Not all transplant nurses do the same kind of work. Because a kidney or part of a liver can be transplanted from a live donor, there are nurses who work with them every step of the way and for years after. Helene Wilkinson, RN, is a Living Donor Kidney Coordinator at University of Maryland Medical Center, in Baltimore. She took some time to answer questions about her job and how it differs from nurses who work with deceased donor organs.
Helene Wilkinson, RN
As a living donor transplant coordinator, what does your job entail? What do you do daily? Do you work solely with donors or recipients? Or do you work with both?
I help guide potential kidney donors through our workup process, schedule surgery, and provide follow-up for two years after surgery. There are two coordinators on our team that work solely with recipients, and my coworker, Jastine Paran, and I work up the donors. We have one other coordinator who works with the paired kidney exchange program, for donors who are not compatible matches for their intended recipients.
The first step in the donor process is evaluating questionnaires, which tells us about the potential donor’s medical history, surgical history, medications, allergies, and psychosocial information. If the donor passes the initial qualifications, we have them complete a blood test to see if they are a match for their intended recipient. If they match, I notify them, and then send them a long list of blood and urine labs to complete. I evaluate the results, and if they are normal, the donor is scheduled to come in for a “donor day evaluation,” which is a full day of testing to determine if kidney donation is safe for them.
During the evaluation day, the donor has an EKG, chest X-ray, and CT scan completed. The coordinators teach an hour-long education session and sit in with the surgeon for a consult with the patient. The donor also meets with a nephrologist and social worker. I compile all the information from these first three steps into a chart and present the information to our transplant committee, which meets every week. The committee consists of transplant surgeons, nephrologists, pharmacists, social workers, and financial coordinators. If the donor is approved by the committee, we schedule them for surgery and pre-admission testing. After surgery, we schedule a post-op evaluation appointment with the surgeon. Then we collect labs on the donor for 2 years postoperatively.
How is this type of coordinator different from one who works with recipients who are receiving donated organs from the deceased?
My role is separate from the deceased donor transplant coordinators. They focus on getting potential kidney recipients worked up and ready to be put on the kidney transplant wait list. They help recipients through their evaluation days, present the patients to the deceased donor committee, and register the patients on the wait list for a deceased donor kidney. I worked in the recipient coordinator role for 6 months before becoming a living donor coordinator. Both roles are very rewarding.
Why did you choose this type of nursing?
I worked on the kidney and liver transplant floor at another hospital for three years. I was ready to step away from working nights, weekends, and holidays, but felt a strong connection with the transplant population. One of my coworkers there had started working as a coordinator at University of Maryland a year prior, and she contacted me about a job position that opened. I interviewed and was offered the position within three days of finding out about the job. It felt like it was meant to be.
What are the biggest challenges of being a living donor transplant coordinator?
The biggest challenge of my job is notifying patients when they are no longer candidates for kidney donation. Our workup is in-depth, and every test requested by our team is to ensure that kidney donation is completely safe for our donors. There are times that I am working with patients for months, and there is a new finding that rules the donor out as a candidate. It is always heartbreaking to make that phone call.
Another challenge is when donors become stressed out about our workup process. There are a lot of unknowns, and sometimes we need to do last-minute testing prior to surgery. Occasionally, patients take out their stress about the process on the coordinators, which can be disheartening. It’s important during those times to step back, view the scenario from the donor’s perspective, and make sure to respond to every situation with compassion and empathy. I am grateful that I am close with the other coordinators in my office, and we have a strong support system to help each other through the tough times!
What are the greatest rewards?
The rewards of my position far outweigh the challenges. Kidney donors are a special patient cohort. These are people who are willing to undergo a surgical procedure to give a piece of themselves to friends and families. Some donors give their kidneys to someone they have never met. I get to partner with the donor through the whole process of giving a kidney to someone else. Every day, I witness the miracle of someone performing a selfless act to better the life of another. I am so deeply inspired by the actions of my donors.
I am also so grateful for, and inspired by, our transplant team. I have a great boss, Tina Stern, who supports me wholeheartedly in my coordinator role, and I work with multiple surgeons who have a deep-seated passion and determination to better their patients’ lives. The coordinators and assistants in my office have become family to me. We support each other and collaborate as a team to help get our patients to surgery as quickly and efficiently as possible. When people ask me if I like my job, I can honestly respond that I love what I do.
What would you say to someone considering this type of nursing work?
If you are considering a job as a transplant coordinator, I highly recommend first having some experience working as a nurse on a transplant floor or intensive care unit. A lot of our coordinators come from this background, and it helps to have the insights gained from working on these types of floors.
If you are feeling inspired about organ donation, there are a number of groups that you can get involved with for volunteer work. This includes organ procurement organizations, such as: The Living Legacy Foundation, which facilitates donation, transplantation, donor family support, and education throughout most of Maryland; Transplant Recipients International Organization; National Kidney Foundation; and UNOS, the United Network for Organ Sharing.
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