A successful lung transplant program requires medical professionals with different expertise. While some aspects of transplantation have become routine, others aspects require innovation. This is where the experience of the team can make the difference between success and failure for an individual patient, particularly if the problem is unusual or serious.
Our multidisciplinary lung transplant team includes pulmonologists, transplant surgeons, nurse practitioners and coordinators, a social worker and an administrative assistant. Each member of the team will want to get to know you and will play different roles in your care. Below you'll find more information on our lung transplant team and the critical role they play in this process.
Role of the Pre Transplant Nurse Coordinator: This person coordinates your care through the transplant evaluation process up until transplantation. In consultation with the transplant pulmonologists and surgeons, they screen medical records of patients referred for consideration of transplant, and coordinate the evaluation process. The transplant coordinator educates all patients prior to transplant about the evaluation process and post transplant care.
Nurse Practitioner: Adam Rabinowitz
Role of the Nurse Practitioner: Transplant nurse practitioners coordinate care throughout the transplant process by maintaining open communication between all team members. They are usually the primary point of contact for referring physicians, team physicians, and patients alike. Our nurses have advanced practice degrees and extensive experience in the management of difficult lung problems and of lung transplant patients. They are able to perform history and physical examination, order tests, make diagnoses, and write prescriptions. After transplant they coordinate care, including adjustment of immunosuppressive medications, ordering and following up on scheduled tests, and keeping the patient and referring physicians informed about progress.
Role of the Administrative Assistant: The administrative assistant will answer the telephone when the patient or family member calls during office hours. They may answer basic questions, arrange for records to be conveyed to and from referring doctors, and schedule any tests or lab work that may be needed. Often they can help solve problems and answer basic questions. In other instances they will pass questions along to the nurse practitioner or physician. Often the administrative assistant may be the person who calls back with routine test results or information.
Role of the Social Worker: The social worker helps to marshal the personal and financial resources necessary to have a successful transplant. They can help the patient meet other transplant recipients or those waiting for transplantation. They will also help the patient and family better cope with the expected emotional stress of waiting for new lung(s). A psychosocial assesment, which includes the social worker, patient, and patient's support people, is generally completed prior to listing. All organ transplant patients are welcome to attend a transplant education series, which meets on the third Tuesday of each month.
Role of the Financial Coordinator: The financial coordinator verifies each prospective patient's insurance benefits and provides that informatmion to the patient and the transplant team. The coordinator also obtains the authorization from the insurance company for the transplant evaluation and organ transplant.
Role of the Transplant Pulmonologist: Transplant pulmonologists participate in the pre-transplant evaluation, in management around transplant, and with the long-term care of lung transplant recipients. The lung transplant physician team includes experts in the evaluation and management of patients with each disease associated with lung failure. They interpret lung function studies and X-rays. Using these tests as guides, and based on thorough patient history, symptoms assessment, and physical examination, they gauge whether transplant is a reasonable choice, and, if so, when. They perform bronchoscopy and transbronchial ("through the airway") lung biopsy procedures.
In addition to transplantation, they will consider or provide other options for lung failure treatment, including changes in the drugs used or their doses, or clinical trials of new medicines or approaches. Once transplantation is chosen as the best option for a given patient, the transplant pulmonologists direct medical management in conjunction with the referring physicians and the transplant nurse practitioners. The goal of this close monitoring by the transplant physicians and transplant nurse practitioners is to keep the patient in the best possible condition while awaiting transplant. This approach can prevent life-threatening problems from arising, or facilitate quick and effective response with medicines or even a temporary artificial lung pump ("ECMO") if a patient deteriorates while waiting for a new heart.
After transplant, the pulmonologist performs regularly scheduled and episodic bronchoscopic examinations, and may perform trans-bronchial lung biopsies during bronchoscopy. In addition, the pulmonary physician team follows patients closely along with the surgeons and nurses, helps to adjust anti-rejection, blood pressure, and other medications, institutes and monitors preventive medical strategies (lipid lowering, exercise regimen), and treats other medical problems (diabetes, hypertension) that may arise.
Role of the Transplant Surgeon: The transplant surgeons work together and coordinate the teams of doctors, nurses, and allied health care providers who perform the transplant. Typically one surgeon will travel with a team to the hospital where the donor is located, to remove the lung from the donor and to "put it to sleep" in a way that is likely to protect ("preserve") its function. Meanwhile, another team of surgeons will prepare the patient to receive their new lung, and then perform the actual transplant procedure. In addition to providing peri-operative care, the surgical team participates actively in the evaluation process, and in the pre- and long-term post-operative management.
During the evaluation phase the candidate's primary contact person will be the pre-transplant nurse coordinator.
Once the evaluation is complete, the transplant team will decide if lung transplant is the best option. The risks and benefits will be discussed with each patient. If the patient and the transplant team agree that transplantation is the best available choice, the patient is then placed on the transplant waiting list at the University of Maryland.