Our Post-transplant Journey: Transplant

22Feb

Today we attended our Med-Ed meeting. One of the hospital pharmacists joined us in the meeting room and gave us an initiation to the world of post-transplant medications. Danica and I attended with Carman and there were two other patients as well. We introduced ourselves, told a bit about where we were from, what had brought us to TGH, how long we’d been here, and which organ our donor had gifted to us.

Our group all received transplant surgery on the same day, Carman, double lung; x, a heart; and y, kidneys & pancreas. I thought on this a moment, we don’t know any details about our respective donors, but it could have been a multi-organ donor and in a way - they could all be related now!

The visual on this has a huge impact on me...picture one person, now put 8 people directly behind this person in a semi-circle (these are the potential organ recipients, from a single donor); now add 15 people behind these eight, now 25 behind them, and another 35 behind them (these are the potential tissue recipients from the same single donor. 83 lives, positively changed for ever!

The first 8 given life they would not have had. That is what each organ & tissue donor could do, should their donated organs and tissue prove to be healthy for use. What a legacy!

Tonight’s buffet of over 2 dozen pills includes:

Clavulin - amoxacillin - to treat a bacterial infection present in the donor lungs

Colace - to soften stool, because the medication cocktail will do the reverse

Cyclosporine* - an immunosuppressant to prevent Carman’s body from rejecting his donor lungs (he says this one smells & tastes like skunk - it isn’t the medication itself though, but the gas injected into the foil blister pack to stabilize the drug that causes this smell and taste. On another note, I wasn’t aware he had tasted skunk before - hmmm)

Heparin (injection) - to prevent clotting

Hydromorphone - to manage pain (he came off the self-administered pump before leaving the ACU - (also leaving behind a few interesting drug-induced accusations and observations)

Lasix - to help reduce fluid levels

Magnesium Oxide - a supplement required to maintain sufficient levels in Carman’s body as his medication cocktail will interfere with the naturally acquired magnesium in his diet. He now takes this in tablet form, but was on an IV infusion immediately following surgery

Metatoporol - to control high blood pressure, fairly common after transplant

Myfortic* - an immunosuppressant to prevent Carman’s body from rejecting his donor lungs (instructions on this puppy include warnings that it is a cytotoxic/biologic agent which should not come into contact with skin or mucous membranes - except for the patient taking it, eye, face and hand protection must be used when handling it)

Nystatin - to prevent Thrush - cause by the candida yeast, which is commonly present in humans but can become life threatening to the immunosuppressed, especially when they are also taking antibiotics

Pantoprazole - to reduce stomach acid, the chance of reflux and the potential to aspirate stomach acid as well as to help protect the stomach from the immunosuppressants

Prednisone* - an immunosuppressant to prevent Carman’s body from rejecting his donor lungs

Septra - to prevent Pneumocystis pneumonia (PCP)

Valganciclovir - to prevent Cytomegalovirus (CMV) a viral infection which can be a fairly benign infection for most people but life threatening for the immunosuppressed

*the immunosuppressant meds are very toxic and necessary to prevent rejection; to minimize and/or prevent damage to the kidneys, Carman will need to ensure he consumes 2L of fluids daily to flush his system of residuals from these meds (no, Ronnie, they don’t mean beer!)