Transplant Journal of Australasia

Between 1967 and 1971, ICU nurses and surgeons managed the earliest attempts at liver and heart transplantation. As clinical outcomes improved, the role of transplant coordination began to evolve. ICU nurses who had cared for transplant patients transitioned into the emerging role of transplant coordinator, initially supporting patients once they were stable enough for discharge. There were no guidelines or job descriptions for the early transplant coordinators. However, over the past 60 years, this role has continued to develop into a more structured and efficient model, with clearly defined responsibilities among pre-transplant, post-transplant, and inpatient coordinators. In the United States of America (USA), nurse practitioners often manage transplant patients in ambulatory clinics. Long hours, commitment and numerous responsibilities may have led transplant coordinators to a feeling of the job being more than a role. For some it may have become a personal identity.

Over the past 20 years, I have been fortunate to be able to combine clinical nursing expertise with academic research skills to contribute meaningfully to the field of Donation after Circulatory Death (DCD) lung transplantation (LTx). While working as a Lung Transplant Research Coordinator the opportunity arose in 2003 to coordinate and participate in the pre-clinical experimental research work that then led to the establishment of Australia’s first clinical DCD lung transplant program at The Alfred in 2006. My nursing background, particularly in cardiothoracic critical care, combined with research and education qualifications, aided the development of practical clinical protocols that were adopted for clinical DCD LTx throughout Australia. In 2009, I created and led the Australian National DCD Lung Transplant Collaborative, uniting all four national lung transplant centres and demonstrating excellent, non-inferior outcomes for DCD lung recipients compared to recipients of lungs from brain death donors. Due to this Australian DCD LTx experience, I became a founding member, and the only nurse, of the International Society for Heart and Lung Transplantation (ISHLT) DCD LTx Registry Committee, contributing international research and publications that have paved the way for increasing acceptability and utilisation of DCD lung donors for LTx world-wide. A 2011 Churchill Fellowship also widened my global perspective on how the DCD lung donor pool could be further expanded. Recently, the development of ‘delayed DCD’ and Voluntary Assisted Dying DCD lung donation protocols are contributing to more successful DCD lung transplants at The Alfred and nationally. This paper describes my involvement in a 20-year DCD journey; how a clinical ICU nurse equipped with an enquiring mind, research and writing skills, could contribute to transformative changes that optimised LTx donation and successful LTx outcomes for many more recipients.

Kidney paired exchange (KPE) programs have become an essential strategy for overcoming immunological incompatibility between living kidney donors and their intended recipients. Australia and New Zealand independently established national KPE programs in 2010 and 2011, respectively. In 2019, these programs were amalgamated to form the Australian and New Zealand Paired Kidney Exchange (ANZKX) Program, one of the first fully integrated transnational KPE programs worldwide.¹ This collaboration expanded donor–recipient pools, improved access to transplantation for highly sensitised patients in both countries and enabled increasingly complex exchange chains across two national health systems.

The expansion to ANZKX introduced significant clinical, logistical, regulatory and organisational complexity. Central to the success and sustainability of this program is the ANZKX Program Coordinator, whose role underpins communication, coordination, risk mitigation, and adaptability across jurisdictions. This article reviews the evolution of the ANZKX program, including its key innovations over the last 6 years, and highlights the crucial role of the ANZKX Program Coordinator in ensuring safe, equitable and efficient trans-Tasman kidney exchange.

Imlifidase (Idefirix^®) is an enzyme that cleaves circulating IgG antibodies, rapidly converting a positive crossmatch to negative within hours. This creates a short window for kidney transplantation in highly sensitised patients who would otherwise have very limited access to a compatible organ. Imlifidase has provisional Therapeutic Goods Administration approval and has been supported for public funding under the National Health Reform Agreement Highly Specialised Therapy pathway, with delivery intended to be restricted to designated centres. Imlifidase is not durable desensitisation, and the trade-off for transplant access is a high early antibody-mediated rejection risk, intensified immunosuppression, increased infection susceptibility, and a substantial care workload. This article provides transplant nurses and co-ordinators with practical information to support their understanding and delivery of imlifidase-enabled kidney transplantation in Australia, aligned with the 2026 Transplantation Society of Australia and New Zealand guideline.

Objective This study quantifies out-of-pocket expenses incurred by rural and regional Queensland patients during the peri and immediate post-transplant period of renal transplantation and gathers patient feedback on financial experiences.

Design A cross-sectional survey was conducted with patients over 18 years of age who underwent renal transplantation from May to December 2023. Participants completed a questionnaire upon returning to their regional hospital, capturing demographics, income sources, expenses and financial assistance received.

Setting The study took place in regional and rural Queensland, Australia, focusing on patients traveling to Brisbane for transplantation.

Main Outcome Measures Average total out-of-pocket expenses, including accommodation, food, transport and medications, along with qualitative feedback on financial burdens.

Results Twelve patients completed the survey, revealing an average out-of-pocket expense of $3,390.49, with food (45%) and accommodation (31%) as major costs. Participants highlighted significant financial strain, especially those without paid leave, and requested increased Queensland Health Patient Transplant Subsidy Scheme (QH-PTSS) coverage for accommodation and transport.

Conclusion Despite the benefits of transplantation, patients face substantial, inadequately addressed costs. Reforming the QH-PTSS to provide comprehensive financial support is crucial for promoting equitable access and reducing financial burdens for rural and regional patients.