2017 Transplant Update

2017 Transplant Update Getting transplanted sooner Donors with increased risk of infection transmission: Why should I consider these deceased donor kidneys?.......p. 4 Living Donor Champion training: Becoming an advocate for organ donation. ……………….p. 6

Education and other resources Why am I getting so many calls about kidneys, but not getting transplanted………………………………p. 8 Smart phone app review …………………………...……..p. 12 Outreach update………………………………………….p. 13 Insurance updates………………………………………....p. 14 Pharmacy reminders……………………………………....p. 15 Sleep connection to kidney health and hygiene tips…,,.…p. 16

Pictures from events

Annual update vs. Newsletter You might have noticed…

We made some changes in how we are communicating with our patients and care givers.

This annual Transplant Update captures key articles, pictures from key events from the prior calendar year and things might want to know.

Donate Life flag raising……………………………..……...p. 18 Living donor recognition brunch …………………………p. 19 NKF Kidney Walks………………………………...….…...p. 20 PKD Walk…………………………………………………p. 22 Delaware Donor Dash………………………………….....p. 23 Explore Transplant training for dialysis unit staff……..….p. 24

Other stuff Outcomes data update (SRTR data)……………………....p. 25

The monthly Kidney Transplant eNews email-based newsletter had its first release April 2018. Sign-up for these updates by visiting our website. https://christianacare.org/services/ kidneytransplant/aboutus/

For weekly updates, please follow-us on Facebook. https://www.facebook.com/ christianacarekidneytransplant/

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2017

Hello Christiana Care Kidney Transplant family!

2017 was another great year for the team and our patients and families so we thought we would provide this annual update to celebrate what’s happened, but also help people prepare for 2018 – another great year to come.

Annual, of course, means once per year. But don’t worry about timely updates because every month we are offering an e-mail based newsletter that you can register for on our website and, of course, the ever present weekly updates on our Facebook page. Fear not, I promise, we will not share Ol’ Doc Swanson your data!

Chief of Transplant Surgery Having always promoted living kidney donors for all our recipients, this year we took an even stronger approach. We created an online training program for persons to learn how to advocate for their family member or friend as a Living Donor Champion, even if they can’t donate directly. As I always say, “It’s not like asking for a cup of sugar.” This just might be the ticket for any of you who might be unwilling or unable to ask for yourselves. You can access this site from this newsletter or on our website. There are other links regarding living donation that you might also find useful. Just click to open the door to your living kidney donor.

On a sadder note regarding the past year is the frequent reminder of the opiate epidemic afflicting the United States and our region. Thirty-percent of the donors in our Gift of Life Organ Procurement Organization are classified as Public Health Service high risk for Hepatitis C, Hepatitis B or HIV transmission with the majority being IV overdoses. Ms. Williams, our Nurse Practitioner, provides us information on the safety of these donors that are often times young and otherwise healthy.

Two of our recipients, Mr. Glen Golley and Mr. Gregory Campbell, share their experiences with their acceptance of a PHS donor and how it changed their lives. Thanks, guys!

Ms. Aline Stant, RN, our clinical supervisor, has taken on the difficult task of explaining why one gets so many calls before you finally get you kidney. It can certainly be a roller coaster with many ups and downs but there is a reason and she takes you through a donor scenario to help you find out. I think this is why you are called a “patient”!

You know us, so we have thrown in some resources and reminders about improving or maintaining your health whether you are still waiting or already transplanted. Sleep apnea is very common in our patients and if diagnosed, the compliance with the treatment can be just as important to the long-term survival of your kidney and you as taking your immunosuppression medications.

My favorite section though is the pictures and reminders of the events of the past year. I hope you enjoy it as well as the rest of our year in review .

Remember, “Keep on Going!”

Page 3 2017

Page 3

Our transplant program’s mission and vision...

Dr. Swanson’s recognition of our patients, their families and our team says it all! As the business leader, I am often asked about the details around our mission, vision, priorities, stats and key achievements.

Our Mission: To provide excellent care to patients with advanced kidney disease, transplant recipients and living donors.

Our Vision: To be the program of choice for local patients based on a reputation of clinical excellence & patient experience.

Ryan Haydu Administrative Director

The Kidney Transplant Program provides value to approximately 1,000 patients each year. > 300 new patients for evaluation services > 150 living donor candidates > 200 patients for pre-op management > 50 patients for pre-op donor management > 235 patients for ongoing post-transplant care > 50 patients for post-donation care Therefore, ~30 patients are transplanted annually in Delaware (out of a total annual market of 55).

Patients receive excellent care and avoid the need to travel out-of-state for their transplant services.

Goals: Promote living donor transplantation Optimize patient access for services Short-term Objectives (July 2017 to June 2018): Transplant website improvements Communication tools for dialysis providers

Maximize patient referrals and evaluations Minimize wait times from referral-to-decision Improve insurance agreements & coverage Quality analytics dashboard

Statistics   

We evaluated 190 new recipients and donors, while managing >535 established patients.

We transplanted 28 patients, of which 8 were from living donors.

Our outcomes data (1-year survival with a functioning kidney) was more favorable at 96.72% than the SRTR projected (94.27%) and the national average (95.23%)

Key Achievements… in 2017 we:  Facilitated two (2) altruistic donor transplants– thanks to gratitude of these individuals; and it also shows their trust and confidence in our team and program.  Updated our website by making all our educational presentations available; and posting a newly created Living Donor Champion training module.  Partnered with Renal Network 4 and our regional dialysis providers to improve the patient support communication tools.  Successfully contracted with Highmark Health Options DE Medicaid and Aetna (for Letters of Agreement), which removed insurance obstacles for dozens of referred patients.  Launched an internal quality analytics dashboard, which monitors patient safety values for both pre– and post-transplant patients.

Page 4

2017

Getting transplanted sooner Donors with increased risk of infection transmission: Why should I consider these deceased donor kidneys?

By Terina Williams, MSN, NP-C, CCTC As many of you may know, the waiting time for a deceased donor kidney is getting longer with waiting periods for some individuals approaching 8 years.

The high mortality or death rate of End Stage Renal Disease (ESRD) and the increasing wait time for a kidney transplant have created an urgent need to expand the use of organs from non-ideal donors.

The Public Health Service (PHS) has created a list of behaviors that increase the chance of a donor having and transmitting viral infections such as: HIV, Hepatitis C, and Hepatitis B.

“The risk of dying on the waitlist is substantially greater than the risk of

These donors may seem non-ideal because of the increased risk associated with viral transmission but there are benefits and value in considering PHS donor offers. Nationally, these donors make up about 30% of all available kidneys.

Benefits include: 1. The quality of PHS kidneys is high as these donors are typically younger without history of medical problems such as high blood pressure, diabetes, and stroke.

viral infection.�

- Dr. Gilibert

2. PHS kidneys have been studied and have been shown to have similar transplant survival rates when compared with standard criteria deceased donor kidneys (KDPI <20% to <85%).

3. Reduce waiting time for transplantation because you will receive more organ offer calls.

4. Depending on the recipient medical problems, the risk of dying on dialysis while waiting for a kidney may be greater than the risk of getting a transmissible infection from a PHS donor.

5. Studies have shown that the risk of transmissible infection from a PHS donor is small.

Page 5

Our patient experience…

Mr. Glenn Golley was 60 years old when he received a kidney from a PHS donor in August 2016.

His donor was in his/her 20s and died from an overdose.

“I had Hep C and my donor had Hep C. I was on dialysis for 1 year and 10 months... and waitlisted for 2 months 4 days. I didn’t think that I would see one for 8 years.

Dialysis made me feel like a zombie.

I feel great now. My Hep C has been treated and my viral load has cleared.”

Glenn Golley

Mr. Gregory Campbell was 59 years old when he received a kidney from a PHS donor in July 2016.

His donor was in their 40s with a history of IV drug abuse and cause of death was due to lack of oxygen to the brain.

“I was on dialysis for 7.5 years and was having issues with my heart.

I waited patiently on the Lord.

I felt the Lord in my spirit when I received the (kidney offer) call.”

Gregory Campbell

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2017

Getting transplanted sooner Living Donor Champion Training: Becoming an Advocate for Organ Donation

By Aline Stant, MSN Living donation offers another choice for transplant candidates, and it saves two lives: the recipient and the next one on the deceased organ wait list.

Reasons why a living donor kidney might be better for you:

“You could get transplanted in a few months… if you have a healthy living donor.”

- Dr. Swanson

Source: Explore Transplant.org

A transplant from a living donor is the best option for most kidney transplant candidates.

Page 7

Programs to help…

Christiana Care’s “Living Donor Champion” training video and Patient Playbook for self-paced learning.

This 20-minute video follows a patient (Derek) through his journey of learning how to recruit a living donor champion, and how they work together to recruit potential donors.

Take the quiz & send the results to us!.

A Patient Playbook and packet of educational and promotional materials is also available.

Playbook Living Donor Facts Living Donation Brochure Paired Donation Handout Living Donation Brainstorm Sheet Living Donation Sample Letters Living Donation Letter Templates Living Donor Champion Facebook Posts Living Donation Online Resource List

National Kidney Foundation’s “Big Ask Big Give” workshop program– hosted at Christiana Care.

This one-day group audience workshop brings patients and their caregivers together with our multi-disciplinary team and other healthcare experts to educate and train folks how to approach recruiting advocates, champions and potential donors.

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2017

Education article Why am I getting so many calls about kidneys, but not getting transplanted?

By Aline Stant, MSN Q: How many calls am I going to get before I finally get a kidney?

A: You may get one call to 30 or more before you finally hear the coordinator say “You are getting this kidney.”

Q: How come I get so many calls? Why can’t you just call me when the kidney is mine?

A: The kidney is a gift, and we have to make sure there are people in line for it in case the first two people in line have some reason they cannot get the kidney. You get the first call before the kidney is removed from the donor. Therefore in order to have someone in line to get the kidney as soon as possible after the kidney is removed, we have to have more than two candidates waiting.

Here’s an example of a kidney offer to help you understand. 

Someone has a tragic accident and they are considered brain dead.



The person noted on their driver’s license that they wanted to be a donor if this ever happened.



The Organ Procurement Organization (OPO) is notified and they send a team of personnel to begin the evaluation process of the donor.



The United Network of Organ Sharing (UNOS) runs the list against only those patients who have the same blood type as the donor.



Using preset rules, the final list is run and sent to the OPO.



The OPO notifies someone at each transplant center where there is a patient listed that shows up on the list.



The transplant center reviews information about the kidney and decides if the kidney is good enough to accept for the patients on their list.



The coordinators from each of the transplant centers call their patients to discuss the donor with their patient.

Page 9

Continued…

Now this is what happens after that….. 

Donor is Blood Type B; UNOS runs the list of all patients with type B blood.

1.

Jane White

Transplant Center 2

2.

Jack Brown

Transplant Center 5

3.

John Gray

Christiana Care Kidney Transplant Center

4.

Judy Silver

Transplant Center 1

5.

Joshua Black

Transplant Center 5

6.

Thomas Wright

Transplant Center 12

7.

Theresa West

8.

XXXX XXXXX

XXXX

9.

XXXX XXXXX

XXXX

10. XXXX XXXXX

XXXX

11. Michael Bay

Christiana Care Kidney Transplant Center

12. XXXX XXXXX

XXXX

13. XXXX XXXXX

XXXX

Christiana Care Kidney Transplant Center

The coordinators from Transplant Centers 2, 5, 1, 12, and Christiana Care call their patients.

They must talk with the patient within one hour of when they were notified. The coordinators have to confirm the patient is available, they are not ill, and that they want the kidney.

Johnita tells Mr. Gray that he is # 3 on the list, Ms. West that she is # 7, and Mr. Bay is #11.

The list is reviewed and the following happens: 

Jane White is available, not ill, and wants the kidney



Theresa West is available, not ill, and wants the kidney



Jack Brown does not answer his phone





John Gray had a heart attack and is still recovering

Patients 8, 9, & 10 are all available, not ill, and they want the kidney



Judy Silver is available, not ill, and wants the kidney



Michael Bay is available, not ill, and wants the kidney



Joshua Black does not want a kidney from a donor that is 60 years old



Patients 12 & 13 also are also ready to go.

How does the list look now?

1.

Jane White

6.

Patient 10

2.

Judy Silver

7.

Michael Bay

3.

Theresa West

8.

Patient 12

4.

Patient 8

9.

Patient 13

5.

Patient 9

Continued on page 8

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2017

Continued from page 7

Why am I getting so many calls?

The Next Step is to run a crossmatch.

A crossmatch checks the donor’s blood against the possible recipient’s blood to make sure the recipient does not have antibodies against the donor. Antibodies are fighter cells that will attack and destroy the new kidney.

(This step can take 5-10 hours) When the crossmatch results are back…  Jane White had a prior transplant and 2 blood transfusions. She has antibodies to the donor.

Therefore, she cannot get the kidney. 

Judy Silver also has antibodies to the donor, probably from her four pregnancies.

Therefore she cannot get the kidney.



The rest of the patients on the list do not have antibodies.

Therefore they could get a kidney from this donor.

How does the list look now?

1. Theresa West

5. Michael Bay

2. Patient 8

6. Patient 12

3. Patient 9

7. Patient 13

4. Patient 10 

Johnita calls Theresa West and makes arrangements for her to be admitted.



Patient 8 is called by their transplant center.

Is that the end?

Sometimes, but not always.

Please continue reading.

Page 11

Dr. Swanson begins to prepare for surgery on Theresa West. 

Patient 8 arrives at their transplant center and they have a fever of 103.5 and a sore on their foot.



The transplant center calls the OPO and tells them that Patient 8 is NOT a candidate.



The Kidney is about 45 minutes from the hospital.



The OPO goes back to the list and reviews it.



The kidneys are out of the donor and need to be placed as soon as possible.



They call the coordinators for patients 9 & 10. The Coordinators try and contact them. They are unable to do so. They try for one hour.



The courier is called and told to not deliver the kidney to the first hospital.



Time is very important.



The OPO then calls Johnita at Christiana Care. She calls Michael Bay and he is requested to go directly to Christiana Care for a kidney transplant.



Dr. Scantlebury knows Dr. Swanson is in the OR and she prepares to place the second kidney in Michael Bay.



Patients who were originally # 7 & #11 got the kidneys.

There are only two kidneys to be donated, so what would have happened if only two people were called in the beginning? The entire process would have been started over and over again until two recipients could be found. Time would be wasted and worse of all, so would the two kidneys!

This is why you get so many phone calls.

You may be a “back up” for many kidneys before you actually get one.

So please answer your phone, stay healthy, and be patient.

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2017

Education article Smart phone app review: Low Phosphorous Foods

By Amanda Caulkins University of Delaware Dietetic Intern For individuals with kidney disease, there are important diet guidelines one must follow in order to maintain their health.

As phosphorus and potassium are abundant in so many foods, knowing which foods are safe to eat and which foods to avoid can be challenging! “Low Phosphorus Foods” is a free app that educates the user on the mineral content in various foods. Not only does the app highlight the phosphorus content in a variety of foods, but potassium content is also featured.

The app opens with an introduction of phosphorus and potassium and how these minerals can affect one’s health. A useful feature on this screen is titled “Double-Danger Foods” where the user can find a list of foods high in both phosphorus and potassium. The opening screen also includes tips for reading food labels and notes the importance of diet while on dialysis.

Other helpful sections in this app are the Low, Medium, and High Phosphorus Foods tabs. Here, users can browse through a food database and view the mineral and nutrient content in each item.

With this app, the user has access to additional resources like the Grocery List, Favorite Food Items, Low Phosphorus Recipes, and eGFR Calculator sections. These are great tools to help kidney patients to manage their disease and keep their health in check.

One disadvantage with this app is that the food database lists nutrient analysis per 100 grams, rather than a household serving measurement. In order to determine the phosphorus content for a particular food, one would need to know the serving size equivalent of 100 grams of that food. Unfortunately, since this is not a standard form of measurement the user would need to visit the USDA Food Composition Database at https://ndb.nal.usda.gov/ndb/nutrients/index to view as a standard serving size. Another con of this app is that advertisements can intermittently appear on the screen. This merely causes a disruption in the use of the app, but may be bothersome to the user.

Overall, the “Low Phosphorus Foods” app is very useful for individuals with chronic kidney disease. Specifically, individuals who wish to learn how to make better food choice while on a renal diet. The nutrition information in this app is provided by the USDA so users can be sure nutrient analysis is accurate. “Low Phosphorus Foods” is available in the Apple App Store for iPhone, iPad and other Apple devices.

Page 13

Outreach to educate staff and patients at dialysis units

By Laura Arentz, MBA, MS, RD Communication with our dialysis centers is a priority.

Keeping the lines of communication open between the dialysis center and transplant program is key to providing the best care for our patients. We rely heavily on dialysis staff to provide accurate information to the patients about transplant and to relay pertinent information about the patient back to the transplant centers. We value this relationship and want to make sure we physically visit each center at least once within a two year basis. Some centers may get visits more frequently upon request or if there are other circumstances requiring more education. Our surgeons, nurses, and business manager all take an active role in outreach.

Our main goals for outreach are:

1. To promote transplant as an option.

2. To encourage patients to find a living donor.

3. To educate dialysis staff & provide updates about their patients status in the transplant process.

Even though we may not be able to physically visit clinics annually, we are always available to send transplant education materials and provide updates regarding patients.

Chairside education is replacing ineffective lobby days.

Inviting different transplant centers to come talk to patients about transplant is a great idea and can be very helpful in facilitating more patients to get on the transplant waitlist and answering difficult or specific questions. Transplant programs have found that â&#x20AC;&#x2DC;lobby daysâ&#x20AC;&#x2122; are NOT an effective way to provide this education since patients are usually in a hurry to get on the machine or to get home after their treatments. Keep in mind that some transplant representatives may not familiar with all of the patients; therefore they are not always sure who they should be talking to (or not all)- as not all patients are potential candidates.

Guidelines for dialysis centers to help make the most of the transplant education days:

1. Place a sign in the lobby with the dates/times the transplant representative will be on site.

2. Identify patients who would benefit from and are willing to speak with the transplant representative BEFORE they arrive.

3. Introduce the representative to the patients and allow the transplant representative to talk with the patients while on the dialysis machine if possible. This will help to ensure that they have the patientâ&#x20AC;&#x2122;s full attention.

4. Follow up by providing all needed records in a timely manner.

Laura educating staff at FKC-Elkton (Elkton, MD)

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2017

Insurance update and reminders

By Barbara Demyanovich Medicare is mailing out new cards in 2018.

So please bring it to your next appointment.

The Centers for Medicare & Medicaid Services is removing social security numbers from all Medicare Cards by April 2019. The social security numbers presently on the Medicare Cards will be replaced with a unique new MBI or Medicare Beneficiary identifier Number. The new number will be 11 characters long and consist of a series of numbers and uppercase letters.

New Medicare Cards are planned to mail out in April 2018 and the mailing must be completed by April of 2019. Christiana Care Kidney Transplant Program asks that all existing patients please bring in their new Medicare Card once they receive it to their next visit.

We also encourage new and existing patients to bring their updated Medicare Card and any other commercial insurance and prescription cards to the office at their next visit.

It is very important to have all patients' updated medical and prescription cards on file in order to process services smoothly with no undue complications.

Donâ&#x20AC;&#x2122;t assumeâ&#x20AC;Ś let us evaluate your insurance coverage.

We partner with >90% plans.

Delaware Medicaid: We encourage patients with Delaware Medicaid to apply to our program for evaluation determination. Both Highmark BC/BS DE Health Options Medicaid and Amerihealth Caritas are now working with Christiana Care to provide kidney transplant benefits to Delaware residents.

Note: Patients that have out-of-state Medicaid will need to have Medicare along with their out-ofstate Medicaid in order to register at Christiana Care for kidney transplant evaluation.

Commercial insurance plans: Although a few commercial insurance companies still do not wish to participate with Christiana Care (for transplant coverage), we encourage all new patients to refer themselves to our program for evaluation- no matter what insurance they may have. Typically, through a coordination of benefits, most patients find they will have necessary coverage. At times, we have also been successful in working out a solution called a Letter of Agreement with the insurance company (such as Aetna). Other times, we discover there may be an exception on a patient's policy (thru their employer) that allows them to register with Christiana Care for kidney transplant evaluation at in-network benefits.

Page 15

Cut costs, not pills

By Eileen Edge, LCSW & Nadia Hellenga, Pharm D Money for medications is a big issue for many post-transplant patients while healthcare cost and prescription drug prices are ever-increasing!

During these tough economic times, some people try to cut costs by skipping medications or trying ways to make them stretch.

As a transplant patient, skipping doses or changing doses on your own is very dangerous to your health and to the life of your kidney. There are many other ways to save money on medications without putting yourself at risk of rejection or other health problems.

1. Shop around for the best prices or deals on prescription drugs.

- Most pharmacies offer price matches. Check out pharmacychecker.com

2. Check for grant programs.

- The Patient Access Network provides reimbursement for certain drugs via an annual grant.

- Healthwell Foundation also provides grants for certain drugs throughout the year.

3. Discount drug programs from community drug stores.

- Wal-Mart savings program ($4 for a 30-day or $10 for 90-day supply of certain generics) - Rite Aid: membership card can be combined with manufacturer’s discounts.

4. Co-pay reduction cards.

- Significant reduction* to your copay for Prograf, CellCept, Envarsus XR, Sensipar. * Cannot be used if you have Medicare, Medicaid or Chronic Renal Rx coverage.

5. Ask your physician or pharmacist about generic alternatives or free samples.

- Your physician may be able to prescribe a lower-cost medication - If your physician approves it is now okay to get a generic for Prograf or CellCept.

6. Member organization discount cards.

- AARP, FamilyWize, American Automobile Association (AAA) offer discounts.

7. Patient Assistance Programs.

- Depending on your income, drug companies may provide medications at a discount or free.

- Merck and Pfizer offer cards to patients whose prescriptions are not covered by insurance.

- Look online for Patient Assistance when starting a new drug. Co-pay assistance cards help.

8. Use mail order after your first few months post-Transplant.

- Some patients can get a 90 day supply for 2-months worth of copays.

- Contact your insurance company for information or next steps.

9. Plan for paying thru your Part D ‘donut hole’.

- Most transplant recipients meet or exceed the donut hole each year.

- Are you saving a credit card to pay that and pay it off throughout the year?

- Do you qualify for other Medicare discounts?

- Visit medicare.gov to see if you qualify for extra help.

- RxAssistance can also help if you can’t afford your meds while in the ‘donut hole’

If you have questions, please ask your transplant pharmacist or social worker for more information.

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2017

Sleep connection to kidney health

By Grace R. Denault, RPSGT, RST, CCSH Academy of Sleep and Wellness Many people are surprised to learn that sleep problems go hand-in-hand with kidney disease.

It’s been found that 80% dialysis patients experience sleep disturbance or sleep disorders. Insomnia is highly prevalent in renal disease patients. It can be characterized by increased time needed to fall asleep, fragmented and interrupted sleep and/or early awakenings. Obstructive Sleep Apnea (OSA), Restless Leg Syndrome (RLS) and Periodic Limb Movement Disorder (PLMD) are also especially common for these patients.

There are many causes of sleep problems in kidney disease patients. People with chronic health concerns are more likely to have worry, fear, anxiety or depression, all of which compromise sleep.

So, you need help to improve your sleep. Now what? Your care should be coordinated by a sleep specialist, which is a physician that is boarded in sleep medicine.

If you’re asked to do a ‘sleep study’, your sleep specialist will: 

Assess your sleep symptoms and history in an initial consultation.



Coordinate testing if needed. Typically at a sleep center location (or sometimes at home).



Review results of your sleep study and develop a treatment plan with you.



Coordinate treatment (such as home medical equipment including CPAP machines)  For CPAP, your sleep specialist will coordinate selection of a Durable Medical Equipment company, and will work with you and the company to help you adjust to treatment.

If you’ve been diagnosed in the past and you’ve lost touch with your sleep specialist, you can find a new one at www.sleepeducation.org.

If you need a new medical equipment company, ask your sleep specialist for guidance and check with your insurance company to be sure they participate with your plan. You may or may not need repeat sleep testing, depending on a lot of factors.

Benefits of improving your sleep quality, beyond good sleep hygiene habits…

A CPAP, or Continuous Positive Airway Pressure, machine can help improve your mood, reduce your risk of depression and improve your overall quality of life.

Source: academysleepwellness.com

Page 17

Sleep hygiene ‘Sleep hygiene’ is the term used to describe good sleep habits.

Considerable research has gone into developing guidelines and tips which are designed to enhance good sleeping, and there is evidence to suggest that these strategies can provide long-term solutions to sleep difficulties.

While there are medications which are used to treat insomnia, these tend to be only effective in the short-term. Ongoing use of sleeping pills may lead to dependence and interfere with developing good sleep habits independent of medication, thereby prolonging sleep difficulties.

Things to consider to help get a good night’s rest (or improve your sleep hygiene): 1) Get regular. One of the best ways to train your body to sleep well is to go to bed and get up at more or less the same time every day, even on weekends and days off!

2) Sleep when sleepy. Only try to sleep when you actually feel tired or sleepy, rather than spend-

ing too much time awake in bed.

3) Avoid caffeine & nicotine. It is best to avoid caffeine or nicotine at least 4 hours before bed-

time. These substances are stimulants and interfere with the ability to fall asleep.

4) Avoid alcohol. It is best to avoid alcohol for at least 4 hours before bedtime, also. Some people

believe that alcohol is relaxing and helps them to get to sleep at first, but it actually interrupts the quality of sleep.

5) Bed is for sleeping. Try not to use your bed for anything other than sleeping and sex, so that

your body comes to associate bed with sleep.

6) No naps. It is best to avoid taking naps during the day, to make sure that you are tired at bed-

time. If you can’t make it without a nap, make sure it is for less than an hour and before 3pm.

7) Sleep rituals. Develop your own rituals of things to remind your body that it is time to sleep.

Some people find it useful to do relaxing stretches or breathing exercises before bedtime.

8) Exercise. Regular exercise is a good idea to help with good sleep, but try not to do strenuous

exercise in the 4 hours before bedtime. Morning walks are a great way to start the day feeling refreshed!

9) Eat right. A healthy, balanced diet will help you to sleep well, but timing is important. Some peo-

ple find that a very empty stomach at bedtime is distracting, so it can be useful to have a light snack, but a heavy meal soon before bed can also interrupt sleep.

10) Consider a sleep study. Talk with your primary care physician about scheduling a sleep study to learn more about whether you might have obstructive sleep apnea (OSA) and if CPAP therapy is right for you.

Source: Delaware Sleep Disorder Center via CCI.health.wa.gov.au

Page 18

2017

Organ Donor Recognition Flag Raising

Wednesday, April 12th, 2017

Thank you to all of our donor families and recipients.

We recognized their gifts of life at the Donate Life Flag Raising.

Page 19

Living Donor Recognition Brunch

Saturday, April 22nd, 2017

Thank you to all of our donors who gave the gift of life.

We celebrated at the annual Living Donor Recognition Brunch at Deerfield golf club.

Page 20

National Kidney Foundation “Kidney Walks” Cape Henlopen State Park, DE (Sunday April 30, 2017)

Salisbury’s Winterplace Park, MD (Sunday May 7, 2017)

Wilmington Riverfront, DE (Sunday October 15, 2017)

2017

Page 21

Page 22

PKD Walk

2017

Saturday, September 16th, 2017 Glasgow Park hosted the Annual Polycystic Kidney Disease (PKD) walk .

Page 23

Delaware Donor Dash

Saturday, September 23rd, 2017

Nemours Gardens hosted the 4th Annual Delaware Donor Dash.

Page 24

2017

Explore Transplant training for dialysis staff Tuesday, June 6th, 2017

The Kidney Transplant Program hosted a dialysis provider training program called Explore Transplant.

The communication skills training program helps dialysis providers increase their confidence in talking with patients about the option of transplant. It also provides them with educational resources to support patient conversations.

There was an impressive turnout of 70 dialysis professionals from various dialysis units across the Delmarva and Brandywine Valley region. Attendees included nurses, dietitians, technicians, and social workers.

All participants received education credits and were able to take education resources back to their dialysis units that included handouts, booklets, and DVDs to share with their patients who may be considering transplant as an option.

For more information, visit Explore Transplant on the web at: exploretransplant.org

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SRTR Report October 17, 2017 (Released on January 5, 2018)

Twice a year (which is how o en the data is published for review), we mail le ers to our pa ents to inform them about our post‐transplant outcomes of our Kidney Transplant Program.

The United Network for Organ Sharing (UNOS) and the Centers for Medicare and Medicaid Services (CMS) re‐ quire transplant programs to do this on a rou ne basis.

Therefore, the outcomes for the Kidney Transplant Program at the Chris ana Care Health System are:

07/01/2014 – 12/31/20161 1‐year Adult GraŌ Survival rate2 1‐year Adult PaƟent Survival Rate

Chris ana Care Kidney Transplant Program

Expected Outcomes Based on Pa ent Characteris cs

Kidney Transplant Na onally

96.72%

94.27%

95.23%

98.15%

96.53%

97.36%

NOTE:   

Gra Survival means that the transplanted kidney con nued to work.

Pa ent survival means that the transplant recipient is alive.

Gra survival is less than pa ent survival because some pa ents have had a second transplant if the gra failed (so the gra was lost but not the person).

1

Most recent timeframe analyzed.

2 18 years of age and older

If you would like addi onal details on this data, or would like to see addi onal informa on, please visit the “Program and Hospital Data” page at www.srtr.org.

Also, feel free to call us at 302‐623‐3866.

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