Two registered nurses share their views from the frontline as they have kept pace with the swift changes that transformed the field of organ transplantation over the last two decades.
 “Patients who received kidney transplants prior to the mid-1980s had tremendous courage,” reflects Pat Lipere, R.N., B.S.N., C.C.T.C., pre-transplant coordinator at SBMC. “They overcame apprehensions about a surgical treatment that offered less than a 50 percent graft survival rate.” With the discovery of targeted medications that could prevent and treat rejection, the transplant team’s confidence grew with its experience, recalls Ms. Lipere, who began her career in nursing in 1983 as a dialysis nurse and the following year joined the SBMC renal transplant team. “It was common for kidney transplant recipients to be hospitalized for many weeks after surgery. It took time to adjust the dosages of medication and we watched closely for infection and rejection. Today, the team is better able to manage the variety of medications and patients typically go home less than a week after surgery.”
Education about transplantation was very limited and informal. “It was just the physician and the nurse presenting information to transplant candidates,” remembers Ms. Lipere. “We soon learned that it requires a multidisciplinary team to prepare and support transplant recipients over their lifetime. Having an organ transplant is like taking home a new baby. You have to know how to take care of it… for the long term,” explains Ms. Lipere.
As immunosuppressive medications and transplant surgical techniques advanced, so did the technology of dialysis. “After erythropoietin was introduced in 1989 to strengthen the hemoglobin, people undergoing dialysis remained healthier and stronger,” she points out. “Naturally, if a patient is healthier going into transplant surgery, the chances for a positive outcome improve.”
 “Little more than 10 years ago most people with end stage renal disease (ESRD) received hemodialysis with no knowledge about any other treatment options,” remembers Alison Jacobs, R.N., M.S.N., C.N.N., Transplant Program Manager at NBIMC, who joined the field as a dialysis nurse in 1986 at SBMC. “Their treatment started and ended with dialysis. Transplant was rarely discussed because the criteria for being listed as a transplant candidate were stringent.”
“The dialysis nurses knew very little about transplantation, how to identify appropriate candidates and assist the patient through the pre-transplant evaluation process,” says Ms. Jacobs. “Saint Barnabas was one of the first centers in the nation to bring together what were then two distinct health care teams… dialysis and transplant.” In 1991, SBHCS created the Transplant Surgeon Designee Course which aims to educate dialysis nurses all over the tri-state region about transplant so that staff can share this knowledge with their patients. Today, by federal mandate, all dialysis patients must be informed about their treatment options, including hemo- and peritoneal dialysis, as well as the transplant alternative.
"The progress in the field of transplantation has been astounding. It is evidenced not only in medical and surgical advances, but also in the improved quality of life enjoyed by transplant recipients and their families,” reflects Ms. Jacobs.
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