There are more than 115,000 individuals in the United States awaiting a potentially lifesaving kidney, liver, pancreas, heart, lung, and/or intestine transplant. This number greatly overshadows the 28,052 solid organ transplants completed in 2012 (http://optn.transplant.hrsa.gov/). Although this imbalance seems dramatic, pharmacists are making a difference in closing this disparity.
Transplant pharmacists are actively involved in efforts by transplant centers to increase and efficiently use the potential organ pool. Many transplant pharmacists assist with living donor programs. Living donation is most common with kidney transplantation, although living donation is also available with lungs and livers (http://www.transplantliving.org/living-donation/). Transplant pharmacists are involved in education and management of both the donor and the recipient. Additionally, many transplant centers participate in paired kidney exchange programs, in which incompatible blood type donor and recipient pairs are matched with others who are compatible. Transplant pharmacists are involved in evaluating patients, helping to make decisions for matching and post-transplant care. Transplant pharmacists also can be key decision makers in their transplant center’s kidney desensitization program. Desensitization typically involves plasmapheresis and/or a combination of medications, such as IV immunoglobulin and rituximab, to reduce the amount and strength of circulating antibodies in the potential recipient to make a previously incompatible donor and recipient pair compatible. Alloway et al have further outlined work roles and responsibilities of the transplant pharmacist (Am J Transplant 2011;11:1576-1583).
Organ Donation Awareness
Beyond routine work duties, many transplant pharmacists have helped to educate the community about organ donor awareness, thus allowing these pharmacists to embrace the public health promotion role that is expected of pharmacists in all areas of practice. Pharmacy students have embraced these organ donation awareness projects/events as well, working closely with the transplant pharmacy community. These collaborations have allowed pharmacy students to learn more about the field of transplant pharmacy.
For the past four years, the American Society of Transplantation (AST) Transplant Pharmacy Community of Practice (CoP) has supported an annual Organ Donation Awareness Challenge. The Challenge highlights partnerships with U.S. schools of pharmacy to increase donor awareness. Past projects have ranged from holding organ donation drives and helping community members sign up on state online registries. One particularly creative example included the development of a special ice cream flavor to celebrate Donate Life Month in April. Past winners of the Challenge have received recognition at the annual American Transplant Congress, with the presentation of an engraved plaque from AST recognizing their school.
The Challenge has been well received by pharmacy students. Jillian Descourouez, PharmD, BCPS, a clinical pharmacist in solid organ transplant at the University of Wisconsin Hospital and Clinics, in Madison, explained, “What amazes me most about the Challenge is the fact that so many students are willing to put in a vast amount of time and energy in developing and implementing such a wide variety of events, with little more incentive than increasing organ donation awareness and a small donation from the American Society of Transplantation for the winning team. While some people may think that pharmacy students have too many things going on with school, work, clubs and their personal lives to dedicate much time to volunteerism, the students who have participated in the Challenge prove this notion wrong.”
Participation in the Challenge has risen steeply in four short years, with only a few schools of pharmacy participating in 2009 to 13 schools participating this past year. The winner of the 2012-2013 Challenge, University of Arkansas for Medical Sciences (UAMS) College of Pharmacy, recently was recognized at the 2013 American Transplant Congress. UAMS pharmacy students educated nearly 300 high school students at four different high schools on organ donation. One of the education sessions was recorded and broadcast by a local news station with an interview of one of the group’s members. Also, Seth Heldenbrand, PharmD, a clinical specialist of solid organ transplant and an associate professor at UAMS College of Pharmacy, participated in a different live local NBC news interview discussing the common myths regarding organ donation. UAMS students educated approximately 200 adults in person and collected more than 200 organ donation pledge forms, many from high school students. Additionally, UAMS students raised $1,000 for their local organ procurement organization by selling Donate Life Month shirts that they designed.
New groups are participating in the Challenge each year. Karen Hardinger, PharmD, BCPS, a clinical associate professor of pharmacy practice at the University of Missouri-Kansas City (UMKC) School of Pharmacy, said UMKC “participated in the initiative for the first time last year. The students raised donor awareness through health fairs and created a manual that instructs students on how to educate potential donors. The students were able to reach numerous potential donors through their efforts and educated many people. I would encourage all schools to participate in this very beneficial competition.”
The Rewards of Educating The Public
Pharmacy students and the community benefit from participation in the Challenge. Dr. Descourouez said, “The Challenge helps students realize there is a bigger picture than completing pharmacy school. It helps to keep their education in perspective as they realize the impact they can have on health care across the United States. By responding to the call for organ donation awareness and increasing the number of registered donors, the pharmacy students participating in the Challenge are increasing the odds that someone waiting will receive a lifesaving organ.”
Pharmacist participants of the Challenge have noted a sense of fulfillment with conducting organ donation awareness projects. “Getting involved with our students and community to promote organ donation awareness was one of the most rewarding things I have done in my career as a transplant pharmacist,” said Dr. Heldenbrand.
This upcoming year, the AST Transplant Pharmacy CoP is supporting the fifth annual Organ Donation Awareness Challenge. The ultimate goal for the project is to have all U.S. schools of pharmacy participating in at least one organ donation awareness activity each year. Each school of pharmacy has been assigned a transplant pharmacist point-of-contact/liaison for assistance with projects. To submit projects for the Challenge, applicants must have a collaborator who is a current member of the AST Transplant Pharmacy CoP. Applicants should submit a two-page, typed summary of activities in paragraph form via email to Barrett Crowther at firstname.lastname@example.org. The submission deadline for the 2013-2014 academic year is May 19, 2014. Those interested in more information regarding the annual AST Transplant Pharmacy CoP Organ Donation Challenge and a copy of the Organ Donation Challenge manual, which lists potential transplant pharmacist liaisons for the Challenge also can email Dr. Crowther at Barrett.Crowther@uhs-sa.com.
Dr. Crowther reported no relevant financial conflict of interest.
The Transplant Pharmacy Community is a major stakeholder in the promotion of organ donation, because without donation there is simply no transplantation. Realization of this undeniable fact has led the American Society of Transplantation’s (AST) Pharmacist Community of Practice to include promotion of organ donor awareness as a major goal since the inception of this community. There can never be enough community education and engagement to explain the “miracle of transplantation” to the public. As pharmacy professionals experiencing this miracle firsthand, we must all do our best to spread the “good news” of transplantation to our colleagues, friends and families. Pharmacists are the most accessible of all health care professionals, and we can collectively have a powerful impact by virtue of this reach.
Pharmacy professionals and students are embracing the entire challenge of transplantation today, and that must include the voices of our patients and their families when it comes to organ donation. You can promote organ donor awareness in many ways and here is a list to start from:
As AST president Daniel R. Salomon, MD, has said, the real answer (to reducing the waitlist of almost 120,000 people) remains, “It’s donation, stupid.” As a pharmacy professional, please help advance this goal by making organ donation awareness part of your life.
During the next year, “The Transplant Pharmacist” column will continue to present contemporary issues in transplant pharmacy for examination. Topics will include novel patient education techniques, analysis of the transplant pharmacy business model and new drug use developments.
If you have any ideas for column topics, please email me at Eric.Tichy@ynhh.org.