Many thanks to Emily Stimpson and Ed Horn for coordinating the content for this month's issue.

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First, we apologize to the ISHLT for this month's issue which lacks fair representation of our Society. Although, all articles are from the United States their content represents concepts and ideas from other countries and applies to what's necessary to enhance the quality of our care and attention to our patients. Many apologies are in order.

In this issue, we begin with a cleansing on Bleaching Organ Procurement Crimes in China by Jacob Lavee in the spotlight. Next, the NHSAH provides us excerpts on Single Ventricle Babies: The Fontans Have Come of Age by Monica Horn, Carolyn Buckley and Helene Morgan, Sense and Sensibilities: Finding Consensus in Adult Cardiothoracic Transplant Nursing by Angela Velleca and a moving summary by Erin Wells' Life is Not Fair.

Robin Klasek and Kyle Dawson start PHARM with Pharmacotherapy Considerations for Agents Used in the Treatment of Non-Tuberculosis Mycobacterial Infections in Cardiothoracic Transplant Recipients. Next is Adam Cochrane with Antifungal Therapeutic Drug Monitoring: Confessions of a Pharmacist, Christopher Arendt with Prothrombin Complex Concentrates to Reverse Warfarin and Treatment Updates in Idiopathic Pulmonary Fibrosis and Considerations in Transplant by Christine Hui before we finish up with the Editor's Corner where a case is made for more involvement from our members to enhance the "equality of condition" of our great International Society.

Vincent Valentine, MD
Links Editor-in-Chief


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Bleaching Organ Procurement Crimes in China

Jay Lavee, MD

For the past thirty years China has been practicing the procurement of organs from executed prisoners for the purpose of organ transplantation [1]. My own personal involvement with the Chinese organ transplantation system started back in 2005, when a Status 1 candidate for heart transplantation notified me that his medical insurance company had instructed him to travel to China in two weeks' time, as he was scheduled to undergo heart transplantation. I later learned that the patient did, indeed, travel to China where the operation took place on the exact date that had been promised [2]. Read more →


Single Ventricle Babies: The Fontans Have Come of Age

Monica Horn, MD, CCRN, CCTC
Carolyn Buckley, MSW
Helene Morgan, MSW

Transplant Coordinator

When earlier literature is compared with the more recent data describing staged surgical palliation for single ventricle infants, skilled surgical technique and precise medical management seem required for better survival. As these children have matured to adolescence, medical experience has revealed improved longevity and quality of life. Over time, these longer term observations have additionally revealed complications possibly associated with the Fontan physiology [1]. Read more →

Sense and Sensibilities: Finding Consensus in Adult Cardiothoracic Transplant Nursing

Angela Velleca, RN, BSN, CCTC

links imageIn November 2014, a consensus document on nursing practice in Adult Heart and Lung Transplantation was published. This document stems from a global transplant nursing conference convened on April 12, 2011 involving members of the ISHLT Nursing, Health Science and Allied Health Council. This conference, which included nursing representatives from 12 countries and 4 continents, sought to define minimal recommendations for transplant nursing education and role responsibilities while also discussing retention strategies and models of care. Of the 77 attendees, 72% were transplant nurse coordinators, 15% were transplant nurse practitioners, 4% were nurse managers, and 6% were nurse researchers. The size of the transplant programs represented ranged from small to large, as defined by the United Network of Organ Sharing. Attendees completed a survey prior to the consensus conference. The survey centered on staffing levels, minimum core competencies, levels of education, roles and responsibilities, and areas of future research. Read more →

Life Is Not Fair

Erin Wells, RN, BSN, CPN

links imageLife is not fair. The sooner you learn that, the better off you will be.

This was my mom's favorite response to all of her three girls' many "that's not fair" comments over the years. Long gone are the days when life's list of injustices included who got to ride shotgun, who used the last of the hot water or who drank the last of the milk. As a transplant coordinator, watching patients and families who wait for a transplant that never comes is what comes to mind when I think about the word "unfair". While losing a patient is never easy, there is an added sharp edge for me when it is a loss of someone who didn't get their shot at a second chance. Read more →


Pharmacotherapy Considerations for Agents Used in the Treatment of Non-Tuberculosis Mycobacterial Infections in Cardiothoracic Transplant Recipients

Robin Klasek, PharmD
Kyle Dawson, PharmD, BCPS

The number of identified non-tuberculosis mycobacteria (NTM) species has increased rapidly over the last decade, and, due to their impaired immunity, cardiothoracic transplant recipients are now at an even greater risk of infection from these organisms [1,2]. Recent increases in the incidence/prevalence of NTMs can be attributed to advancements in the techniques for their detection and identification [1]. The incidence of NTM infections is greater in lung and heart transplant recipients, with rates up to approximately 8% and 3%, respectively. The most common manifestations of NTM infections are pulmonary and skin, or soft tissue infections, and the frequency and manifestation of NTM diseases are partially determined by the geographic distribution of the different species [3]. Read more →

Antifungal Therapeutic Drug Monitoring: Confessions of a Pharmacist

Adam Cochrane, PharmD, BCPS

links imageThe ability to perform therapeutic drug monitoring (TDM) for antifungal therapy has been available for nearly a decade. Initially, there was not a wealth of data on how to adjust doses based on serum drug levels, or what levels should be targeted to maximize efficacy and minimize toxicity. To be fair, I wasn't quite sure of the role of antifungal TDM in our patient population either. Over time, we have gained significant experience with antifungal TDM, and it is now the standard for all of our patients on voriconazole and posaconazole. Read more →

Prothrombin Complex Concentrates to Reverse Warfarin

Christopher Arendt, PharmD, RPh

links imageIf you prick us, do we not bleed? - William Shakespeare, The Merchant of Venice, Act III, Scene 1

For decades we have used oral anticoagulants to reduce thrombotic risk. All too familiar are the surgeon, anesthesiologist, perfusionist, and allied staff with the effects of the vitamin K antagonist (VKA) warfarin in the pre-, peri- and postoperative arenas. Center specific protocols and professional guidelines have been developed to contend with the balance between bleeding and clotting risks and anticoagulation management at varied times in a patients surgical care [1,2,3].Warfarin reversal has traditionally been done with the use of intravenous (IV) or oral phytonadione (Vit K) and Fresh Frozen Plasma (FFP) to replete vitamin K dependent clotting factors (II, VII, XI, X). Read more →

Treatment Updates in Idiopathic Pulmonary Fibrosis and Considerations in Transplant

Christine Hui, PharmD

links imageIdiopathic pulmonary fibrosis (IPF) is a chronic, progressive, and fatal lung disease that is characterized by irreversible loss of lung function [1,2,3]. IPF remains the most common interstitial lung disease referred for lung transplantation and the second most common disease for which lung transplantation is performed [4,5]. Two medications, pirfenidone (Esbriet) and nintedanib (Ofev), appear to slow disease progression in IPF and were recently approved for use in the United States by the Food and Drug Administration (FDA) [2,3,6,7]. The approval of these medications signifies a turning point in the management of IPF as pharmacologic options are now available. Read more →


Tocqueville, Democracy, Involvement and the ISHLT

Vincent Valentine, MD

links image"The health of a democratic society may be measured by the quality of functions performed by private citizens." - Alexis de Tocqueville

Alexis de Tocqueville was born of noble descent in Paris on July 29, 1805 and died at age 53 with tuberculosis on April 16, 1859. He got his name from a village near the city of Cherbourg in Normandy. Raised as an aristocrat, he was a liberal who rejected the old French regime of aristocracy. From his father's library he explored and studied the provocative French Enlightenment authors Montesquieu, Voltaire and Rousseau. While studying law, he read the 18th century philosophes and concluded that democracy would replace aristocracy everywhere and that America was more advanced in democracy than any other nation on earth. As a result Tocqueville wanted to study America to determine what could be learned about democracy, and possibly be applied to France. Therefore, he and his close friend, who became his alter ego, Gustave de Beaumont, received official permission to study the uncontroversial problem of prison reforms as a pretext to learn about democracy in the United States in order to shape the political future of France. Read more →


Vincent G Valentine, MD

Editorial Staff

"When the past no longer illuminates the future, the spirit walks in darkness"
— Alexis de Tocqueville

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Disclaimer: Any opinion, conclusion or recommendation published by the Links is the sole expression of the writer(s) and does not necessarily reflect the views of the ISHLT.