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The Complex Multidisciplinary Team Involved in Heart and Lung Transplantation

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Javier Carbone, MD, PhD
Complutense University
Madrid, Spain

The management process for heart and lung transplantation is very complex, with transplantation teams comprising heart and lung surgeons, cardiologists, chest physicians, critical care specialists, and other clinical specialties. Many other professionals are involved in the direct care of patients including specialists in infectious diseases, internal medicine, pediatrics, and clinical immunology. Examples of other clinical services include the nephrology department, where the patient undergoes apheresis for desensitization.

Nurses perform specialized tasks related with distinct procedures of transplantation. Transplant nurses also provide specialized nursing care, support, and education for patients and their families throughout the transplant process. Pre- and post-transplantation activities (preparation for surgery and discharge) are relevant.

Transplantation requires a spectrum of laboratory investigations. Laboratory immunology procedures related to thoracic transplantation include HLA typing of donors and recipients and assessment of anti-HLA and other relevant antibodies. Immunochemical assessment of humoral and cellular immunity markers is also performed. The hematology department covers automated hematology, hemostasis, thrombophilia, and anticoagulation therapy as well as transfusion medicine. Biochemical tests include the assessment of immunosuppressive drug levels. The pathology department covers histopathology of allograft rejection including C4d or C3d deposition in heart and lung allografts and more recently, underlying molecular mechanisms involved in allograft rejection. Radiology departments are actively involved in all kinds of imaging techniques.

The complexity of the procedure involves many other professionals and departments such as psychosocial management of transplant candidacy and post-transplant evaluation. Socioeconomic support and social support are covered by social workers.

A series of allied health professionals also play a role. These include clinical laboratory scientists, clinical officers, dental hygienists, dietitians and nutritionists, laboratory technicians, medical interpreters, medical radiation scientists, occupational therapists, paramedics, perfusionists, physical therapists and physiotherapists, recreational therapists, and social workers.

The multidisciplinary nature of transplantation teams is well established in transplant centers for coordination and performance of procedures and protocols. ■

Disclosure Statement: The author has no conflicts of interest to disclose.

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