Wednesday, September 8, 2010

Transplant Rotation

Hi all,
A few weeks ago I completed my transplant rotation in Tampa, FL. I've been so busy since returning home (currently on my month off), that today is my first real day of being lazy with a very short to-do list. Just wanted to share some of my experiences from my time in Tampa.

Prior to my rotation starting I was excited that I had a transplant rotation in the hopes of getting to see the more clinical side to pharmacy and maybe even seeing a transplant done. But as I soon found out I would not be in the hospital at all, rather at a specialty community pharmacy near Tampa General Hospital, called BioScrip Pharmacy. BioScrip Pharmacy specializes in HIV, transplant, and other complex conditions. This rotation was actually more of an HIV elective in that we saw and counseled so many more HIV patients than any other. It was a good opportunity to see certain medications that I am not as familiar with dispensing.

There were a few days that my preceptor scheduled me to visit the transplant floor at Tampa General Hospital and also LifeLink (located right next to TGH) so that I could see the entire process that a transplant patient goes through in order to receive their new organ. The following is a little of what I learned and sort of a picture that you can see of what all the journey entails...

For a patient requiring a transplant they first come to LifeLink which is where they will have an entire medical assessment of their current health status and will be approved to be placed on the "waiting list". I was able to sit in on one classes for patients who are trying to get on the waiting list. Its was really kind of cool to come into a big room and see all of the faces of the people waiting for an organ with their loved ones (spouses, siblings, children, and friends) and also so sad to witness the desperation in all of their lives. The class lasted all afternoon for several hours and here is a bit of what I learned.

The United Network of Organ Sharing, also known as UNOS, maintains the national waiting list and keeps all the transplant statistics. The first kidney transplant done was in 1954 and was done in twin brothers. Because they were twins there was no need for immunosuppression therapy (medications that help to decrease the immune response your body may have that would reject the newly transplanted organ). There is also a way to test for matching today that is a simple blood test, however back then they tested for a match by doing a skin graft. If the skin graft did not die then they thought that transplanting an organ might be a success.

So for todays transplant patient they will come to LifeLink for a series of blood works to do crossmatching and such and also a full day of assessments that include (but not limited to) getting the patients weight (transplant surgery has a BMI limit of 35), chest x-rays, ECHO, abdominal CT scan, EKG, doppler, pap smear, mammogram, stress test, and colonoscopy depending on patients age. The transplant patient is not allowed to smoke because of the concerns of not being able to come off of the ventilator after the surgery. After this day of assessments are completed the medical review board will assess all of the medical and financial information and will either approve or reject the patient from being put on the transplant waiting list.

Once the patient is on the waiting list, they do just that. Wait. The average wait time is about 1-2 years depending on what organ you are waiting for and what your blood type is. While you are on the wait list you must call your coordinator to inform them when you are going on vacation, have any change in phone number or contact information, when you get sick or have been taking any antibiotics.

Once an organ comes available, the patient gets a random phone call, may even be in the middle of the night, and will rush safely to the hospital. Just because you get the phone call doesn't mean you get the organ. They call about 2 people to come in at once so it is important to ask whether you are the primary or the secondary person when you are called. Once both patients arrive they do another blood test to check the antibodies for matching and also weigh the patient and assess if they have recently been sick, etc. If the primary patient is unable to receive the organ than they will give it to the secondary patient so the organ is not wasted.

Lets talk about kidney transplants. I learned that when they do a kidney transplant they leave your kidney in you. They just put the healthy kidney in and connect all the goods. So kidney transplant patients could be walking around with anywhere from 3 to 5 (or maybe more) kidneys in them depending upon how many transplants they have received. The surgery for a kidney transplant will last about 3 hours and the patient will stay in the hospital for about 5 to 7 days. It is important to monitor for graft rejection in this time and to ensure that the transplant is a success. I spent a day at Tampa General Hospital on the transplant floor and was able to go in and assess the patients and to help monitor them during their stay at the hospital post transplant. This was a pretty cool day.

Then comes the after care. Transplant patients must be on numerous amounts of medications for a very long period of time (some they may take the rest of their lives) to prevent their body from rejecting the organ that was transplanted. These medications also require blood tests to monitor levels, have some pretty terrible side effects, and may cause infections since they are taking immunosuppresant therapy. And when infections occur, this requires more medications to help treat or prevent the infection. See how all this gets real complicating real quick. So then there is me, on my rotation at BioScrip pharmacy, where the transplant patients come in to to get their medications and I will be counseling them on all these regimens. So it was a pretty cool month but sort of just another community/retail pharmacy setting.

Once I got back home from Tampa, we went to Destin for a week and went to the beach and just relaxed. It was so nice. We celebrated Laurens bday while we were there and then when we got home we celebrated Mirandas with a surprise birthday party. I am so thankful for great friends! I have about 3 more weeks until my next rotation starts so I am really being lazy and it feels so good!

One Big Thing I learned is that if you want to be an organ donor then TELL YOUR FAMILY. Just because it may say so on your drivers license, doesn't mean you will be able to. Your family can override this if they dont know your wishes.