“The job of the transplant team does not end with successful surgery,” explains Martin Jacobs, M.D., director of outpatient transplant services for SBMC. “Our goal is to assist patients in their recovery to the fullest capacity, both physically and emotionally.”
The SBHCS Renal and Pancreas Transplant Centers’ long-term graft survival rate surpasses the national average due, in part, to the depth and experience of its post transplant team and the clinical care, patient education, and psychosocial support that it provides. Other services offered include nutritional and exercise consultation that assists transplant recipients in returning to activities of daily living.
“Prior to receiving a kidney transplant, a large percentage of patients have struggled for many years with chronic illness,” says Dr. Jacobs. In addition to the physical changes brought on by the surgery and the side effects of the immunosuppressive medications, it is a challenge for recipients to accept responsibility for their own health and to become independent from the care that medical personnel and loved ones provided for so long. “The physicians and nursing staff provide the practical aspects of care while our support staff assists recipients in returning to work and all of the other activities of normal life.”
Education, Education, Education
Providing education about the benefits and responsibilities of transplant is a priority at the SBHCS Renal and Pancreas Transplant Centers. Education begins when candidates are considering the option of transplant and continues throughout the lifetime of the transplanted organ. Recipients and their families learn to recognize the early signs of infection, the negative side effects of the immunosuppressive medications, as well as the risks of developing other medical complications.
“Our emphasis on patient education helps reduce complications and readmission to the hospital,” explains Meg Caputo, R.N., C.C.T.C., inpatient coordinator. “The more the patients understand about transplantation, the more control they have over their own health and the less anxiety they feel.”
“Taking Back” One’s Life
“The strong communication between all the members of our team allows us to be proactive in helping recipients manage all the changes in their lives,” says Adriane Shaw, M.S.W., one of three full-time social workers at the SBHCS Renal and Pancreas Transplant Centers. The social workers meet individually with recipients and their families to identify and address any obstacles that might prevent them from maintaining a healthy organ. A support group meets regularly and individual and family counseling can help patients adjust to the changes in their lives.
 The post-transplant SBMC team members are, from left, seated, Adriane Shaw, M.S.W., transplant social worker; Debi Girone, R.N., inpatient nurse coordinator; Martin Jacobs, M.D., director of outpatient transplant services; Janice Purpura, medical assistant; Patty Burricilli, medical assistant; and from left, standing, Gary Friedman, M.D., clinical director of transplant; Ann Murtha, R.D, transplant nutritionist; Meg Caputo, R.N., in-patient nurse coordinator; Annette Ferebee, R.N., outpatient nurse coordinator; Dianne D’Uva, R.N., outpatient nurse coordinator; Colleen Walsh, R.N., clinical nurse practitioner; Marcia Krupit, M.S.W., transplant social worker; Melissa Dowd, R.N., outpatient nurse coordinator.
SBHCS social workers guide patients through the maze of insurance issues and entitlement programs and advocate for them in seeking financial assistance. They also prepare patients to re-enter the workforce, or begin a career if chronic illness prevented employment in the past. “It’s a big step in the rehabilitation process,” explains Ms. Shaw. “We recommend that people take advantage of the vocational rehabilitation resources in their communities before they even receive their transplant.”
According to Scott A. Ames, M.D., surgical director of renal transplantation at NBIMC, working helps patients to maximize their rehabilitation potential. “Over 70 percent of patients return to work post-transplant. Recipients are more likely to return to work if they are educated or trained in a job skill, if they worked before or during dialysis, or if they dialyzed for less than one year.” He recommends that those on dialysis keep working, even part-time, to increase their likelihood of continued employment post-transplant and to maintain employee health benefits.
 The NBIMC Renal and Pancreas Transplant Center post-transplant team includes, from left, front, Alison Jacobs, R.N., M.S.N., transplant program manager; Sadanand Palekar, M.D., clinical director; Melvin Goldblatt, M.D., program director; Scott Ames, M.D., director, transplant surgery; (second row, from left,) Jennifer Hinkis, R.N., B.S.N., transplant coordinator; Gail Mesavitz, M.S.W., social worker; Bess Molnar, financial/data coordinator; Carmen M. Flores, R.N.C., and Verna Willis, R.N., B.S.N., transplant coordinators.
For most patients, rehabilitation is the process of restoring what one has lost during the journey through kidney failure. For others, bypassing the dialysis step helps them control their destiny to the fullest. Diabetic patients may choose transplantation as a treatment alternative in lieu of dialysis. “Early kidney transplantation alone, or simultaneous kidney/pancreas transplantation, is very successful when done pre-dialysis,” explains Dr. Ames. “Statistics indicate that 70 percent of diabetics receiving combined kidney/pancreas transplants are employed, function better in activities of daily living, and are more mobile than their non-transplanted counterparts.”
Proactive in Preventing Problems
Under the direction of Dr. Jacobs at SBMC, Melvin Goldblat, M.D., at NBIMC, and other transplant nephrologists, a nurse practitioner and six outpatient nurse coordinators monitor the recipients’ kidney function and watch for any signs of rejection or infection. All waiting rooms and exam rooms are adorned with bulletin boards and leaflets reminding patients to consume a proper diet, when to resume various levels of activity, and how to contend with the temporary side effects of their medications. “With a multidisciplinary team I can put patients in direct contact with someone who can help them through any difficulties or stress before it affects their ability to maintain their kidney,” says Melissa Dowd, R.N., B.S.N., C.C.T.C., outpatient nurse coordinator.
Making Healthy Choices
Immunosuppressive medications stimulate the appetite and cause a redistribution of body fat. Combined with the temptation to indulge in foods that were taboo on the highly restricted diet required during dialysis, weight gain is a common occurrence after transplant. A registered dietitian assists patients in maintaining a healthy diet and an appropriate exercise program. “Like all Americans who want to stay healthy, transplant recipients should make good choices in their diet and include exercise as part of their daily routine, says Ann Murtha, R.D. “I meet with patients shortly after surgery and motivate them to get into good eating patterns right from the start.”
In addition, the Center for Health and Wellness at the Saint Barnabas Ambulatory Care Center offers personalized fitness programs and group exercise classes to help patients exercise regularly.
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