By Laurie Shore, MSW, L C SW

In 2005 there were 16,476 kidney transplants completed nationally. For patients with end-stage renal disease (ESRD), kidney transplant is a treatment option that is an alternative to hemodialysis and peritoneal dialysis. In kidney transplantation, a doctor surgically places a healthy kidney from another person into your body. The kidney may come from a living or deceased donor. Although transplant is not a cure, it provides the ability to resume a lifestyle without the constraints of dialysis. The transplant process can be overwhelming and frightening, but it is a process that you can manage once you understand your responsibilities. It is imperative that you are educated and informed as you proceed. It takes a team effort to make sure you are physically and emotionally prepared for this life altering experience. It is important to feel comfortable with the team so you can address all your concerns as they arise. You are the number one member of the team and together you can work towards the best possible outcome. While all members of the transplant team participate in determining if you’re a candidate for transplant, each member has a specialized role. Keep in mind, team members may differ in each center. In this article you will meet members of the transplant team and learn the role of each.

You:

Each member of the transplant team is highly skilled and wants the best outcome for you, the patient. But the most important member of any transplant team is you. Each member of the transplant team will respond to your actions. You know your body best. You must be your body’s advocate. Try to avoid skipping doctor visits. Eat right and exercise. Take your medications as they are prescribed and tell your healthcare team about any health changes you experience.

Transplant Surgeon:

The transplant surgeon communicates with the team to determine if you are a candidate. He will perform the transplant surgery and monitor you after the surgery for any complications such as infection or rejection. The surgeon will also work with the transplant team to make sure test results and adjustments to medications are proper.

Transplant Physician (Nephrologist):

As a kidney disease patient, you see your nephrologist on a regular basis in the doctor’s office or dialysis center. Transplant centers also have nephrologists as part of their team. Your transplant nephrologist works with you before and after the transplant. He is responsible for monitoring your kidney function along with other medical concerns. Depending on the transplant program, you may be required to meet with their transplant nephrologist for a period of time before you are released to your own nephrologist. It will be necessary to continue to see your regular nephrologist years after the transplant.

Transplant Coordinator:

The transplant coordinator has an enormous role. This person usually is a registered nurse and works closely with you before the surgery. This person is responsible for overseeing the entire organ transplant process. This may include:

• Scheduling pre-transplant testing which involves determining where your testing is approved.

• Coordinating with you and your dialysis unit to be sure your testing is complete.

• Evaluating the medical status of any potential living donors.

• Consulting with surgeons, physicians and dialysis center and hospital staff on a regular basis.

• Contacting you with instructions when an organ becomes available.

Social Worker:

Every transplant recipient is assigned to a social worker who will complete an assessment to ensure your needs are met prior to the transplant. The social worker role may have some variation at each center. Social work services will not only be available to you, the patient, but also your family and to the donor. The social worker provides support, education and counseling to reduce stress during the transplant process. Social workers usually have extensive knowledge of the community services provided to transplant recipients. The transplant social worker is highly skilled at assisting patients and their families with adjusting to life as a chronic disease patient. The social worker also acts as a sounding-board so you and your family can feel comfortable having open discussions with him. The social worker may also be able to advise on Medicare, Medicaid and other insurance related issues.

Psychologist/Psychiatrist:

In addition to your social worker, many transplant centers have a psychologist or psychiatrist to assist in coping with the transplant experience and the changes it will make in your life. This person will perform psychological evaluations and participate on the interdisciplinary treatment team.

Pharmacist:

Your pharmacist is a valuable member of your healthcare team with a wealth of information about the medicines you take. The basic duties of a pharmacist are to inform patients how to correctly use the medications. As a transplant recipient, you will get to know your pharmacist very well. In order to keep your kidney functioning properly, you will have to take prescription drugs for the rest of your life. Pharmacists are experts in medicine and its side effects and are able to assist with your medication concerns.

Dietitian:

The dietitian may complete a nutritional assessment on you. He will help you develop an eating plan that provides a balanced diet and appropriate calories. The goal is to create a practical plan that fits your lifestyle and helps you live a healthy life.

Transplant Financial Coordinator:

The transplant financial coordinator will help you understand the cost of transplantation, what you are expected to pay and what insurance will or will not pay. Many people will have to draw funds from their savings and investments. The financial coordinator will address any federal or private assistance available in your area as well as other financial options available.

The Transplant Team:

Vincent Lombardi, the famous Green Bay Packers football coach, once said, “Individual commitment to a group effort - that is what makes a team work.” This is also true in transplantation. You, along with your team, are all committed to a common goal-- to improve quality of care and quality of life. Your active participation on the team is key for a positive outcome of your kidney transplantation.

References:

1. Before Surgery, A Patient’s Guide to Kidney

Transplant Surgery

UCS Kidney Transplant Program

http://www.kidneytransplant.org/patientguide/index.html

2. Role of the transplant financial coordinator and its effect on recipient compliance.

Transplant Proc. 1999 Jun; 31(4A):55S-56S.

PMID: 10372049 [PubMed - indexed for MEDLINE]

3. Transplant Living

UNOS

http://www.unos.org/

Laurie Shore, MSW, LCSW, is a pre-transplant social worker for LifeLink HealthCare Institute in Tampa, Fla. She is President of the AAKP Tampa Bay Chapter, and an AAKP National Board Member.

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