ChristianaCare is home to Delaware’s only adult kidney transplant program. Its team of six nurses plus other health care professionals coordinate care for hundreds of patients. Led by Heather Crumley, MSN, RN, PCCN, clinical manager, the transplant nursing team serves as the powerhouse of care coordination and quality outcomes for this unique and vulnerable patient population.
The team includes Aline Stant, MSN, RN, Clare Shumate, BSN, RN, Christy Sentman, ADN, RN, Jennifer Davis, MSN, RN, and Stacey Strazzella, BSN, RN, CCRN. ChristianaCare’s kidney transplant program started in 2006 and still cares for many of their first patients.
Before ChristianaCare’s program started, kidney disease patients living in Delaware would drive to Baltimore or Philadelphia several times a week to receive their care. Thanks to this program and its’ nursing team, these patients are able to get nationally recognized care right in their home state. The program follows nearly 300 post-transplant and 200 pre-transplant patients; not only in Delaware but as far as California, Georgia, Florida and Washington state for living donors.
Care Coordination & Education Powerhouse
Clare, Jennifer and Stacey are among the first kidney transplant team members a patient will meet. Their unique focus is on care coordination for pre-transplant patients. A pre-transplant work-up or evaluation can take anywhere from 3 to 12 months and then once placed on a waiting list, patients may wait 5 to 10 years for a transplanted kidney. During this time, Clare, Jennifer and Stacey are working with the multidisciplinary team and patients to schedule tests, track appointments, monitor compliance with hemodialysis sessions, and move patients towards transplant.
Clare shares that education is a major focus of their work on this team; education for patients on transplant and contraindications to transplant, education for family members supporting kidney transplant patients, education for community members on kidney disease prevention and education for hemodialysis centers.
Reflecting upon her work, Jennifer shares that the reason this care coordination and education are critical to their nursing care is because “we are not just helping patients with their kidney disease, through our comprehensive evaluation process, we are also identifying other cancers and diseases in patients and improving their overall health.” Jennifer is one of the newer team members but advocated to be a part of it. “In my experience as a nurse, I believe we all hope and strive to truly make a difference and heal others with our care, and achieving that gives us the most job satisfaction. In this specialty, it really does happen. We heal our community one kidney transplant at a time. It is both a privilege and honor to be part of such an amazing team that helps coordinate giving these patients the ‘gift of life’ through transplant.”
Stacey finds that patients frequently express their gratitude for the nursing partnership during the education and care coordination time prior to transplant. “The patients are very forthcoming about their illness and are extremely hopeful that our program can help them have an improved quality of life. My job is to evaluate them for transplant listing and when they become listed, to make sure their general health maintenance is up to date. This involves a lot of time talking directly with our patients to check on them and be sure they are keeping up with their health care.”
After the care coordination and education process is nearly completed, the nursing team presents the patient to the multidisciplinary transplant team for discussion and decision making. The kidney transplant team includes the transplant surgeons, nephrologists, a pharmacist, a dietitian, a social worker, financial coordinators and the nurse transplant coordinators. The nurse presents the entire overview of the patient’s health evaluation and a collaborative decision is made regarding transplant.
Once a patient is approved for transplant and placed on the list, the waiting begins. All nurses on the kidney transplant team rotate providing on-call coverage 24/7 and 365 days a year in case they get a call that a kidney is available for transplant on one of their patients. They work closely with the United Network for Organ Sharing to ensure patients quickly receive the news of a possible kidney allocation. Jennifer said, “While we all work separately in the many different roles of the transplant team, we all share this wonderful privilege: to be on call to coordinate patients receiving the ‘gift of life.’”
Clare said that helping patients in this way is her calling and the bonds that she and her team develop with patients and families are incredibly strong. She wants nothing more than for the patients they serve to receive a transplant. “We help get them in contact with providers in the community and help coordinate the care they need to stay as healthy as possible throughout their wait time and after transplant. We coordinate this care in the communities where they live, making it as easy as we can for our patients to receive this much needed medical care.”
Living Donation – Care for Exceptional People
Aline has been a nurse for 46 years with 42 of those years caring for kidney patients. She currently serves as the living donor coordinator for ChristianaCare’s kidney transplant program. Living donation is a unique focus and one that Aline finds very special. “Working with living donors is such a different type of nursing. These patients are kind and generous and they donate for many reasons.”
A living donor is a person who has elected to donate one of their kidneys to another person. The living donor may elect to be a non-directed donor, meaning they will donate their kidney to anyone in need or they may elect to be a directed donor, in which they donate their kidney to a specific person. To date, 82 living donors have donated a kidney in Delaware’s transplant program.
These living donors are healthy individuals with an exceptional desire to make a difference in someone’s life. You can read a special story on a Delaware living donor and kidney recipient here.
Aline’s role is to guide the living donor through the process, completing evaluations that will determine the ability of the person to donate their kidney. Unfortunately, 70% of those worked up for living donation are unable to donate a kidney. Aline offers alternatives for those unable to donate; they can serve as a donor champion. A donor champion will go out into the community and advocate for living donation. They educate their neighbors and others on the living donor process and how they can truly change someone’s life.
Aline continues to follow living donors after the kidney donation so she can maximize their wellness and kidney health throughout their lives. Most kidney transplant programs only follow donors for the required two years; however, ChristianaCare’s kidney transplant caregivers continue to see donors as long as they like. This typically involves an annual wellness appointment for living donors.
Aline explains that living donation provides the best outcomes for kidney transplant patients. “The living donor kidney typically lasts longer on average. This is because the kidney comes from a healthy donor and does not go through the trauma of a deceased donor. The cold ischemic time is a lot less with a living donor kidney.” The cold ischemic time refers to the time the kidney goes without blood flow during the transplant process.
Caring for Patients After Transplant
Christy serves as the nurse renal transplant coordinator for post-transplant patients. “I became a nurse because I wanted to be in a profession that serves and I stay for the same reason, to serve people,” Christy says. Several key functions of Christy’s work include laboratory testing, follow-up clinic appointments, caring for the transplanted kidney, monitoring for rejection, provider referrals for follow-up and other multidisciplinary appointments.
Another big part of her work is helping patients manage a new lifestyle post-transplant and without hemodialysis. In a single operation, a kidney patient goes from hemodialysis three times a week with a certain set of appointments and medications to a whole new set of medications and appointments and life without hemodialysis. This is a difficult transition for patients to make and nurses help fill this gap and ease the transition. Patients who have received a kidney transplant are always followed by the team because it takes a village.
As previously mentioned, community outreach is a big part of this team’s work. These nurses are continuously educating the public and other health professions on kidney disease and transplant options. This team organizes and/or participates in 5K marathons that support numerous organizations including the National Kidney Foundation, Gift of Life and Polycystic Kidney Disease Foundation.
Heather, Aline and the ChristianaCare kidney transplant nursing team organize an annual education symposium held for the multidisciplinary team in which health care providers learn about transplant. Planning is currently underway for this year’s symposium, slated for October and likely to be held virtually. The symposium is open to all caregivers in the region and includes topics for nurses, social workers and dieticians.
The nursing and multidisciplinary teams go out into the community for health fairs, blood pressure screenings, and educational events to promote prevention of kidney disease, treatment with transplant and living donor awareness. Additionally, the team always looks forward to the annual holiday party, hosted by the kidney transplant team’s two physician leaders – Drs. Sidney Swanson and Velma Scantlebury – bringing together the kidney transplant team, patients, families and community members for a celebration of life, giving and gratitude.