Transplant Digest Spring/Summer 2018, Issue No. 24
Organ donation after Medical Assistance in Dying (MAID) By Dr. Jeff Zaltzman In this issue... Medical assistance in dying (MAID) became legal in Québec in December 2015, and the rest of Canada in June 2016. While the vast majority of MAID occurs in the hospital setting, there is a growing number of cases occurring in homes or hospices. The majority of patients who have undergone the MAID process have done so for advanced cancers. However, some patients have elected MAID for conditions with a progressive disabling neurological deterioration and progressive loss of autonomy and function.
Organ donation after Medical Assistance in Dying (MAID) From The Editor’s Desk Bone Disease after Kidney Transplantation Post Transplant Recommended Vaccines
In Ontario, Trillium Gift of Life Network, (TGLN) the organ donor Delayed Graft Function organization undertook an evaluation and developed a process Urine ACR for organ and tissue donation from eligible Ontario patients for Practical tips for medication undergoing MAID. Ontario is the first jurisdiction in North America management to have organ and tissue donation from patients who choose MAID as an end-of-life option. Although this has occurred in some Post Kidney Transplant Clinic European countries, what is unique to the process in Ontario is the Changes Its Patient Education Process ability to obtain first-person consent from the potential donor after their initial decision to undergo MAID. The discussion about organ Post-Transplant Chat: donation takes place after the patient makes a decision to end his Allergies after Transplantation or her life, and once eligibility criteria have been determined. As an Research Education and example, patients with cancer would be excluded from consideration Innovation Day within Diabetes of organ donation following MAID, whereas patients with a Comprehensive Care Program progressive neurological condition may be candidates. In general, 2018 patients have the ability to consider organ and tissue donation while 7th Connect and Learn a Big Success they are alive, and planning for donation and transplantation can be Being a Living Donor Coordinator made weeks in advance. Eligible patients are admitted to hospital and undergo appropriate blood tests and evaluation to ensure Contact information their suitability as organ and tissue donors. Allocation of organs is determined in advance of the MAID process, and patients’ rights and autonomy are respected throughout the course. At the time of the MAID procedure, transplants surgeons are on standby and can begin to recover suitable organs once death has occurred. In general this process happens very quickly. To date there have been six MAID organ donors, and dozens of MAID tissue donors in Ontario. Suitable organs for transplant include kidneys, liver, pancreas, and lungs. Although MAID does not occur in every hospital in Ontario,
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Transplant Digest 1 Spring/Summer 2018
From the Editor’s Desk Welcome to another information-laden edition of Transplant Digest. Unlike most other publications in this field, Transplant Digest is targeted toward kidney transplant recipients and donors, their care providers, health care professionals of all stripes, and just about anyone interested in transplantation. Our model of trying to provide something useful for everybody has proven to be quite successful over the past decade. If you have any ideas or can think of any suggestions to help us make Transplant Digest better, please do not hesitate to share them with us. In this issue, our dedicated Senior News Correspondent Galo Meliton delivers two articles related to patient education, and our Living Donor Coordinator Michelle Gabriel writes about our Research Education and Innovation Day. You might be motivated by these articles to attend future similar events. We have an interview with Kevin Bradley about being a Living Donor Coordinator. Our transplant pharmacists Elena Nazvitch and Francine Kwee provide practical tips for medication management and post-transplant vaccination respectively. Our ever-popular Post-Transplant Chat covers post-transplant allergies. Articles on delayed graft function, post-transplant bone disease, and organ donation after medical assistance in dying (MAID) complete our offerings in this issue. The Transplant Team wishes you a happy and healthy spring and summer, and a rewarding life related to Transplantation, in whatever capacity that may be. I look forward to meeting you again in the autumn. Dr. Ramesh Prasad, Editor
MAID story continued from page 1
because some religion-based institutions have forbidden MAID, the rights of patients are protected and their wishes always respected. There are individuals who do not agree with MAID for religious, medical or other reasons. However from an organ and tissue point of view, those that choose MAID and want to be donors are now allowed to have their wishes respected. Each patient should be extended autonomy and dignity to provide first-person consent in accordance with their own preference on organ and tissue donation.
Criteria for Medical Assistance in Dying In accordance with federal legislation, for an individual to access medical assistance in dying, he/she must: 1. 2. 3. 4. 5.
Be eligible for publicly funded health services in Canada; Be at least 18 years of age and capable of making decisions with respect to their health; Have a grievous and irremediable medical condition (including an illness, disease or disability); Make a voluntary request for medical assistance in dying that is not the result of external pressure; and Provide informed consent to receive medical assistance in dying after having been informed of the means that are available to relieve their suffering, including palliative care.
Donation approach All approaches for organ and tissue donation will be performed by an expert in donation from TGLN. A pre-approach plan will be developed with the most responsible physician to ensure that the approach will be minimally inconvenient and also respectful of the patient’s wishes. Patients will then be approached directly, in-person by an organ and tissue donation coordinator (OTDC) whenever possible. 2
Bone Disease after Kidney Transplantation Dr. Ramesh Prasad Bone disease, specifically osteoporosis or “bone loss”, is a common but underrecognized problem after transplantation. Besides the usual blood and urine tests, kidney transplant recipients are reminded to have their bones monitored in the form of bone mineral densitometry, or BMD, at regular intervals. We often discuss BMD reports in the Transplant Clinic, particularly the “T Score”, which if less than -2.5 indicates osteoporosis. Here is some more information about posttransplant bone disease that you may find useful. Bone loss occurs early after transplantation. Some studies suggest bone is lost at up to 2% per year, but fortunately the rate of bone loss can be stabilized. Osteoporosis increases the risk of fractures. Most fractures occur in the hands, feet, and ankles. Many patients come to transplantation after already having chronic kidney disease for a long time, and a burden of bone disease to go along with it. Other risk factors for osteoporosis include older age, female sex, low body weight, a family history of osteoporosis, diabetes, deceased donor transplantation, and the pre-transplant use of prednisone for native kidney disease. In the last case, it is helpful to undergo DXA (dual-energy x-ray absorptiometry) scanning before your transplant, to help with comparisons afterwards. Although improved kidney function after transplantation helps bone health, common anti-rejection medications can worsen bone health too. Drugs like prednisone and cyclosporine, as well as persistently overactive parathyroid glands after transplantation can all lead to more bone loss. All patients should therefore undergo a DXA scan at least once every two years, either through the family doctor or the Transplant Clinic. DXA measurements are usually taken in the spine and hip, to represent different kinds of bone in the body. Bone biopsies are usually not performed unless there is severe bone pain, before treatment is started. Osteoporosis can hopefully be prevented by early mobilization after the transplant, performing regular weight-bearing exercises, and stopping smoking. The evidence associated with stopping prednisone at preventing osteoporosis is not good. The blood calcium, phosphate, 25-hydroxyvitamin D, alkaline phosphatase, and parathyroid hormone (PTH) level are often checked, and any abnormalities addressed. Oral calcium supplements are often helpful, and vitamin D can be considered if the blood calcium level is not high. Bisphosphonate drugs like alendronate, etidronate, and pamidronate are not used to prevent osteoporosis. Once osteoporosis is diagnosed, however, bisphosphonates may be used. Denosumab is an antibody that can also be used to treat osteoporosis, but data with denosumab and PTH analogues in transplant patients is very limited. These medications all have side effects however, and so you must have a discussion with your doctor before starting any of these drugs. Regular follow-up BMD testing will be required. Sometimes a bone specialist can be consulted as well, for additional advice.
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Post-Transplant Vaccinations Timing of vaccination • Wait 1 month post-transplant for influenza vaccine • Wait 6 months post-transplant for other routine vaccines
Vaccinations considered safe • • • • • • • • • • • • • •
·
Influenza types A and B (inactivated) Tetanus -Diphtheria – Pertussis (Td; Tdap) Haemophilus influenza B (Hib) Hepatitis A Hepatitis B Meningococcus Pneumococcus (Both Pneumovax® and Prevnar®) Polio (inactivated) Typhoid Vi (inactivated) Tetanus Japanese B Encephalitis Human Papilloma virus (Gardisil ®) Cholera/ETEC Traveller’s Diarrhea Vaccine (Dukoral ®) Herpes Zoster (non-live) (Shingrix ®) - Wait at least 1 year from a prior episode of shingles before being vaccinated
Vaccines to avoid (AVOID ALL LIVE VACCINES) • • • • • • • • • •
Bacillus Calmette-Guérin (BCG) Intranasal Influenza (FluMist ®) Measles, Mumps, Rubella Typhoid – oral (live) Polio – oral (live) Smallpox Herpes Zoster (Zostavax ®) Yellow fever Rotavirus Varicella (Chicken Pox)
Vaccination booster recommendations • Tetanus-diphtheria (Td) every 10 years for life • Influenza every year for life • Pneumococcus (Pneu-P-23)– five years after first dose (once only)
For more information: KDIGO Care of Transplant Recipient Chap 12 Vaccinations (www.kdigo.org) Canadian Immunization Guide (https://www.canada.ca/en/public-health/services/canadian-immunization-guide.html) Centre for Disease Control and Prevention (www.cdc.gov/vaccines/recs/default.htm)
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Delayed Graft Function Dr. Ramesh Prasad Delayed graft function (DGF) is a medical term that means a kidney transplant is not working right away. Everyone hopes that the new kidney transplant will start to work immediately, and in fact many times the kidney starts to produce urine on the operating room table itself. However, about 25% of the time this does not happen. The new kidney does not produce any urine, the amount produced is very small, or the quality of the urine is not very good. As a result, it becomes necessary to continue dialysis after the transplant. The medical definition of DGF is the need for dialysis in the first week after transplant. Dialysis is needed when the blood potassium is very high, there is too much fluid in the body, or the patient feels sick because of accumulated kidney toxins. What causes DGF? There is always some injury to the kidney when it is taken out of one body and put into another. The kidney is always vulnerable to injury without its usual blood supply, although it is usually cooled down to reduce its energy needs. The risk of DGF is increased if the donor is old, since older kidneys do not handle the stress of transplantation as well as younger kidneys. Other risk factors include deceased donation, donation after cardio-circulatory death, and a long time between removal of the kidney in the donor and implantation in the recipient. Various chemicals accumulate inside the kidney when it does not have a blood supply, and when the blood supply is restored these chemicals spread throughout the kidney, causing more injury. Some drugs are now being tested to try to prevent DGF, but those kinds of studies are in a very early stage presently. There are no medications to kick-start the new kidney; it must recover on its own. The good news is that in about 90% of cases, DGF will resolve and the patient will no longer need dialysis. The waiting time can be a week to several months. Patients do not need to stay in the hospital until DGF resolves, since kidney function recovery can be monitored in both the dialysis centre and the Transplant Clinic. You will have to continue your dialysis diet for a while longer. A transplant biopsy is sometimes needed to make sure that rejection has not set in. Serial ultrasounds may be performed to make sure the kidney has proper blood supply and urine drainage. As DGF gets better, the patient will first notice a larger amount of urine being produced. Symptoms like loss of appetite, weakness, and swelling slowly improve. The amount of weight gain between dialysis sessions slowly reduces. Finally, the creatinine level in the blood gets lower when checked each time before the start of dialysis. If the creatinine goes down on its own without dialysis, it may be time to stop dialysis entirely! At that point we usually wait another week or two before recommending removal of dialysis lines, PD catheters, and such. Often the creatinine will decrease into the normal range after DGF. Although it is desirable to avoid DGF, it is unfortunately not completely preventable. On your part, if DGF happens to your kidney transplant, keep yourself mobile, avoid dehydration or volume depletion by maintaining an adequate diet, take all your transplant drugs as prescribed, avoid pain medications that can damage the new kidney, and do what you can to help control your blood pressure or blood sugar. Pay close attention to your incision and promptly report any unusual changes. The Transplant Clinic is here to guide you through this stressful time.
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What is the Urine Albumin-to-Creatinine Ratio? The urine albumin-to-creatinine ratio, or ACR, is a urine test you are asked to provide each time along with your regular blood testing. It may be the only urine test you are asked to provide, apart from the occasional urine culture if a urinary tract infection is suspected. The urine ACR has mostly replaced the 24-hour urine collection in post-transplant care because it is both accurate and convenient. Most transplant patients will have an elevated urine ACR even without a problem, so it is important to look for trends in the urine ACR to determine if it is stable, increasing, or decreasing, prior to making decisions about managing it. A rising urine ACR may indicate a problem with the transplant kidney such as rejection, leakage of protein from your own kidneys, or may indicate leaky blood vessels throughout your body, placing you at higher risk for heart disease.
Practical Tips for Medication Management after Transplant Elena Nazvitch, BScPhm, PharmD, RPh After your transplant, taking your medications safely and effectively becomes an important aspect in maintaining the new kidney’s health. While in hospital, patients are introduced to their new medication regimens, which include “immunosuppressant” medications that are used to prevent the body from rejecting the kidney. Here are some tips for questions you may be faced with after discharge.
How can I remember to take all my medications as prescribed? Remembering the exact doses and timing of several new medications can be challenging. However, it is important to not miss or skip any doses. You can use the medication schedule you were given in the hospital to help you remember. If doses or medications are changed, you can ask the pharmacists at the transplant clinic to update your schedule and provide you with your current list. Alarms and alerts on your phone or other electronic devices can be used to remind you when it is time to take your medications or you can schedule your administration times around daily actions such as ’brushing your teeth’ or ‘going to bed’ to help you remember that it is time for you dose. Patients are usually encouraged to be in charge of their own medications, but if you find it very difficult to manage, a blister pack or pill organizer can sometimes be helpful; raise your concerns at your clinic visit or with your pharmacy.
What about the timing of drug levels? Drug blood concentrations are checked for some of the “anti-rejection” medications to ensure that they are maintained in a “therapeutic target”, which means that the level should be high enough to suppress the immune system so the body does not reject the kidney, but not high enough to cause toxicity. You will be given instructions on the administration time around blood work for the specific “anti-rejection” medication you are on. For example:
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• With Tacrolimus (Advagraf®) - concentration has to be checked right before your next dose is due – so on the day of your blood work, do not take this medication until after the blood work is complete. • With Cyclosporine (Neoral®) - concentration has to be checked two hours after you have taken the dose. Adhering to the correct timing of the drug levels, will help with dose adjustment of your medication.
Can other medications be safely taken after the transplant? Before starting any new prescription or over the counter medications, it is always a good idea to check with the transplant clinic if they are safe to use. Some common medication like ibuprofen (Advil®) can potentially damage the kidneys and are not recommended after transplant. Others can interact with your transplant medications, increasing or decreasing their levels in your body. Your doctor can also call the transplant team to discuss any medication changes.
What about herbal medications? Herbals and natural health products can also cause side effects and drug interactions, just like any other medications. Do not use herbal products without the advice of a physician and always check with the transplant team if they are safe to use before starting.
Which pharmacy should I use? There is no need to change pharmacies after your transplant. You can continue using your regular pharmacy as long as you are satisfied with the care you are receiving. It is a good idea however, to fill all your prescriptions at one pharmacy so that they have the information about all your medications and can identify potential drug interactions. Please note that some medications, for example Aranesp®, can only be filled at the St. Michael’s outpatient pharmacy.
What happens if I am admitted to hospital? During hospital admission, doctors and other health care professionals make decisions about continuing and adjusting doses of patients’ home medications. It is important to maintain an updated list of all your medications and present it to the hospital upon admission. The fact that you had a kidney transplant and the names and doses of your transplant medications have to be communicated to your health care team at the hospital as soon as possible so that appropriate decisions can be made during your admission. Your health care team at the hospital can also contact the transplant clinic if needed. After your discharge, let your transplant team know of any changes made to your transplant medications.
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Post-Kidney Transplant Clinic Changes Its Patient Education Process Galo Meliton, RN, C Neph (C), Senior News Correspondent The post- kidney transplant clinic recently changed its education process for kidney transplant recipients, their families and friends. We are now holding group classes instead of the old system where the post-kidney transplant nurses went across the street to the Hospital to give patients and their families discharge teaching. There were some challenges that came with the old system: it was difficult to pin down a good time for the teaching; patients were either at tests or busy with other activities. Some of them were not physically or emotionally ready for any involved teaching. After team collaboration, it was decided that the bedside transplant nurses will be the ones providing the patients being discharged the basic “need to know� information. The recent introduction of Patient Oriented Discharge Summary (PODS) is very timely as well in this new initiative. They serve as a guide for the bedside nurses in terms of the basic information the patients need to know prior to discharge. The Transplant Coordinators in the post - kidney transplant clinic provided the bedside nurses in-services in regard to the PODS and basic information they need to inform patients who were being discharged. The rest of the information is now being shared with them in a more detailed manner in the form of a group class. Several classes have been held to date. The response has been nothing but positive from the kidney recipients, their families and friends. They also appreciate hearing other people’s questions and find them very beneficial as well. Patients have been very gracious as well sharing their experiences with one another, which is yet another benefit to this change in process. Lucy Chen, Case Manager, is conducting a survey amongst the patient and staff participants in terms of what is and what is not working in this initiative.
Thanks go to Lucy Chen, Sarah Mattok, RN and Fernanda Shamy, RN who collaborated in putting this initiative together with the staff on 8CS especially Colleen Johns, Clinical Leader Manager and Charlie Yang, Case Manager.
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Post-Transplant Chat: Allergies after Transplantation Kevin Bradley RN, Kathryn Salvatore RN, Jennie Huckle RN, Galo Meliton RN, Fernanda Shamy RN, Sarah Mattok RN
1. What are the most common medications that people are allergic to?
People are commonly allergic to antibiotics such as penicillin, those related to penicillin and sulfa drugs. Other common medications that people are allergic to include NSAIDS (eg. Aspirin, Ibuprofen) as well as ACE inhibitors (eg. Ramipril, Perindopril)
2. Does an allergy to one medication predict an allergy to another one?
Yes it is possible. Allergy to one medication may predict an allergy to another one if the two drugs share the same or similar chemical structure. For example, if you are allergic to penicillin you may also find that a cephalosporin such as cephalexin causes a reaction for you. However, the prediction is not always conclusive and allergy testing can be done to see if cross-reactivity truly exists.
3. What are the symptoms of a drug allergy?
Itching, rash and hives are symptoms of a mild or moderate allergy. More serious symptoms may include a wide spread skin reaction. Difficulty breathing, facial swelling, and fast heart rate are other severe symptoms. If you experience any of these severe symptoms call 911 or go to your nearest Emergency Department.
4. Do allergies carry over after the transplant? What new allergies are found after a transplant?
Yes, allergies do carry over after transplant. If you are allergic to a particular medication before your transplant the same allergy will be carried over after your transplant. It has been noted that a patient did develop a new peanut allergy after their transplant, although this is rare.
5. Can I be allergic to one of the transplant drugs?
Yes it is theoretically possible; but it is very rare. More commonly, patients have an intolerance or sensitivity, and side effects that are not allergic in nature. The side effects may be managed by your kidney doctor.
6. I have seasonal allergies. Do these put me at higher risk for drug allergies as well?
No, seasonal allergies do not increase your risk for developing drug allergies. Continued on page 10
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7. My seasonal allergies are treated with medications like nasal sprays. Are there similar medications for drug allergies?
Like most other allergies, the primary drug allergy treatment is avoidance of the allergen. If you experience mild allergy symptoms such as itchiness, over the counter anti-histamine medications such as Benadryl or steroid creams may be used. However, if a severe anaphylaxis reaction occurs, call 911 or go to your nearest Emergency Department immediately.
8. Do I need to see an allergy specialist?
It may be beneficial to see an allergy specialist if you have severe environmental and/or medication allergies, or multiple allergies.
9. My doctor feels I really need one of the medications to which I am allergic. What can be done about it?
I n most cases your doctor can prescribe an alternative medication. However, if the prescribed medication causes mild allergic reaction symptoms and it is felt to be the best treatment option available, then your doctor may prescribe an anti-histamine such as Benadryl to take during the course of the treatment. If it is a moderate or severe reaction, further testing can be done by an allergy specialist, such as a drug challenge. Sometimes the allergy specialist will ask you to undergo a desensitization procedure, in which you are slowly exposed to the medication over a long period of time
10. Do I need a Drug Alert bracelet?
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It is beneficial to have an alert bracelet especially for those with severe reactions eg. Anaphylaxis. It is wise to ALWAYS carry a list of all the drugs you are currently taking, and make special note if you had past reactions to specific medication. Always share this list with your health care team.
Research Education and Innovation Day within Diabetes Comprehensive Care Program 2018 Michelle Gabriel, RN, BScN The Diabetes Comprehensive Care Program held their 16th Biennial Research Education & Innovation Event on March 2, 2018. This year’s theme was “Integration, Partnerships & Collaboration: Transforming the future of healthcare” as a way to set the stage for upcoming change as an organization. It was well attended by the different departments and clinical areas under the DCCP as well as our colleagues in the Nephrology Program at Michael Garron Hospital. The event was kicked off by poster presentation’s and mingling in the exhibition hall. The posters highlighted the amazing work being done within the diabetes comprehensive care program from dialysis and renal transplant to diabetes management and eye care. Dr. Doug Sinclair opened the oral presentations for the afternoon. Dr. Sinclair was recognized for his years of service and commitment to the DCCP program. Dr. Sinclair will be leaving St. Michael’s in June 2018. Jonathan Fetros, director for DCCP welcomed all attendants and introduced the key note speaker, Lori Spadorcia. Ms. Spadorcia shared the journey of transformation for CAMH in both the community and as an institution. She stressed the importance of building relationships when embarking on change, stressing that an individual is just one member of a larger team. Oral presentations followed the keynote address, highlighted projects within the DCCP that foster teamwork and collaboration for improved patient care. Jonathan Fetros delivered closing remarks, followed by further mingling and review of posters in the exhibit hall. A big thank you to all the members of the planning committee that helped make this event a success. A special
thanks to the chairs of the committee – Charlie Yang & Elizabeth Ball, as well as Jacqueline Chong for all their hard work and dedication to this event. Thanks to the sponsors of this event, including the Print Shop, Medical Media Centre, Public Relations and the Catering Department at St. Michael’s Hospital.
The next generation of transplant professionals!
Dr. Prasad recently delivered a keynote address to enthusiastic members of the McMaster McMaster Undergraduate Research in Science Association (MURSA) and McMaster Medicine and Health Society (MMHS) about a career in Kidney Transplantation. Some of these youth seemed especially keen to become part of the next generation of transplant professionals!
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Being a Living Donor Coordinator Ana Gajic, Senior Communication Advisor, St. Michael’s Hospital Kevin Bradley is a living donor co-ordinator in the Kidney Transplant Program at St. Michael’s Hospital. A registered nurse by training, Bradley’s job is to coordinate the potential kidney donor and pre-emptive recipient’s work-up processes. He also co-ordinates out-of-country donors, a unique opportunity offered at St. Michael’s. Tell us about your role in the Kidney Transplant Program. My colleague and I facilitate the testing for potential living donors. Part of my role is to facilitate donors who come from overseas to donate a kidney to a family member or loved one. Why is the opportunity of out-of-country donation unique? Many transplant programs don’t offer out-ofcountry donation because it can result in little yield. I’m happy to work for an organization that understands the GTA is a multicultural place and that many of our patients who need a kidney donor don’t necessarily have a large network in Toronto to reach out to. When it comes to looking for a donor, their only opportunity may be someone overseas. We believe they should be given that opportunity and all attempts should be made to help facilitate this. How many countries have you facilitated donors from? Russia, Myanmar, South Korea, the United Kingdom, the United States, Spain, the Philippines, India, Bangladesh, Pakistan, Venezuela, Somalia and Sudan. How does out-of-country donation work? The patient in Canada identifies a friend or family member abroad, and the potential donor initiates contact with us. We then ask for a few formal 12
tests to be done and once we’ve verified that this may work, we ask the family member to come to Canada for a stay of at least three months. Trillium Gift of Life Network also helps with some of the expenses through the Program for Reimbursing Expenses of Living Organ Donors. What are some of the challenges with facilitating outof-country donation? Sometimes, communication can be a barrier. Depending on which country people are from, they also may need a visa, which is always an uncertainty. Once we review everything, we send a letter of support for a visa to help the process. What has been a surprising aspect of your job? We try to communicate directly with the potential donor to avoid a conflict of interest. I’ve learned in this role that Google Translate is my friend. I wrote to someone in Tagalog using Google Translate and the potential donor who received the email asked whether I was from the Philippines. So I knew the translation was good! What’s your favourite part of your job? I love meeting people from around the world and having the donation come to fruition. Seeing someone get an opportunity for a transplant that they may not have had otherwise is a great gift. What do you want people to know about organ and tissue donation? One deceased organ donor can save eight lives and tissue donors can enhance more than 70. It’s a unique gift because not everybody who dies can be an organ donor. I also want people to learn more about living donation. It’s a great opportunity to see your loved one lead a better quality of life.
7th Connect and Learn a Big Success Galo Meliton, RN, C Neph (C ), Senior New Correspondent The 7th Connect and Learn, an education event for kidney transplant recipients, their families and friends was a big success. The event was held on Friday, April 13, 2018 at the Li Ka Shing Research Institute. It was attended by close to 100 people. The day was started by an excellent talk by Tess Montada- Atin, Nurse Practitioner on diabetes prevention, new available treatment, as well as the state-of- the- art technology in terms of blood sugar monitoring. After Tess’ talk, there was a patient panel composed of three kidney transplant recipients who had their kidney transplants in different years. The session was titled “Patient Panel: Transplant Through the Years”. They provided the audience great insight in regard to what their lives were like before their kidney transplants and what their lives had been like over time. There was much audience participation throughout this session.
Interested in becoming a patient advisor for Kidney Transplant Clinic? We are currently seeking patients before or after transplant, caregivers, kidney donors, and community member to join our group.
Next were presentations on “Getting Involved and Giving Back”. Galo Meliton, RN spoke about the High School Outreach Initiative (HSOI), a tri- hospital outreach program run by St. Michael’s Hospital, Sick Kids Hospital, and the Toronto General Hospital in collaboration with the Trillium Gift of Life Network (TGLN). Maryjo Vradis, a kidney recipient spoke about her experience in being an active volunteer to this initiative. Rosa Militano, a kidney recipient’s spouse, spoke about the Patient and Family Advisory Committee (PFAC) to encourage the audience in joining the group who looks at improving patient processes whether it is regarding patient education booklets or clinic flow. Several members of the research team in the kidney transplant department then spoke about the different research topics currently being looked at in the clinic, as well as ways on how one could be involved in a research study. Lastly, Dr. Deepali Kumar, an infectious disease specialist at the Toronto General Hospital, spoke about the relevant vaccinations kidney transplant recipients and their care givers need. The verbal and written feedback we received was all positive. Patients and their guests were able to meet and connect over lunch. They were happy to know that other people are going through the same things they themselves are going through!!!
A big Thank You and congratulations
to the organizing committee: Sharon Lee, Social Work, Lucy Chen, Case Manager, Jenny Accettura, Clinical Dietitian, and Galo Meliton, RN (Emcee). Thanks go as well to Sheila Buencamino, Clerical Assistant for assisting in the registration process.
The next Connect and Learn is for Friday, October 26, 2018. 13
Become a Patient and Family Advisor at St. Michael’s You sometimes notice things we don’t. Things like how your care is provided, and how we could be doing better. Play a valuable role in helping to ensure the best possible patient experience at St. Michael’s. Become a Patient and Family Advisor. Visit stmichaelshospital.com/patientandfamilyadvisors for more information.
For more information, please contact PatientandFamilyAdvisor@smh.ca
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St. Michael’s Hospital Renal Transplant Program (across the hospital) 61 Queen Street 9th Floor Toronto, Ontario, M5C 2T2 Phone: (416) 867-3665 Please send your comments or suggestions of topics for future publication to: jayomam@smh.ca Disclaimer Note: Views presented in this newsletter are those of the writers and do not necessarily reflect those of St. Michael’s Hospital or the University of Toronto. Subject matter should not be construed as specific medical advice and may not be relevant. For all questions related to your own health please contact your health care provider.
Contact Information Dr. Ramesh Prasad – Editor Meriam Jayoma-Austria, RN, BScN, CNeph(C) – Newsletter Coordinator
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April is Be a Donor Month.
Help our network of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital reach our goal of registering 1,000 organ and tissue donors in April. Use your health card to register or check your status here: https://beadonor.ca/campaign/oursharedpurpose