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School of Medicine
The Cutting Edge - Teamwork and Communication are Key to Lung Transplant Success
Cutting Edge Fall 2009
Teamwork and Communication are Key to Lung Transplant Success
Date: December 21, 2009
Members of the lung transplant team meet regularly to discuss patient cases.
In the most severe cases, it can take only a few hours for a patient to be approved for and receive a new pair of lungs. The recovery, however, can take months, even a year or more. But a successful lung transplant requires something more than time and a surgeon. It takes a team effort.
In the weeks, months or years following surgery, lung transplant patients are vulnerable to myriad risks and difficulties, from their demanding medication regimens to illness, infection or organ rejection. Ensuring a good outcome means careful coordination among providers based throughout the hospital—pharmacists, pulmonologists, social workers, physical therapists and, of course, the transplant coordinators and surgeons—whose job doesn’t end when the incision is closed.
“During the year after the operation, patients may experience a lot of different challenges and problems,” says cardiac surgeon Ashish Shah, director of Hopkins Hospital’s lung transplant program. “That’s why the team is so important for understanding and managing those problems and avoiding trouble so that patients can continue to heal rather than have setbacks that might injure the lungs.”
The procedure is a heavy undertaking, even in the challenging and complex world of transplant surgery. Shah and his colleagues perform about 20 lung transplants each year. While that number might sound low compared to other organ transplants, Hopkins remains one of the higher-volume hospitals in the nation, in part because of the program’s aggressive approach. “We use every possible donor,” Shah says, “and as a result, most of the patients on our waiting list get transplants.”
Even so, only about 20 percent of patients referred to the lung transplant program actually make the list. The decision to transplant is made by the entire team, Shah says, and it depends on a long list of factors, including any health problems that might render the new pair of lungs unuseful. The team makes the call at its weekly meeting when the members gather to discuss each individual case. “There’s a lot of work that goes into screening these patients,” Shah says. “We know that for the best chance of success, there has to be a lot of communication and understanding between those of us providing the care.”
Without complications, patients spend two to three weeks recovering in the hospital. When things go wrong, all bets are off, Shah says: “We’ve had people spend six months with us.” During such times, the multidisciplinary approach of the transplant team becomes crucial to patients’ recovery. Patients may find themselves working with several providers from different disciplines throughout the hospital, or even staying on different floors. For instance, the medical intensive care unit may take over care when the transplant is finished, all while communicating constantly with the patient’s pulmonologist and surgeon.
“We really don’t want to have to reinvent the wheel or create avoidable problems when we’re tending to a patient,” Shah says. “The team really encompasses every area of the hospital, respiratory therapists, specialists and physical therapists, who are all working with one another to make sure a patient does well.”
To schedule an appointment with the Johns Hopkins Lung Transplant Program, call 410-614-4505