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JC was referred for liver transplantation to the Liver Transplant Unit at Austin Health in December 2009. At the time of referral, JC was a 36-year-old male with primary sclerosing cholangitis (PSC) and ulcerative colitis (UC). He was managed medically for a few months and then completed a liver transplant work-up. He was placed on the Victorian Liver Transplant Waiting List in May 2010. In late June 2010, his bilirubin was rising, and he was jaundiced and lethargic. A week later, his alanine aminotransferase (ALT) began rising. In early July, he was admitted to hospital in acute liver failure. His condition continued to deteriorate and he was listed as a Category 2a across Australia and New Zealand in mid-July. Category 2a is national liver transplant listing for patients suitable for transplantation with acute liver failure from whatever cause who are not yet ventilated but who meet the King's College criteria. At the time of listing, there was no diagnosis for his acute failure. The purpose of this paper is to explore JC's case. [ABSTRACT FROM AUTHOR]

Collection of blood and marrow stem cells from healthy donors for transplant into patients with life-threatening illness is well established in clinical practice. More than 600 allogeneic transplants are undertaken each year in Australia. Policies for donor selection, assessment, care and follow-up are standardised and monitored by regulatory authorities4,5. This paper aims to report the following cases in light of published literature. All identifying details have been removed to protect patient privacy. The first case is a 68-year-old male, Mr X, who experienced hypotension and bradycardia, necessitating admission to the coronary care unit after donating bone marrow to his brother. He also experienced pain and fatigue for several weeks after donation. The second case is a 37-year-old female, Ms Z, who required insertion of a large bore central venous catheter to ensure adequate venous access for apheresis stem cell donation for her sister. She experienced pain from filgrastim injections and an episode of hypocalcaemia during apheresis. Both donors made a full recovery. However, the donation process is not entirely without risk and these cases emphasise the importance of rigorous donor screening, donor education to ensure informed consent, and follow-up of donors in the long term. [ABSTRACT FROM AUTHOR]

As living renal donors face a unique decision of self-sacrifice that is not without risk, there is an ethical imperative for health professionals to understand the donors' perspective. The findings presented in this paper contribute to this area by documenting living renal donors' expectations of quality of life and longevity for the recipient, post-transplant. The longitudinal study involved an open-ended, explorative, qualitative, methodological approach, involving interviews with 20 (n=20) living kidney donors at four points in time over two years. The findings in this paper are from the first interview prior to the donation surgery. The findings on the donors' expectations for the recipients' future were predominantly characterised by a tension between an enthusiastic optimism and a realistic awareness of the medical problems associated with the kidney disease and transplantation. In terms of the immediacy of the transplant operation, the donors expressed high hopes of success combined with an informed understanding of the possibility of rejection. The donors interviewed expressed an acceptance of such risks. The important longitudinal finding is that the cohort demonstrated an ongoing high level of satisfaction with their decision making. Consequently, the findings on the living renal donors' perception about the recipients' quality of life and longevity can be viewed as reflecting an appropriately screened and satisfied group of donors. [ABSTRACT FROM AUTHOR]

Kidney transplantation is an effective treatment if patients adhere to their prescribed medications, whilst non-adherence jeopardises graft survival. This paper aims to outline the design, development and evaluation of a video, which was created in partnership with patients, to support medication adherence in kidney transplant recipients at 1-4 months post-transplantation. This study formed part of a larger, three-phase intervention research project. Patients were recruited from five hospitals that offer adult kidney transplantation in Victoria, Australia. During Phase One, 25 patients who had maintained their graft for ≥8 months or had experienced a graft loss due to medication non-adherence were interviewed. The transcripts of the interviews were analysed to identify potential storytellers and the story plot. In Phase Two, storytellers of both genders, different ages and ethnicities were involved in the videotaping process. The first draft of the video was evaluated by an expert panel using content validity. During Phase Three, the final 18-minute video, which addressed transplant medication management, was viewed by 33 newly transplanted kidney recipients. To them, the video reiterated the importance of medication adherence and 62% thought the video contained helpful tips. Upon concluding the intervention period, five participants from the intervention group participated in a focus group to evaluate the acceptability of the video, which revealed a mixed reaction from the participants that are mainly positive. Using patients' stories, which is a novel way of engaging newly transplanted kidney recipients, has the potential to support medication adherence and promote long-term graft success. [ABSTRACT FROM AUTHOR]

Purpose Since 2006, the Alfred Hospital has increasingly utilised controlled DCD donor lungs to optimise LTx opportunities and reduced waiting list (WL) deaths. This study evaluated the impact of DCD donation on LTx WL time and mortality, and compared post-LTx outcomes of DCD and contemporaneous DBD LTx performed over the first 10 years. Method This was a retrospective analysis of all LTx done at our institution between May 2006 and February 2017 (n=696, 150 DCD LTx, 546 DBD LTx) was undertaken. WL time/mortality, donor and recipient demographics, early outcome measures, survival and cause of death were compared. Our institution regularly utilises extended DCD and DBD donor lungs; however, it does not yet routinely utilise ex-vivo lung perfusion (EVLP) to evaluate these extended donor lungs, unlike many programs in the USA and Europe. Results The use of DCD donors has resulted in 25% more LTx annually, reduced overall WL times (245 to 135 days, p<0.001) and WL mortality (29% to 5%, p<0.01) from 2006 to 2017 respectively. Compared to DBD, DCD donors were intubated in ICU Longer (115 vs 79hrs, p<0.01), were older (45 vs 41 yrs, p<0.01) and were less commonly distant (>300 km) donors (20% vs 35%, p<0.01). DCD recipients compared to DBD had a reduced WL time (101 vs 120 days, p=0.03) and longer graft ischaemic time (323 vs 287 mins, p<0.01). There was no difference in intensive care unit (ICU) or hospital length of stay between DCD and DBD; and importantly, no significant difference in 1, 5 or 10 year survival rates comparing DCD vs DBD (96%, 69% and 53% vs 92%, 64% and 51% respectively, p=ns). Conclusions Controlled DCD donation has significantly and safely increased overall LTx numbers, without reducing DBD LTx (Figure 1), and has also reduced WL time and mortality with excellent 1, 5 and 10 year LTx survival for both DCD and DBD LTx compared to ISHLT at our institution (Figure 2). Importantly, our results also show that EVLP is not required for a successful utilisation of DCD donor lungs for LTx. [ABSTRACT FROM AUTHOR]

Type 2 diabetes mellitus (DM) in the renal transplant population is becoming a major concern and cardiovascular disease due to diabetes is the most common long-term effect of kidney transplantation. Diabetes, if not treated and managed effectively post-transplant, can lead to devastating consequences with increased graft and recipient loss. Clearly this increasing emergence of diabetes post-transplant points to a strong need for early identification so effective management can be implemented. This paper identifies why there is an increased risk of diabetes in the post-transplant population, what clinical gaps exists in identifying and diagnosing these patients, what the current recommendations are to manage this chronic illness and how the introduction of a nurse practitioner can fill this gap within their scope of practice. [ABSTRACT FROM AUTHOR]

The article discusses the 2011 Transplant Nurses Association (TNA) Conference that was held on 13–14 October at the Crowne Plaza Hotel in Adelaide, Australia. Several topics discussed at the conference included an overview of the TNA's inception and development, organ procurement process in the operating theatres and current issues in lung transplantation. Results for the winners of the free paper and poster sessions are also included.

The article discusses the highlights of the 2013 Transplant Nursing Association (TNA) Conference. The presentation "Improving Medication Adherence in Transplantation" was delivered by Professor Cynthia Russel. An update on the developments in the Donation Sector was given. The winners for the Best Paper, Best Poster and Best First Time Presenter for the year were named.

The number of people waiting for a transplant far outweighs the number of organ donors in Australia. The Northern Territory (NT) of Australia has the highest incidence of end-stage kidney disease (ESKD) in Australia. A large proportion of those with ESKD are First Nations Australians that require renal dialysis and who are more likely to require and benefit from a renal transplant. In 2018, 53% (21/40) of potential organ donors referred to DonateLife NT identified as First Nations Australian; one of these went on to become an organ donor. DonateLife NT coordinates all organ donation activities across the NT and is responsible for increasing community awareness, promoting the importance of organ donation, and discussing willingness to be an organ donor with families. During these activities with First Nations Australians, a variety of views that influence thoughts and decision making about organ donation have become very apparent. To explore this further, a literature review was undertaken to determine the views on organ donation among First Nations People and consider how this compared to the anecdotal experience of DonateLife NT. Findings from the literature review are consistent with the experience of DonateLife NT. To optimise dialogue about organ donation with First Nations People, it must be conducted in a respectful and culturally appropriate way. This serves to empower through enhancing knowledge and understanding and enables the ability to make informed decisions. Further qualitative research is recommended to increase understanding of the views of First Nations Australians about organ donation and ultimately ensure that donation discussions are appropriately informed, culturally secure, and form part of quality end of life care in hospital settings. [ABSTRACT FROM AUTHOR]

Coordinating organ donation is complex, multifaceted and resource-demanding. The acceptance of an organ offer in NSW is largely dependent upon the accuracy and quality of information given by the state donor nurse consultants to the transplant coordinators during the referral process. The information is conveyed as a verbal report from data collected on the Australian Transplant Coordinators' Association (ATCA) Confidential Donor Referral Form (CDRF). Organ offers before 2006 were previously provided through separate phone calls to each transplant coordinator or unit. One organ offer can take up to 30-45 minutes and the process is prolonged for interstate referrals, thereby lengthening the organ donation process. Miscommunication can occur between multiple telephone exchanges; therefore, an organ offer via teleconference was trialled in New South Wales (NSW) to avoid unclear or inadequate communication. This paper will describe the teleconferencing facilities available in NSW from its trial to implementation. [ABSTRACT FROM AUTHOR]

Absolute uterine factor infertility (AUFI) is defined as the absence (congenital or acquired) of a uterus or the presence of a non-functional uterus, e.g. severe Asherman's, adenomyosis or fibroids. Prior to 2014, the only options for women with AUFI to obtain parenthood were either surrogacy or adoption. For many women, these options are not acceptable due to ethical, religious or financial constraints. Uterus transplantation is an emerging area and has significant research opportunities available. In 2014 the first baby was born following a uterus transplant in Sweden. Several countries have now embarked on establishing a uterus transplant program and, to date, more than 70 transplants have occurred worldwide with 18 live births reported. There is currently no international data registry, therefore these figures may not be accurate. It is proposed that a mandatory data registry becomes available to ensure accurate figures are known. In September 2019, Royal Prince Alfred Hospital was granted ethics approval to establish a uterus transplant database which includes capturing clinical data and research outcomes. The research includes collecting patient-reported outcomes through the use of questionnaires, and collecting additional blood and tissue samples which will be stored in a biobank facility for future research studies. [ABSTRACT FROM AUTHOR]

The advance of renal replacement therapy options for people with end-stage kidney disease has given rise to the development of specialist renal nurses including the renal transplant coordinator. The renal transplant coordinator role requires a high level of specialist knowledge in renal and transplantation nursing plus a commitment to following through with people in the long term. To find out just what renal transplant coordinators in Australia do, an interview was conducted with renal transplant coordinators from each Australian state and territory. Their stories relate to transplanting units; referring centres; and, adult, paediatric, statewide and national renal services. They demonstrate the diversity that exists within the role of the renal transplant coordinator. [ABSTRACT FROM AUTHOR]

The article offers information on the Transplant Nurses Association (TNA) conference on 15–16 November, 2012 at The Rydges Hotel in Melbourne and focused on the theme "transplantation, moving forward into the 21st century". It includes insights to nursing in the 21st century by Susan Chernenko, nurse practitioner and the topics discussed were donation and addiction medicine.

Due to the large number of patients on the waiting list, a relatively low deceased donor rate and a waiting list mortality around 20%, New South Wales (NSW) has been a net importer of donor livers from interstate centres that have declined to use them for various reasons. The Australian National Liver Transplant Unit (ANLTU) at the Royal Prince Alfred hospital (RPA) in Sydney aimed to examine the clinical outcomes of liver transplants using interstate donors where the 'home' state had declined them. From 2004 to 2013, a total of 665 livers were transplanted in our centre, of which 98 donor livers were imported from interstate. After excluding urgent, multi-organ, re-transplants, donation after circulatory death (DCD) and paediatric recipients, there were 55 transplants (interstate group) for comparison with 365 recipients (local group) with the same exclusion criteria. The interstate group had longer cold ischaemic times, compared to the local group (hours, 9.12±0.18 vs 7.22±0.18; P<0.0001). The overall quality of donor graft in the interstate group was significantly worse compared to the local group (DRI, 1.97±0.3 vs 1.57±0.4: P<0.0001). No significant difference in graft survival was recorded between the two groups (months, 93±6.5 vs 96±2.8; NS). Three interstate recipients (5.5%) were re-transplanted compared to 10 (2.7%) in the local group. The ANLTU found that livers that have been declined by other centres can often be transplantable with comparable graft and patient survival. [ABSTRACT FROM AUTHOR]

Aim The recruitment and retention of nurse specialists and Nurse Practitioners (NP) is critical to the viability of the West Australian cardiac transplant program. The aim of this project was to design and implement a training program incorporating education and clinical competency as part of a long-term succession plan. Body Models of care at heart transplant centres were reviewed. Recommendations from the International Society for Heart & Lung Transplantation consensus document on the minimum experience and education qualifications for current adult nursing practice in heart and lung transplantation were considered. Key components and core clinical competencies were identified and a series of 6 modules were designed. An expression of interest for a 6-month clinical nurse (CN) training program was issued; 13 applications for the training position were considered, 2 applicants were accepted. The CNs identified their own learning needs, attending weekly education sessions with the NP and engaged in therapeutic and professional relationships with all members of the multidisciplinary team. Evaluation included direct observation by the NP, case management and self-assessment. Progress and feedback were provided on a weekly basis. Professional development logbooks were completed, providing proof of learning and experience, incorporating clinical example and peer review. Conclusion There was positive feedback from both candidates on completion of their training program, each described an improved knowledge and clinical competency within the specialist area. Succession planning is required to ensure the experience & knowledge of advanced nursing practitioners is shared. The provision of ongoing education and mentorship is needed to continue career development and encourage retention of nurses long into the future. [ABSTRACT FROM AUTHOR]

Background: Cardiac allograft vasculopathy (CAV) in the post-cardiac transplant population is partially attributed to the presence of traditional cardiovascular (CV) risk factors. In order to provide optimal care post-transplant, early identification of modifiable CV risk factors needs to be undertaken and managed appropriately. The purpose of this retrospective project was to: (1) examine the incidence of the CV risk factors of hyperlipidaemia, hypertension, diabetes and obesity in this population, and (2) compare the results with those reported worldwide by the International Society of Heart and Lung Transplantation (ISHLT). Methods: A retrospective audit was undertaken to determine the prevalence of the CV risk factors up to five years after orthotopic heart transplant. A non-random convenience sample was utilised at the Alfred Hospital, Melbourne, Australia. Results: Changes in CV risk factors from baseline to five years after cardiac transplantation were observed in 25 patients (mean age 50 years ±13 with a majority males, n=21). Primary diagnoses were cardiomyopathy, ischaemic heart disease (IHD) and congenital heart disease. Significant differences were observed from baseline to five years post-transplant in systolic blood pressure (BP) (p=.001) and body mass index (BMI) (p<0.001). Five years after transplant, raised cholesterol levels and BMI greater than 25 kg/m2 was observed in over 80%, with raised systolic BP in 42% and diabetes in over a quarter of subjects. Conclusion: This retrospective audit supports monitoring traditional CV risk factors in this vulnerable population. The incidence of CV risk factors identified correlates with ISHLT's reports on this population. [ABSTRACT FROM AUTHOR]

Following an out of hospital cardiac arrest, Matthew donated his kidneys and corneas. Whilst many of the challenges faced during the organ donation process are commonplace, for a regional hospital that had not experienced any donation activity for approximately 10 years, many issues proved difficult. To add to the complexity of the case, Matthew was also a staff member of our regional hospital. What we discovered during this case highlighted the many gaps in our policy and led to the development and implementation of a more comprehensive, relevant document, reflective of the current donation process. By clearly outlining and defining the role each staff member would be required to fulfil during a case (within this health care facility) the donation process has improved markedly. Anecdotally, staff confidence and interest in organ donation has increased, as evidenced by both critical care and operating room staff demonstrating their interest in either participating in further education or, more importantly, becoming clinical champions, in their practice areas, for organ and tissue donation. [ABSTRACT FROM AUTHOR]

The author discusses the Australian government's national reform agenda to increase donation for transplantation. It presents the nine key elements of the national reform agenda and six strategic priorities for 2011-12 that guides the implementation of the national reform agenda. Also discussed are the efforts to increase the consent rate with the delivery of a national Professional Education Package (PEP).

The article presents update on the activities of the Australasian Transplant Coordinators' Association (ATCA) that include the 2013 conference in Sydney, New South Wales, the 2013 ATCA Annual General Meeting (AGM), and the preparation for the Go Live date in 2014.

The author thanks everyone for electing her as the National President of the Transplant Nurses’ Association (TNA). She states that her current role is working as the senior liver transplant coordinator including deceased donation and coordinating the living donor programme. She informs that she recently attended the annual International Transplant Nurses Society symposium in Seattle and that it was a great opportunity to network with other transplant professionals.

The article highlights the success in individual solid organ transplantation since 1967, when the 1st successful pancreas-kidney transplant was done followed by a heart-kidney transplant in 1978.

The author reflects on the completion of 20 years of Transplant Nurses Association (TNA). She states that to understand the history of TNA she poured over several early issues of the Transplant Journal of Australasia (TJA) and found out how TNA has developed into a national body with state branches, standards committee and a national education committee. The author also informs that this is her last editorial and she enjoyed her term immensely.

The author offers a report on the meeting of International Liver Transplant Society Congress in Valencia, during which she updated her knowledge on the latest innovations. She mentions that the Transplant Nurses Association (TNA) and Australasian Transplant Coordinators Association (ATCA) provided delegates with an overview of the organ and tissue donation and transplantation process. She informs that TNA scholarships are available for financial assistance to attend the annual TNA conference.