Coordinators Play Key Role in Growth of Solid Organ Transplant

Clinical role has expanded to encompass all aspects of transplant

Duke transplant coordinators
Judy Smith, BSN, RN, CCTC, left, with Cindy Lawrence, MSN, BSN, RN. Duke photo by Erin Roth.

The transplant coordinator role has transformed from an inpatient/outpatient clinician with advanced training to a patient care manager, evolving into a key clinical contributor to the growth of solid organ transplantation.

Beginning as a nurse with specialized training, the growth and complexity of the coordinator’s role has evolved rapidly to remain synchronized with the medical and scientific advances of transplant medicine.

Coordinators have played a significant role in the growth of The Duke Transplant Center, which surpassed the 10,000th solid organ procedure during 2022, says Ian R. Jamieson, MBA, MHA, vice president of the center.

“The success of solid-organ transplantation can be attributed to two foundational developments: The advent of cyclosporine in the 1980s coupled with the advancing profession of transplant coordinators,” Jamieson says.

Over the past 10 years the number of transplant coordinators at Duke has increased from 38 to 63 and the volume of transplants among all programs has increased from 321 to 605, according to Jamieson. The number of active post-transplant patients followed in all programs has increased from 1,928 to 4,610.

Two of Duke’s most experienced coordinators—Cindy Lawrence, MSN, BNS, RN, who works with the lung team, and Judy Smith, BSN, RN, CCTC, supporting kidney—describe a growing, ever changing specialty that requires a disciplined focus on patients and families, both inpatient and outpatient, from initial assessment to post-procedure care and long-term follow-up.

Beginning as “transplant nurse clinicians,” Lawrence and Smith succeeded by focusing on what they say is the most important part of the job: creating and maintaining the patient and family connection.

“We are the caregivers who know the patients best,” Smith says. “We communicate with the families, we understand their financials, their medical literacy, their insurance coverage. We are also the first clinical team member to review the labs after a transplant.”

Launching their transplant careers in an era of paper patient records, Lawrence and Smith have adapted and expanded their roles as clinical processes and information technology improved.

One of the most challenging periods, they say, has been the uncertainty triggered by COVID 19. Immunosuppressed transplant patients were particularly vulnerable and frightened. “Patients were terrified,” Smith says. “It was an emotionally charged time.”

Cindy Lawrence, MSN, BSN, RN

With 37 years as a coordinator, Lawrence is Duke’s longest tenured transplant coordinator. “When I began, the position was a relatively new role. We were not even called coordinators,” she says. Lawrence began her transplant career with the kidney program in 1985, and was one of two nurses with advanced training supporting both heart and lung transplant teams in 1992, which was the year Duke started its lung transplant program. This year, approximately 16 coordinators work around-the-clock supporting lung transplant alone.

“The growth in our transplant programs at Duke has been phenomenal,” Lawrence remembers. “Now we have teams of coordinators who focus on a single phase of the transplant process.”

“Some focus on living donors, others on pre-transplant processes while another group monitors the patient after transplant,” Lawrence says. “In each of these phases, we maintain communication with the families while coordinating care with other hospital clinicians.”

As a new graduate nurse in 1980, Lawrence came to Duke to get tertiary care experience but was immediately attracted to the transplant coordinator role. “I was a brand new nurse, but I was bitten by the transplant bug right away. The benefits that transplant offered for patients were very clear. I was fascinated with the role and began to move in that direction – and never looked back!”

Judy Smith, BSN, RN, CCTC

As coordinator responsibilities grew, transplant physicians relied increasingly on those individuals to help in transplant assessment, preparation, and monitoring following the procedure.

“Doctors rely on us to look at lab results and help to identify and report abnormal results,” says Smith, who is a certified transplant coordinator. “We are expected to assist and help problem solve solutions and then to educate the patient and family in the plan/solution”

“What we really worry about early in transplant is whether a patient is experiencing a rejection episode. The more quickly you act when that occurs, the better chances of saving the organ.”

Both Lawrence and Smith emphasize the collaboration among many teams of specialists that guides transplant assessment and care, requiring contributions from transplant-trained nutritionists, psychologists, and others. Living donor advocates play an important role as well, Smith adds.

“During our multi-disciplinary listing conferences, when we are reviewing patients on the wait list, we have contributions from everyone on the team, and everyone’s  concerns are taken into account,” Smith says. “It’s a career that provides a great sense of satisfaction. After 45 years of nursing, the last 19 years spent in transplant have been the most rewarding.”