National Transplant Nurses Day

As transplantation science advances, nurses trained in this specialty continue to be in great demand. Single and multi-organ transplants are becoming more common yet there is still a great need for donors. Nurses Announcements Archive

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Specializes in Nephrology, Cardiology, ER, ICU.

End-stage organ failure can take many roads: heart failure leading to need for a heart transplant, renal failure with the goal of transplant, cirrhosis and liver failure, diabetes and pancreas transplant, cystic fibrosis and lung transplants. Transplant nurses are at the forefront of care for these often very complex patients and they too have different roles:

  • Pre-transplant care of the patient preparing for transplant: coordinating testing, education regarding wait lists, continued optimization of health and emotional support.
  • In-patient nurses care for patients who are actively having transplant surgery or are too ill to be in the community.
  • Post-transplant nurses care for the patient after transplant with education, monitoring of immunosuppressant levels as well as coordinating care.
  • Many other nurses come into contact with transplant patients while they undergo care unrelated to transplant

Heart Transplants

End-stage heart failure is the main reason patients need a heart transplant. Patients who are awaiting a heart transplant often must stay in the hospital for prolonged periods of time while waiting for an organ. Heart transplants are decided on the basis of need. Patients often require an intra-aortic balloon pump (IABP) or ventricular assist device (VAD) as a bridge to transplant. Heart failure cases have increased dramatically from 5.7 million (2009-2012) to 6.5 million (2011-2014) cases in the US for people over the age of 20. Nurses that care for patients who are admitted to the hospital while awaiting transplant often care for them for weeks or months.

At Debakey Heart and Vascular Center at Houston Methodist Hospital, nurses have developed a program to assist patients while they wait. For instance, everyone knows how sleep deprivation can affect patients. So, lab draws are scheduled at 8 am instead of 4 or 5, interruptions are kept to a minimum during the night by using video cameras on the patients, and vitals are monitored remotely. Ambulating patients with IABPs isn’t possible when placed in the usual femoral approach. However, by placing axillary aortic balloon pumps (PAxIABPs), patients can be more mobile and even ambulate in the hallways with assistance and monitoring.

Kidney Transplants

End-stage renal disease (ESRD) can occur from many causes including genetic, congenital or acquired illness. In the US, the leading causes of ESRD are diabetes and hypertension. Many patients with ESRD end up on dialysis while awaiting transplant. Wait lists for kidneys can be just a few days to several years. Living donor transplants statistically have a longer life then deceased donors. Living donors undergo rigorous testing to ensure that both kidneys are very healthy and donation. If the donor develops ESRD they are then considered immediately for transplant. Again the care of transplant nurses is very important in renal transplants for many of the above-mentioned reasons.

Multi-Organ Transplants

Sometimes, an illness causes multi-organ failure or it multi-organ failure can result due to a slippery slope of illness that affects one organ which in turn stresses another and causes failure. According to the United Network for Organ Sharing (UNOS), “the number of multi-organ transplants (MOT), excluding kidney/pancreas and heart/lung, has nearly doubled in the past six years from 625 procedures in 2012 to 1,035 in 2017.”

The Future

The American Society of Transplantation paints a bright future for organ transplants. “Solid organ transplantation is one of the miracles of modern medicine: it saves lives and improves the quality of patients' lives. The future of transplantation is full of exciting possibilities. New options include vascularized composite allograft (such as face or hand) transplants, protocols permitted the successful minimization or even discontinuation of immunosuppressive medications, and the use of stem cells for organ regeneration.”

More nurses will need to be educated in the care of transplant patients. Many of these patients are already in the community, either awaiting an organ or having received one. Care of these patients can be very complex and will require a multi-disciplinary approach for successful outcomes.

allnurses.com thanks all the nurses that care for transplant patients on National Transplant Nurses Day.

References

American Kidney Fund: Transplant Central
American Society of Transplantation Nurses Develop Protocols for Patients with PAxIABPs

United Network for Organ Sharing

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