Solid Organ Transplantation

Wow, it has been almost 15 weeks since I last posted.  I’ve been caught up with my Acute Care Rotations at the University of Minnesota Medical Center – Fairview; it’s been an amazing experience, and I have learned so much!

Let me tell you about one of my 5 week experiences.  I’ll have to post later on the other two… 

Block 7: Solid Organ Transplant
During this rotation I followed patients who were admitted for a kidney, liver, pancreas, or simultaneous kidney-pancreas transplant.  Some patients I followed post-operatively, as they were admitted after a deceased-donor was identified and immediately went into surgery upon arrival to the hospital.  Other patients were admitted a day or two before their planned kidney transplant from a living-donor, either a related-donor or a living-unrelated-undirected kidney.  It always was amazing to think of how selfless and generous a person was to donate a kidney, either to somebody they know OR somebody they don’t know!  Most kidney transplant recipients have been on dialysis for YEARS, so getting a kidney gives them back some freedom and time, as they hopefully won’t need to go for thrice weekly dialysis runs for 4-6 hours. 

A typical day consisted of getting to Unit 7A around 7am, and looking at my patients, collecting lab values and reading progress notes – basically combing through their chart to find any concerns I may have about their medication therapy that I can bring up with the team during daily rounds.  Rounds are organized by the transplanted organ: kidney, pancreas, and liver.  The pancreas team usually covers the simultaneous kidney-pancreas transplant patients.  The team consists of a midlevel provider (Nurse Practitioner, NP, or Physicians Assistant, PA), the Pharmacist, Social Worker, Nurse, Dietician, and the Attending Physician.  Outside of every patient’s room, the team discusses progress the patient is making, plans for the day, and addresses concerns with lab values or medications.  Then the Attending physician, midlevel provider, and nurse enter the room and assess the patient.  After assessing the patient, they leave the room and again huddle around in a circle outside the patient’s room and talk about how the patient is doing and what the plan is; and if I had a concern, this is when I’d bring it up!  Other healthcare providers were always nice and receptive to my suggestions or concerns, and if I was wrong to be concerned about something – they’d take the time to teach me why! 🙂

I learned alot about the managment of patients pre and post transplant, including monitoring improving renal, pancreas and kidney function following transplant, following protocols for inducing immunosuppression, monitoring and modifying immunosuppression regimens according to drug levels, and evaluating the patient on an individualized basis.

This was my first acute care rotation, so it was a STEEP learning curve.  All the drugs that are used frequently on an outpatient side I was pretty familiar with, but IVIG? mycophenolate? sirolimus?  Woah, I had to refresh my memory quite a bit.

One of the coolest things about this rotation was seeing how grateful the patient’s were for receiving a transplant.  I had conversations with new admits when reviewing their Prior-To-Admit medication lists, and some expressed to me their feelings when they received the call about an organ being ready for them.  Some people cried for joy, some were sad, knowing a person had died in order for them to get an organ, some described it as “the best call they had ever recieved.” 

My sister works as a nurse on the transplant floor, and I now have a deeper understanding of how difficult but rewarding her job is.

Thanks for reading! – Heather
Stay tuned for my next post, describing my experience in the Cardivascular ICU…

FYI:
Graduation Countdown: 15 days!!!!
Wedding Count Down: 44 days! 🙂

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