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Courtesy of Johns Hopkins Hospital	More NurseWeek Features   Smoke-Free Zone   Nurses and patients tackle nicotine addiction   Bloodless Survival     Surgical techniques to use when transfusion drops out of the equation
Michele Walton, RN, a transplant nurse at Johns Hopkins Hospital in Baltimore, administers IV medication to a patient. Transplant nursing is becoming even more exciting, as medical professionals have developed strategies within the last few decades that have expanded the living donor pool.

Terri Cook, RN, has met patients with such advanced stages of lung disease that they couldn't even sneeze. But, after these patients-some of whom were in wheelchairs-had undergone lung transplants, Cook has seen them ride horses in horse shows, run farms and play basketball.

"It's exciting when it works and people feel they have such a benefit from transplants, and I guess that's what keeps me doing [my work as a transplant coordinator]," said Cook, coordinator and member of the lung transplant team at Johns Hopkins Hospital in Baltimore.

Transplant nursing is becoming even more exciting, as medical professionals have developed strategies within the last few decades that have expanded the living donor pool. The strategies also have allowed medical professionals to perform rescue therapy on patients who produced antibodies after their transplants to attack the donated kidney.

Gone are the days when kidney donors and recipients had to be related and have compatible blood types with a negative crossmatch-meaning that the recipient could not have preformed antibodies against the donor's blood.

Today, medical professionals use plasmapheresis, which removes antibodies, on kidney recipients whose blood types are incompatible with their donors' or who have positive crossmatches with their donors.

Then, kidney recipients undergo a procedure called intravenous immunoglobulin (IVIG) to restore the antibodies that would protect them from infection but not attack the donated kidney. IVIG modulates the immune system so that it either no longer makes the antibodies or no longer responds to the donor's antigens, said Mary Jo Holechek, MS, CRNP, CNN, nurse practitioner in the adult abdominal organ transplant service at Hopkins.

The living donor pool also has increased because of the advent of living liver donor transplants and the laproscopic procedure for kidney donors.

Although only a handful of facilities in the United States perform plasmapheresis, IVIG, living liver donor transplants and laproscopic procedures, Holechek said she sees more facilities using the procedures within the next five to 10 years. As more facilities adopt the procedures, more patients should receive transplants and live longer, better-quality lives.

Medical professionals have used plasmapheresis, or the procedure of removing a patient's plasma, where antibodies reside, to treat various diseases since the 1970s. Hopkins began using the procedure on kidney patients in 1994.

During the first plasmapheresis on a kidney patient at Hopkins, the donor and recipient had a negative crossmatch before the transplant; however, the procedure was used on the recipient after the transplant because the recipient had begun to produce large quantities of antibodies to attack the donated kidney.

From this form of "rescue therapy," where antibodies are removed after the kidney transplant, pre-emptive therapy-or removing the antibodies before the transplant-evolved, so that plasmapheresis could be used even on recipients who showed a positive crossmatch before the transplant. Hopkins first used the pre-emptive procedure in 1998.

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