Transplant Flow

Referral
Upon referral from a primary care physician, the Transplant Coordinator completes a demographic and clinical summary sheet and sends it to the Transplant team for review. The Transplant Coordinator collects the medical history, physical examination results, radiology studies, lab work, and requests other needed information from the primary care physician. The transplant surgeons review this information and formulate a customized plan of care. After the transplant office obtains insurance authorization, a transplant evaluation is scheduled with a multidisciplinary team.

Evaluation
The transplant evaluation can be conducted on an outpatient or inpatient basis, and typically requires 1 to 2 days in Birmingham. The evaluation includes diagnostic testing, consultations by Cardiology, Nephrology, Hepatology or any subspecialty relevant to the care. The multidisciplinary team evaluates the patient and provides education throughout the evaluation. This team includes a pharmacist, a nutritionist, a child life therapist, a social worker, a psychologist, and the RN Transplant Coordinator. The patient is presented to the multidisciplinary team for consideration of transplant when all aspects of the evaluation are completed.

Pre-Transplant
After the evaluation, the patient is discharged to his/her local medical provider. Children’s of Alabama Transplant Coordinators will list the patient with the United Network for Organ Sharing (UNOS) and obtain authorization for the transplant procedure from the insurance company. The patient’s listing status with UNOS is based on his/her current medical condition and lab tests. During the waiting period, the RN Transplant Coordinator will be in close communication with the referring physician to keep him/her informed about the patient’s condition.

Transplant
When an organ becomes available, the Transplant Coordinator contacts the family and requests that they come to the hospital. The patient is admitted to the Transplant Unit and is prepared for surgery. During the surgery, the family will be updated about the patient’s condition and the progress of the procedure. Immediately after surgery, the patient is admitted to the Intensive Care Unit (ICU). The length of time spent in the ICU varies based on each child’s needs. Once the patient is stable, he/she will be transferred to the Transplant Unit.

Post-Transplant and Follow-up Care
The organ recipient and family will be educated on transplant maintenance and care including: medications, nutrition, scheduled lab work, clinic visits, activity level, returning to school, immunizations, and dental care, as well as individual specific instructions.

At a typical follow-up clinic visit, the doctor and the nurse will discuss the patient’s current health, check the patient’s weight and blood pressure, and perform a physical examination. Blood work will be ordered at each appointment to evaluate the organ’s function, to observe for signs of rejection, and to monitor the effectiveness and level of the immunosuppressant medications.

Throughout the transplant process, the referring physician will be regularly updated on the patient’s progress by the Transplant Physician or the Transplant Coordinator. When the patient is discharged, the Transplant Coordinator will send the referring physician a packet of information outlining a treatment regimen, including medical records, current medications, and the recommended laboratory schedule. Transplant surgeons will continue to keep the referring physician aware of any changes to immunosuppressant medications and annual evaluations.