The pioneer of liver transplantation, Dr Thomas Starzl, once said “The history of medicine is that what was inconceivable yesterday and barely achievable today often becomes routine tomorrow”1. Half a century after the first human liver transplantation, this life-saving procedure is becoming more common due to increasing donor rates.
The jury is in: multiple studies show that exercise and physical activity are linked to improved survival rates in transplant recipients. This is the objective of Fit for Life!, the award-winning initiative of the World Transplant Games Federation that is proudly supported by Astellas and was introduced globally in 2016. The aim of this paper is share the authors’ thoughts on the complexities involved in encouraging people to ‘get fit’.
Liver transplantation is the standard of care for children with end-stage liver disease (ESLD)1. Since 1986, over 370 transplants have been performed at The Children’s Hospital Westmead (CHW). Biliary atresia is the main indicator for liver transplantation with inborn errors of metabolism (IEM), also known as metabolic disease, the second most common indicator for liver transplantation2. In the last three years, the Complex Hepatology and Liver Transplantation Unit received an increasing number of referrals for liver transplant assessment for children with metabolic disease. This paper will discuss these diseases where neurological impairment from repeated metabolic crises is the impetus for referral to our unit, not ESLD. Managing this new cohort of children has presented our team with new challenges and led to changes in our practice. In some transplant centres these livers have been used for domino transplant3.
Organ and tissue donation and subsequent transplantation is a multi-complex procedure, requiring an array of specialist surgeons, physicians and health practitioners. Patients accepted after extensive testing and preparation for the transplant list know that the process of identifying a suitable organ may take some time and while waiting they may continue to physically deteriorate. Transplant surgery is now well established in major Australian hospitals and the current waiting list is approximately 1,400 patients.
Studies of pre- and post-lung transplant patients show the emergence of both positive and negative psychosocial effects. In May 2016 the author, a retired psychologist, underwent a double lung transplant due to deteriorating lung function. At 18 months post-transplant, the author reflected upon the major lessons he learned and the ways in which his transplant provoked him to reconsider many life perspectives.
When engaging with patients preparing for and recovering from organ transplantation, nurses engage with the myriad of medical and surgical procedures and ways in which transplantation impacts quality of life and future aspirations. The critical role played by the carer of a transplant patient is included, along with appropriate hospital-based interventions for both carer and transplant recipient designed to promote psychological well-being.
I was very privileged to receive one of two inaugural Astellas Practice Development Award in 2017 that allowed me to attend the 14th Congress of the International Society for Organ Donation and Procurement (ISODP) in Geneva and visit SwissTransplant in Bern. I divided what I learned from the Congress in to themes as there were many breakout sessions and so many topics to choose from. The days were very long and often began at 7.30 am and finished at 7 pm. I concentrated on the topics of Consent, Ethics, Global perspectives, Education, Tissue, Innovations and Challenges as they relate to my specialty in deceased organ donation.