's office and having a conversation with them.
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No, no, no, no, no.

Let your AME talk with them, AFTER your current medical expires so they have no jurisdiction. At this level, they will demand to know your name and if you have a current medical you will lose it - which means now you've lost your medical and you're ineligible even for a driver's license medical for sport or hopefully under PBR-II. You'd have to jump through all their hoops and reestablish your medical eligibility to their standard, not yours.

If you're already dead they can't shoot you. If you're still alive, expect to be executed.

The reason people treat the FAA like the enemy is because sometimes they act like it. They do things that have very negative impacts on pilots and it's tedious, co$tly and time consuming to overcome them. Ask me about my 2 echo-cardio grams and a stress test over a genetic condition I've had all my life.

Sometimes those things are necessary, but they're not always.
 
bflynn said:
No, no, no, no, no.

Let your AME talk with them, AFTER your current medical expires so they have no jurisdiction. At this level, they will demand to know your name and if you have a current medical you will lose it - which means now you've lost your medical and you're ineligible even for a driver's license medical for sport or hopefully under PBR-II. You'd have to jump through all their hoops and reestablish your medical eligibility to their standard, not yours.

If you're already dead they can't shoot you. If you're still alive, expect to be executed.

The reason people treat the FAA like the enemy is because sometimes they act like it. They do things that have very negative impacts on pilots and it's tedious, co$tly and time consuming to overcome them. Ask me about my 2 echo-cardio grams and a stress test over a genetic condition I've had all my life.

Sometimes those things are necessary, but they're not always.
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We'll have to agree to disagree. When I got my cardiac-related SI I did so mid term in a two year 3rd class and never involved my AME. I jumped into the process with both eyes open and armed with a good understanding of the rules and it worked out perfectly. My advice does not come from some imaginary perspective, it's a pirep.
 
bflynn said:
No, no, no, no, no.

Let your AME talk with them, AFTER your current medical expires so they have no jurisdiction. At this level, they will demand to know your name and if you have a current medical you will lose it - which means now you've lost your medical and you're ineligible even for a driver's license medical for sport or hopefully under PBR-II. You'd have to jump through all their hoops and reestablish your medical eligibility to their standard, not yours.

If you're already dead they can't shoot you. If you're still alive, expect to be executed.

The reason people treat the FAA like the enemy is because sometimes they act like it. They do things that have very negative impacts on pilots and it's tedious, co$tly and time consuming to overcome them. Ask me about my 2 echo-cardio grams and a stress test over a genetic condition I've had all my life.

Sometimes those things are necessary, but they're not always.
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If you make them your adversary, they will be your adversary, if you ask them to advocate, and then cooperate, then they will help you out. No different from most relationships. We create our own reality with our thoughts and acts.
 
Unregistered said:
A couple of points:

1. I personally do not WANT anyone to die on my behalf. I guess I have it a little better than many, living in a "no helmet" state. Prime organ donor country.
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Didn't mean to imply that you did. But fact of the matter is that is the most likely source of your transplant. My sister perished from ALS, but donated on her way out. Very unusual to get such good tissue from someone as young as her, as least that's what the transplant folks said.
 
Steingar,

Just so you understand, my condition has caused so much damage to organ that the only way is a full organ replacement. At one point they investigated the partial with hoped for regeneration, but the portal vein issue negated that.

Kinda like Marvel Mystery Oil in an engine with plugged oil passages. Not a good choice only made worse by the circumstances.

But thanks again for the wisdom. And blessings upon your sister for her acts of life saving kindness.

Original Poster. Grounded for a while.....
 
Unregistered said:
Steingar,

Just so you understand, my condition has caused so much damage to organ that the only way is a full organ replacement. At one point they investigated the partial with hoped for regeneration, but the portal vein issue negated that.

Kinda like Marvel Mystery Oil in an engine with plugged oil passages. Not a good choice only made worse by the circumstances.

But thanks again for the wisdom. And blessings upon your sister for her acts of life saving kindness.

Original Poster. Grounded for a while.....
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I understand completely. I meant what I said, the wait itself is a horrible thing and it is a horrible thing that you're waiting for. I look forward to the day when our embryological wisdom matures to the point where your wait will be for a replacement organ grown for you.
 
Stewartb said:
We'll have to agree to disagree. When I got my cardiac-related SI I did so mid term in a two year 3rd class and never involved my AME. I jumped into the process with both eyes open and armed with a good understanding of the rules and it worked out perfectly. My advice does not come from some imaginary perspective, it's a pirep.
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Mine is a pirep too. You had a good outcome, that's a bit like saying "well it's 0/0 and RVR 300, but we got down. You should try". Not everyone will be successful and those that aren't pay a high price.

I'm not advocating hiding anything. The OP is self-grounded, which is the proper thing to do. Waiting until his medical expires is self-protection in order to preserve the sport option. If you want your medical back, you're going to have to jump through their hoops anyway. But if you talk to them now and they pull it (and they will pull it), then you only have the option to fully restore your current medical before you can fly anything.

That isn't adversarial, that is approaching the rules from the most advantageous standpoint.

I advocate an AME just because they are better equipped to negotiate the return to medical status if you choose to go that route, they have the contacts and they will spend time on your behalf. Without them, it is also very easy to miss something little and have it mean that you're taking a step backward or even starting over, waiting weeks between steps.

Dr. Chien's advice to me still holds - get your stuff in order, then approach the FAA. If you come at them asking "How does this look for certification?", it's a very different conversation than "here's my problem what do I do". But you're not necessarily equipped to have that first conversation on the topic of a transplant...heck, your AME will probably struggle with it.
 
Unregistered said:
A couple of points:

1. I personally do not WANT anyone to die on my behalf. I guess I have it a little better than many, living in a "no helmet" state. Prime organ donor country. What I don't quite get is the MELD (Model for End Stage Liver Disease) number, which is a major decision point when it comes to recipient selection along with the standard match criteria. In my locale, a number like 35 gets things hopping. But I am told that in TN (for example), hospitals treat a number in the 20s similarly. I bounce around between 25 and 35, but for the most part, just sit and wait. Boring as hell!!! And all the technology advances are great, but they are certainly down the road.
Original Self Grounded Anonymous.
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Regarding the MELD score and your observations...

Transplants, while overseen by UNOS, are still a local/regional affair. Each OPO and transplant team/program have some variability in their listing criteria. Likewise, the number of patients listed combined with the average donor "throughput" establish the relative priority/wait time. Time and distance are considerations. For example, Hawaii is a closed system, due to the time/travel constraints. Anything donated in the islands typically stays in the islands, at least with heart, lung and liver. Kidneys can handle a bit longer ischemic time.

With liver, its not time on the list, its acuity. I've seen acute tylenol overdoses from suicide attempts go into fulminant hepatic failure, then get listed and get transplanted within the week (or not transplanted and die in short order). Likewise, folks can hang out on the list for years waiting to get sick enough for transplant, or waiting for a directed donation or living donation.

I work and play on the gulf coast. We have entire suburbs of people who put a bottle to their head and pull the trigger, or have hep C, or both... Its quite tragic, but if they get 6 mos of sobriety (an arbitrary time limit but useful threshold, as sobriety is a strong indicator of post transplant success) they can be listed, but the list is a long one even with a couple programs in town. Living in an area with less of that population makes for a shorter list.

People with money, who can travel at the drop of a hat, who find themselves in such a predicament, will attempt to get listed in several different areas, or move to the one that works with the lower MELD scores to expedite a potential transplant.
 
Doggtyred said:
I've seen acute tylenol overdoses from suicide attempts go into fulminant hepatic failure, then get listed and get transplanted within the week (or not transplanted and die in short order).
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How does the system allow this?

Good luck to the OP.
 
Everskyward said:
How does the system allow this?

Good luck to the OP.
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The specifics on this issue aren't privy to me. In this case it was the estranged husband of an old high school classmate who was suicidal over his wife leaving him. Perhaps it was his only attempt, and not a repetitive pattern of behavior. I answered my classmates questions and didn't pry.

Believe it or not, the science shows that addicts (drunks and drug addicts) who can remain sober are usually good candidates, and typically do better in post transplant care than folks with other pathology failing their liver. I sat through a two day CE seminar on this very issue a few months ago. But I would not be able to look a mother in the eye and tell her that her dead son, who was killed by a drunk driver, would be giving his liver to a former alcoholic with end stage alcoholic cirrhosis.

That being said.
I have made a personal choice not to work in transplant medicine because some of the things I have been PERSONALLY privy to over the years in various roles in ICU and interventional cardiology as a nurse... I would have a hard time accepting some of the things I saw and putting my name to it facilitating it... Given it would be my professional duty to treat without regard to my prejudices, I don't put myself in that position.

For instance.. I've cared for:

A person over age 60 who had a preoperative complication during their THIRD heart transplant and had an anoxic injury.... (and people waiting for their first....)

The night that there were two lungs and a heart available, and only two transplant teams, and at some point after it was too late to offer the heart to someone else and have their transplant team come in..... the two lungs were split to two separate single lung recipients instead of a single recipient of a double lung. There wasn't a third surgical team for the heart. It went to waste. Sadly, had the neighboring transplant team from a few miles away been aware, they could have had their patient in-house and ready. The at fault program got probation.

Then there's the way that some transplant surgeons fudge the acuity numbers or set the donor parameters for potential offers way outside the range of appropriate to increase potential offers (which would then be declined in most cases...) ... or depending on the organ, list early in disease in order to maximize calendar time and put folks at the top of the list on those that was primarily calendar-priority rather than acuity-priority lists

Then there was the long ago story of Jesica Santillan (http://en.wikipedia.org/wiki/Jesica_Santillan).. in which i have no personal firsthand knowledge. Organs are rare, and we are giving them to foreigners when we don't have enough for our own citizens... never mind the MIND BOGGLING foul up that brought her situation into the public eye in the first place (type incompatible transplant resulting in hyper acute rejection)... people were dusting off old textbooks to figure their way out of that one, such a thing having not happened for decades...
 
Everskyward said:
How does the system allow this?

Good luck to the OP.
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Same way we will do heroic surgery on a prisoner slated for execution, sheer stupidity and an irrational fear of death to the point we believe we can deny it. Why we try to save suicides is really beyond me, why it's illegal, doubly so.
 
A note to say I am still among the living. No donor/no transplant. The wait continues. When my LTD (Long Term Disability) benefits run out, I am going to have to go back to work. I can only imagine the fun that will be - somehow going to job sites and testing things. But personally I would rather check out (of the big game) doing something productive instead of sitting around waiting to die.

OP
Still Grounded Until Further Notice.
 
Not much to add on getting around the medical hurdles, but I got my license changed over recently and finally decided to get that little heart added to it. I wish you the best of luck.

lego.png
 
Thank you for checking that box. Please make your wishes known to family/NOK as well.

Hopefully your thoughtfulness will give life to one who will be grateful for the chance to carry on.
 
Sad thing is how many viable organs, even with all the paperwork squared away, get wasted. Happened when my friend's son died after a head injury, something legal to do with pulling the plug. All they could take was skin and corneas. Saddest thing was he should have never been put on the machine after the skull cap was removed and the Dr realized the brain was mush. Then they made her order the plug pulled.:mad2: I ate the Dr's ass for that.
 
1 August 2015. Still alive, still no transplant. MELD number still hanging at 25. I wuls like to just shove it aside and live what I have left. No AME ever caught it (even when I didn't know it was a problem.) Go off of warfarin and back to xarelto - no number to maintain. Will continue to take lactulose so I don't get symptoms of hepatic encephalophy (even though the side effect means I can't be far from a loo) and the other stuff that keeps things on an even keel.

No plans to try for the left seat (FW) or right seat (RW). Might get SES endorsement or something. I have the $$$, but need to read the rules to be sure if it is allowed.

OP
Still Fighting, but getting tired of the wait.

PS - I don't know if my earlier attempt went into moderator limbo or if I failed to enter correctly. If so, I apologize for similar posts
 
Yep, being on the transplant list can be a bumpy ride. My son was called in and admitted one time but the kidney turned out not to have survived the recovery/transport. Had to go home after getting close. Fortunately a few months later he got his double (kidney/pancreas) transplant.
 
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