Transplant Digest issue 35 by St. Michael's Hospital

Transplant Digest

Fall 2023 / Winter 2024 Issue No. 35

Kidney Transplant at 87! Jennifer Meriam Jayoma-Austria, RN, How do you react when you get a referral for an 85 year old for kidney transplant assessment? In the early 2000’s most of the patients who were referred for assessment to get on the provincial kidney transplant waitlist were in their 50’s and 60’s. Over time, I have noticed that a lot of patients with advanced age are being referred for kidney transplant assessment. In the last 10 years, I have been getting referrals for patients who are in their early 70’s and mid 70’s. In the last 5 years, I have been getting patients who are in their late 70’s and early 80’s. I am often asked if age is an exclusion factor for kidney transplant. My answer has always been the same. Our program does not exclude patients based on their age. It is the overall medical condition that could prevent the person from getting on the list or getting a transplant. When I received the referral for Mr. Tauro, I checked his date of birth twice to ensure I got it right. Then, I wondered if he was healthy enough and willing to undergo a major surgery at his age. It was in July 2020, when Mr. Walter Tauro was assessed at SMH Kidney transplant program. As part of his assessment, he needed clearance from a cardiologist and a hematologist. I had the pleasure of speaking to his cardiologist who said, “I am amazed how you are transplanting nowadays. He’s good for surgery”. The last obstacle was a hematology clearance for which he needed a bone marrow biopsy. Continued on page 2

Mr. Walter and Mrs. Macrina Tauro

In this issue... •

Kidney Transplant at 87!

•

From The Editor’s Desk

•

Transplant Tourism

•

World Day Against Trafficking In Persons

•

CMV Infection In Kidney Transplant Recipients

•

Welcome

•

Edema After Kidney Transplantation

•

Interview with Walter Tauro

•

Getting To Your Transplant Clinic Appointment

•

Heart Health

•

Letter To The Editor

•

Returning to Work – What Happens to My Disability Benefits?

•

Tribute to a colleague and friend

•

Remembering Brian Flood

•

Kidney Transplant Symposium 2024

From The Editor’s Desk Dr. Ramesh Prasad Welcome to the Fall 2023/Winter 2024 issue of Transplant Digest. Our Kidney Transplant Program continues to be one of the busiest in the country, with excellent short and long-term graft survival rates and patient experiences and outcomes. We have a team of dedicated health care professionals with decades of expertise in all aspects of kidney transplantation surgical and medical care. As a non-primary care clinic, our telephone and email response times to health concerns are among the very best in health care. While our preferred language of communication remains English, we have team members who also speak French, Cantonese, Hebrew, Hindi, Italian, Mandarin, Punjabi, Romanian, Russian, Spanish, Tagalog, and Telugu. In this issue, we cover a diverse array of topics including transplant tourism, edema, CMV infection, heart health, returning to work, and getting to your transplant appointment. We have a letter to the editor about presumed consent for kidney donation. We have a tribute to a patient who was one of our biggest supporters, and report on our oldest ever kidney transplant recipient. We hope you enjoy these topics and others. We will also be happy to include in future issues articles about topics of special interest to you, whom we are here to serve. Kidney Transplant at 87, cont’d from page 1

I asked Mr. Tauro if this is something he really wanted and his answer was a very clear “yes”. All the results were satisfactory. He was placed in the Ontario kidney transplant waitlist program based from his initial date of dialysis. As his pre transplant nurse coordinator, I had mixed emotions. I was excited, a little nervous and happy. Listing him for kidney transplant proves that it is not the age that matters; it is the overall health of the individual that determines suitability. It was Sunday, June 11, 2023 that Mr. Tauro got a kidney. He celebrated his 88th birthday in September 2023. I wish Mr. Tauro all the best and more years to spend with his wife, children and grandchildren. Thank you to everyone, especially the staff at Pickering DMC who helped in the whole process. 2

Contact Information Dr. Ramesh Prasad – Editor Meriam Jayoma-Austria, RN, BScN, C.Neph.CNewsletter Coordinator Please send your comments or suggestions of topics for future publication to: meriam.jayoma@unityhealth.to St. Michael’s Hospital Kidney Transplant Program (across the hospital) 61 Queen Street East, 9th Floor Toronto, Ontario, M5C 2T2 Phone: 416-865-3665 Disclaimer Note: Views presented in this newsletter are those of the writers and do not necessarily reflect those of St. Michael’s Hospital or the University of Toronto. Subject matter should not be construed as specific medical advice and may not be relevant. For all questions related to your health please contact your health care provider.

Issues With Transplant Tourism Maureen Connelly, RN Over the years, the transplant clinic staff have seen several patients go out of the country to receive a transplant. The reasons are varied. Their living donor family members may be unable to travel here, and the recipient still has health care coverage from their country of origin. This choice is still not the recommended option. We encourage patients to bring their out of country donors here. Travel costs are reimbursed through the Program for Reimbursement of Living Organ Donors (PRELOD). The testing hospitalization and surgery are covered on the recipient’s Ontario Health Insurance. Not all transplant tourism is illegal. Commercial transplantation is estimated to account for 5% to 10% of kidney transplants performed annually through out the world, (World Journal of Transplantation 2012 February 24, : 2(1) 9-18) Several scenarios for out of country transplants include: 1. Having dual citizenship and being able to be listed for a deceased donor transplant in their country of origin where wait times may be shorter. 2. Having a transplant assessment done by our pre-transplant clinic, then once completed, requesting their medical records, and going out of the country for a transplant. 3. Going out of country without a robust transplant assessment done here prior to leaving or being declined as a transplant candidate for medical reasons. Both these scenarios have the worst outcomes for transplant failure, drug resistant infections or death. 4. Purchasing a kidney through a third-party vendor.

5. Paying to receive listing priority on deceased donor wait lists out of country. 6. Being advised when to book travel flights to coincide with next scheduled prison inmate executions to receive a living-dead donor as told to me by a patient and described by author Jan Wong in her book Red China Blues. A five-year retrospective review showed we have had fifty transplant patients return to clinic after receiving a transplant elsewhere. The most common countries include India, Iraq, Iran Pakistan, Sri Lanka, Turkey and China. The vast majority bring limited records from their hospitalization and surgery which can add to the challenges of providing post- transplant care. We are not able to accurately account for patients who die out of country post- transplant, but occasionally will receive word from dialysis centers informing us of their deaths. Besides the medical complications commonly seen with commercial transplants are the moral and ethical dimensions. Transplant staff continue on page 5

Transplant Tourism, cont’d from page 3

can experience moral distress. Despite this we provide nonjudgmental care for patients who return seeking post- transplant care. However, seeing patients in clinic on return with multiple complications requiring hospitalizations and dying is difficult.

The practice of paying for a living donor kidney is illegal in Canada and most other countries. The Declaration of Istanbul (www.declarationofistanbul.org) outlines the international condemnation of this practice. The donors are usually poor vulnerable individuals whose lives are not improved by donation and often can be worse off due to poor pre-op screening.

CMV Infection In Kidney Transplant Recipients Dr. Darren Yuen In the last 3 years, we have unfortunately learned how COVID can have serious consequences for kidney transplant recipients because of the immunosuppressive drugs they receive. Thankfully, with the arrival of vaccines and the introduction of precautionary measures such as masking, we have been able to reduce the risk of these problems to a much more manageable level. However, COVID is not the only virus infection that kidney transplant recipients can get. We have known for a long time about another virus, cytomegalovirus (CMV). CMV is very common in our community, with roughly 50 – 60% of adults having been exposed in North America, a number that increases to > 90% by age 80. In most people in the general population, CMV leads to cold-like symptoms, or may not even cause symptoms at all. This is because the intact immune system quickly controls the virus and prevents it from causing more serious disease. Importantly, once you have had CMV infection, you rarely get rid of it completely. Like chickenpox, your immune system “puts the vi-

rus to sleep”. However, the virus can sometimes “wake up” again if your immune system weakens, leading to recurrent symptoms. Because of the immune suppressing drugs they take, kidney transplant recipients can not control CMV infection as well. CMV is therefore more likely to cause a severe cold, or even infect and injure other parts of the body. The most common symptoms that CMV can cause in kidney transplant recipients are: fever, cough, shortness of breath, fatigue, and diarrhea. If left untreated, CMV can rarely cause liver and neurologic problems. Importantly, many of these symptoms look exactly like any virus infection, including COVID-19. What should I do if I develop these symptoms? If you develop symptoms such as fever, cough, shortness of breath, fatigue, and/or diarrhea, you should give us a call or email our clinic (if during business hours), and if after hours, please go to your local hospital’s Emergency Room. continue on page 6 5

CMV Infection, cont’d from page 5

What we will suggest (or the Emergency Room doctors): 1. Test yourself for COVID-19 with a rapid antigen test 2. Perform a blood test for CMV (called a CMV PCR test). This tests for the CMV virus. 3. If you test positive for CMV, we will adjust your anti-rejection drugs to allow you to fight off the infection, while also still protecting against rejection.

Farewell

How do we protect against CMV infection? At this time, unfortunately there are no vaccines that exist for CMV. To protect patients against CMV, we screen people before their transplant for their risk of CMV. Most people have already been exposed to CMV before, and have developed some immunity and have “put the virus to sleep”. Their risk of CMV reactivation is generally fairly low because we give anti-rejection drugs that are less likely to cause CMV reactivation. However, in some people, we give a more powerful anti-rejection drug that can lead to CMV reactivation. In this case, we give an anti-CMV drug called valganciclovir (also known as valcyte) for 6 months, when the risk of CMV infection is the highest because patients are on the highest doses of anti-rejection drugs. We also know that people who have never developed immunity against CMV before transplant, and who receive a kidney from a donor who has been exposed to CMV before, are at the highest risk of developing active CMV infection. We give these patients an anti-CMV drug called valganciclovir (also known as valcyte) for 6 months, when the risk of CMV infection is the highest because patients are on the highest doses of anti-rejection drugs. 6

Kevin Bradley, SMH Living Donor Coordinator, has accepted a new role in California, USA. We wish him all the best.

Welcome

Alexandra Manzo, RN is the latest member in the post-transplant team. Welcome Alex to the world of kidney transplantation.

Edema after Kidney Transplantation Dr. Ramesh Prasad Edema is swelling caused by too much fluid trapped in the body’s tissues. It is a common symptom after kidney transplantation, and warrants attention. The swelling is most commonly seen in the ankles and feet, but can also occur in the abdomen and face. In the worst cases, water enters the lungs and causes shortness of breath, a condition called pulmonary edema. Some variation in the amount of swelling seen in the feet and ankles occurs from gravity. In the morning, most of the swelling is in the back, but over the course of the day, this fluid moves downwards because of gravity. In severe cases, the body weight increases. There needs to be at least 3 litres of extra fluid in the body before it even becomes visible. The blood pressure may be high as well. The causes of edema range from trivial to very serious. One of the more common causes of edema we see in the Transplant Clinic is excess fluid retained from the kidney transplant operation. The new kidney needs lots of fluid to help it perk up, and the new kidney needs to learn to get rid of the fluid. This fluid shows up more easily in parts of the body where blood flow is suboptimal, such as at the site of previous blood clots, dialysis catheters, and fistulas. Other common reasons for edema include protein leak into the urine leading to less protein in the blood, causing fluid to leak out from Edema of the lower extremities

the blood vessels into the surrounding tissues, kidney failure, and certain medications such as prednisone and calcium channel blockers. Less common causes are congestive heart failure and liver cirrhosis. How is edema treated? Keep in mind that “fluid retention” is actually “salt retention”. Therefore, restricting your dietary salt intake in consultation with a dietitian is extremely important. “Water pills” or diuretics such as furosemide are actually “salt removing pills”, so the less salt you eat, the less of such medications you will require! Your medication doses might be adjusted, but the doses may also be split to enable more salt removal. A blood test called “NTpro BNP” can help distinguish heart causes of edema from other causes, and also help adjust the dose of your diuretic. The NT-pro BNP test can be performed most easily at St. Michael’s Hospital. Too much diuretic can cause your kidney function to decline, so it might becoming necessary to live with a little bit of edema to help preserve kidney function. Measuring your weight regularly with a good quality scale at home is important. Remember that 1 kilogram of weight could mean 1 litre of extra water retention, so if you do gain more weight, call the Transplant Clinic for advice. In all cases, please inform us of any new edema, so that we can see you sooner than your next appointment if needed. 7

Interview with Walter Tauro Jaspreet Sidhu, RN

Jaspreet: Hi Walter, it is so nice to see you looking so healthy, vibrant and happy. It has now been almost 3 months since your kidney transplant. How are you feeling overall and how has life changed for you since you got the transplant? Walter: I feel great! I get to live a normal life. I don’t have to wake up early and spend my day at dialysis. My life used to revolve around dialysis. I can sleep in late, I can spend my day gardening and playing with my grandchildren. I can go for walks, I can meet my friends and family whenever I want without having to worry about dialysis. I have more energy now. When I was on dialysis, I was usually tired. I really feel wonderful now. J: How did you feel going in to the transplant? Did you ever feel scared, or have doubts about going through with the transplant? W: I was scared at times, of course. It is a major surgery. One of my doctors told me on dialysis that if I get the chance to have a transplant I should take it. I did not want to miss a 2nd chance at life. That is how I looked at it. Dr. Prasad and the surgeons explained all the risks to me, and even told me I’m at a higher risk of 8

complications such as stroke or cardiac issues, due to my age and other health issues. I was scared, but talking to my team of nurses and doctors at St Micheal’s really helped me overcome my fear. Everyone from the pre transplant team, the team on the ward and the post transplant team helped me every step of the way. They made me feel so at ease. I remember when I was going in for my transplant, the last words the surgeon said to me was “don’t worry, we will take good care of you.” I closed my eyes, prayed and the next thing I know, I’m waking up in the recovery room and was told my kidney transplant was successful. I was so happy. J: I remember your first clinic visit, you were quite weak and had a few post op complications. You also had to be readmitted for a short while. How did that feel? W: Yes, I remember. I had a few minor complications… I was never worried though. My kidney function was good almost immediately. This gave me a lot of reassurance. The transplant team here made me feel so well taken care of as an outpatient and were in constant communication with me and my other health care providers. When I was admitted, all the nurses and doctors took very good care of me. I had trust in my medical team and faith in God throughout. J: I feel like you had such a positive outlook always, from the day I met you. Do you think that has helped you do so well post transplant? W: I hope so! (laughing) I am a positive person. I love my life and want to continue to enjoy it. J: How do you feel being the oldest person in the world to successfully undergo a kidney transplant? Did you ever think you were too old to get a kidney transplant? W: Well I am very proud to be the oldest person to have a kidney transplant. At times, yes I did think maybe I’m too old…. Then I thought about my life. I have so much I want to experience still.

Continued from page 7

I want to be able to travel again, to play with my 2 grandchildren and I also have a daughter I look after too. I have a wife I want to spend time with, I have family and friends. I want to be around for as long as possible to experience life and the company of my loved ones. J: What are some plans you have for the future? W: I want to travel. I am originally from South India and haven’t been back for over 15 years. When I was on dialysis I wasn’t able to travel. I also want to travel to Europe. I’m also really looking forward to next week… I’ll be 88! I’m having a large dinner celebration with my family and friends. I’m also celebrating my 2nd chance at life. J: You received an anonymous deceased donor kidney. What is your advice to others considering organ donation? W: You can’t put a value on organ donation. It is an invaluable gift that can give another person a 2nd chance at life. J: The kidney you received was from an anonymous donor. What would you want to say to the family of the donor? W: I thank them, from the bottom of my heart, words are not enough to describe how eternally grateful I am for the gift of a new life. I encourage everyone to sign their organ donation cards. I am also so grateful to the team at St Michael’s, thank you for giving me a 2nd chance at life.

Getting to Your Transplant Clinic Appointment

Visiting the Kidney Transplant Clinic is an essential part of your post-transplant care. The importance of history taking, a directed physical examination, and an in-person review of your laboratory test results cannot be over-emphasized. There is also the ability to quickly order new tests if needed, recruit other health care providers to meet you immediately if needed, and discuss your health with close relatives or friends you have brought into the room with you. However, coming to the clinic can be challenging. Inclement weather, traffic blockages, lack of available nearby parking, taking time off work, and expense are just some obstacles patients may face in getting here. That is why we try to handle as many clinical concerns over the phone as possible, including emergency prescription refills. Most laboratory testing can be performed at outside facilities. Patients who live at a distance and those who are elderly or physically challenged can choose to have their annual clinic visits during the warmer months of the year. We try to synchronize clinic visits with transplant operation anniversaries, so that laboratory test results are as current as possible, avoiding the need for repeat testing on the day of the clinic visit. If absolutely necessary, Transplant Clinic visits can be synchronized with other clinic visits or reasons that you need to visit St. Michael’s Hospital. Please contact our social worker Sharon Lee if you are still finding it difficult to come for your Transplant Clinic visit. 9

Heart Health and Nutrition Emily Campbell, RD CDE MScFN Registered Dietitian Many individuals develop high cholesterol after kidney transplant due to medication side-effects, lack of activity, poor diet, weight gain, or family history. With high cholesterol levels, it means that you have more fat in your blood; this fat can clog arteries and blood vessels. When this occurs you are at increased risk of heart disease or stroke. There are many lifestyle factors that you can use after transplant to help lower your risk of high cholesterol. Let’s take a look at some of them: 1. Add more sources of soluble fibre which helps to soak up cholesterol. Some of the best kidney-friendly sources of soluble fibre include: legumes and beans, tofu, flaxseed, sunflower seed, oatmeal, Brussel sprouts, sweet potato. Looking to include more soluble fibre sources? Try these strategies: • Add lentils or beans to your soup or salad • Snack on hummus and vegetables • Add ground flax seed to yogurt or oatmeal • Choose whole grain pasta and breads 2. Include more whole grains. These are a source of fibre and phosphorus after kidney transplant. A common concern is the PRODUCT

White Bread (1 slice) Whole Grain Bread (1 slice) Parboiled White Rice (1/2 cup cooked) Brown Rice (1/2 cup cooked)

amount of potassium and phosphorus in whole grains. Let’s take a look at them to compare: Even whole grains can be included in a low potassium or low phosphorus diet because we do not absorb the full amount from the food with whole grains. Speak with your renal dietitian to learn how much and how often you can consume whole grains. 3. Aim for regular physical activity such as aiming for 150 min brisk walking and it may also be beneficial to include muscle and bone strengthening exercises 2 times per week. Speak with your healthcare team before starting any new routine and when it is safe to do so after your transplant. 4. Stop smoking. This is a risk factor to high cholesterol. If you have questions about foods to include to reduce your cholesterol. Ask to speak with your renal dietitian.

POTASSIUM (MG)

PHOSPHORUS (MG)

FIBRE (G)

1.2

2.1

0.8

1.5

Letter to the Editor Nick Lacivita

On April 13, 2023 I received a phone call in the late evening stating that I was to receive a kidney transplant the next day. At first I thought it was a prank call but when I verified it, I was ecstatic. I won the lottery. The next day, I received a kidney. Four months later, after receiving the kidney I am feeling much better even though initially I developed an infection. Prior to my surgery, I was on dialysis for 3 years. As a result of having Type 1 diabetes for over 30 years, my kidneys failed. As time went by, I could feel a deterioration in my body taking place. But what choices did I have? I realize that I had 3 options: do nothing and die, continue dialysis, or get a new kidney. Fortunate as I was, many are not. In Ontario, there are over 1600 people waiting for a life saving organ transplant. Every three days, someone will die because they did not get their transplant on time. Only 35% of Ontarians are registered to donate and 12.6 million people are unregistered. 90% of Ontarians support organ donation. So what is the solution – how do we get enough kidneys to meet the demand? The solution lies partially in presumed consent or “opt out” legislation. In short this mean people are presumed to consent to donate after they die. In Ontario, we must provide consent in a number of ways to donate our organs. However, few people make conscious effort to provide consent even though they want to. The system has already been running in Nova Scotia successfully with 40% increase in organ

donation. New Brunswick and British Columbia are also about to implement it. I ask myself why not Ontario. This legislation was first introduced by Peter Kormos – a staunch supporter of organ donation over 20 years ago. Since then it has been revised seven times by the NDP health critic France Gelenas but nothing has happened. This system has been employed also in the U.S., Spain, France, Italy and 22 other countries. Spain has taken the lead in organ donation with 20% in E.U. and 6% worldwide. From a cost effective point of view, presumed consent also makes sense. Dialysis costs roughly $100,000.00 per year per patient in Canada. By comparison, a transplant costs approximately $66000.00 with continuing costs of $23000.00 for monitoring and medications. These are significant savings for an overburdened health care sector. The “opt out” policy option is a proven solution. One that saves lives. It is also a fact that matches the incredible compassion and generosity of Canadians. I am deeply grateful and humbled by the new kidney I have received. I have made it my mission to advocate for presumed consent here in Ontario so that many people can live their lives with a renewed purpose and focus. I am awed by the number of young people who have yet to reach the prime of their lives and are awaiting anxiously a kidney transplant. Finally, I would like to say to the donors – keep the legacy of your life alive through organ donation. To the recipients – take good care of the organ you have received. Treat it with dignity and respect for it is genuinely a gift of life. To all Ontarians I say – where there is a strong will, there is a way. Put pressure on your MP’s so that this bill may be passed into law. It is long overdue. 11

Returning to Work – What Happens to My Disability Benefits? Sharon Lee, MSW, RSW Medical treatments, new technologies, skills training and vocational rehabilitation are allowing more people with health disabilities to overcome barriers to accessing, maintaining and returning to work. Many who are waiting for a transplant and those who have had a transplant want to return to work. Moreover, many have had to take time off work to look after their health care needs such as dialysis. During this time, disability benefits often form the basis of their income, namely Canada Pension Plan –Disability (CPP-D), Ontario Disability Support Program (ODSP), Employment Insurance Sickness Benefits and Group / Individual Disability Insurance. I will look at CPP- D and ODSP and how these benefits are affected upon return to work both before and after kidney transplant?

Return to work before transplant Many are under the impression they cannot work because their CPP-D or ODSP benefits would be cut off or reduced to the point that it would not make financial sense to work. You be the judge of this. People on Canada Pension Plan Disability (CPP-D) can do a limited amount of paid work 12

without having to notify Service Canada. As of 2023 you are allowed to earn up to $6,600 per year (before taxes). If you earn more than this amount you have to notify Service Canada and your benefit status will likely be reviewed. Additionally, earnings between $6,600 and $18,508.36 (CPP’s substantially gainful employment threshold) may show you are regularly capable of working and may affect your benefits. Service Canada looks at this on a case-by-case basis and will consider a variety of factors. CPP - Disability Vocational Rehabilitation Program. This is a voluntary program that helps CPP-D recipients return to work. You may be eligible for employment counselling, financial support for training and job search services. You will need to have a stable medical condition amongst other eligibility criteria. The program works with community partners to provide service. You will receive regular CPP - D benefits while you participate in the program. Your vocational rehabilitation specialist will help you look for a job after completion of the program and your benefits will continue during this period.

What happens if you are unable to continue working because of the same or a related disability? Within 2 years from the date your benefits stopped you can ask to have your benefits automatically reinstated without having to go through the usual application process. If you have been working for more than 2 years and up to 5 years, you may be eligible for a fasttrack reapplication process. This is a simpler and faster process than filing a new application. People on ODSP can earn up to $1000/ month through employment without it affecting their ODSP payments, benefits or eligibility. If they

earn more than $1000/month (after taxes), their ODSP is reduced by 75% of the amount they earn over $1000. The amount that ODSP takes is called a clawback. When the clawback reduces a person’s ODSP payment amount to zero they are no longer eligible for ODSP income support or most related benefits. ODSP Employment Supports is a program that assists people with disabilities find work (even if you have never worked before or have been out of work for some time). ODSP will connect you with a community service provider to figure out what kinds of support you need to help you get and keep a job. Services offered may include the following: job preparation and job search assistance, employment and training start-up benefit, childcare costs and other work related benefits. You do not have to be receiving income support from ODSP to be eligible for this program but you must have a ‘substantial physical or mental disability that is expected to last a year or more and makes it hard for you to find or keep a job.’ What happens if you leave ODSP for a paying job? Talk to your caseworker about the Extended Health Benefit and Transitional Health Benefit. These can help you pay for some of your health care costs if they are high or if you do not get comparable health benefits from your employer. What happens if you lose your job or find you can no longer work after leaving ODSP? You may be eligible for rapid reinstatement. This process makes it easier and faster to start receiving benefits again without having to go through a disability assessment. However, you must qualify financially and meet all other requirements.

ODSP unless you have a disability alongside a transplant. These government programs consider transplant recipients to be recovered within three to six months following transplant. In the case of CPP-D, if you return to work on a regular basis you may be able to continue to receive your benefits for 3 months. This gives you and Service Canada time to evaluate your ability to work regularly. If after 3 months you remain capable of working your benefits will likely stop. With ODSP, your benefits will likely stop if you no longer meet their definition of disability under the Ontario Disability Support Program Act. Above all, speak with your Service Canada representative or ODSP caseworker about possible implications to your benefits and their programs that assist with return to work. Work offers structure, social contact and a sense of identify and purpose among other benefits. Return to work is a complex process due to facilitators and barriers (medical and non-medical) influencing and supporting workplace re-entry. Given this, early and safe return to work planning is essential to the recovery process. This planning often includes money matters whilst keeping your health care needs a top priority. Speak to your health care team about any concerns you may have about returning to work. Also, social work can connect you with a vocational rehabilitation program in your area. In the next article, I will look at preparing yourself (from a mental health perspective) for the return to the workplace.

Returning to work after transplant Returning to work is an important goal for many transplant recipients and part of the recovery process. If you have a successful transplant you may no longer qualify for CPP-D or 13

A Tribute to a colleague and friend Maureen Connelly, RN and Galo Meliton, RN How Do You Say Goodbye to a Friend? The Kidney Transplant Program staff are mourning the loss of a longstanding transplant nurse. Fernanda Shamy passed away on Oct. 12th after a prolonged illness, surrounded by her family in the Palliative Care Unit at Sunnybrook Hospital. Fernanda started her nursing career on the inpatient nephrology/endocrinology unit in the early 1980’s. From there she worked in the hemodialysis unit before transitioning to the post transplant clinic where she worked for more than 20 years. Her patients benefited from her clinical expertise along with her compassion, kindness, and patience. Her colleagues loved her for her quick laughter, level headedness, strong work ethic and perseverance. Fernanda was the kind of nurse every other nurse would want to have caring for them. Fernanda had a good heart. You could tell she genuinely cared for her patients. One valuable lesson we all learned from her is the art of listening, how to really and truly listen to patients’ concerns. She would often ask patients to repeat what she just told them to make sure they understood the message she wanted to convey. She exuded confidence and yet was humorously self-deprecating at times. She is remembered for her enduring resilience and unwavering support to her colleagues. It has been said that in one’s lifetime, they will only have very few people 14

Simulation center at Li Ka Shing

who will truly influence them in a positive way. We are proud to say that Fernanda was one of those people who not only taught us about kidney transplant nursing, but also valuable life lessons. For that we are all forever grateful. She was very genuine with no artifice, with Fernanda, what you saw was what you got. We will continue to carry the torch to be better nurses because of her and that this clinic is better because of her influence. So, from the bottom of our hearts, we thank her. We are extremely grateful to have known and worked with her. Most of all, she was not only a nursing colleague and mentor, but a cherished friend. Our sincere sympathy to her family.

Remembering Brian Flood 1943-2023 Maureen Connelly, RN

The next time you come to the transplant clinic, look up at the sign on the wall – The Flood Family Waiting Room, then take a moment to reflect on how we have all benefited from this family’s generosity in making our clinic space such a beautiful place of healing. The patriarch of this family was Brian Flood who passed away June 8th, 2023.

involved in his care and an example for us all to aspire to. He treated all the team the same with kindness and respect. He always expressed such gratitude for his care and never complained despite his health challenges. His strength of character and quiet sense of humour was always a joy to see. He was a true gentleman.

Brian lived a remarkable life despite the challenges of living with kidney disease. He received a kidney transplant in 2000 after six years on the waiting list and doing dialysis three times a week in our hemodialysis unit. It was a common sight to see Brian sitting in his dialysis chair while working away at the same time.

Brian was a law partner at Tory’s in Toronto where he was known for his legal acumen and for mentoring young lawyers. He gave his time generously as the Chair of Premier Harris’s Advisory Board on Organ and Tissue Donation. He was also the inaugural Board Chair of the Trillium Gift of Life Network, Ontario’s organ and tissue donation agency. It was Brian’s early vision and work that contributed to TGLN’s success today in improving organ donation rates in Ontario.

I asked him one time how he coped with dialysis for so long while maintaining a busy law practice. His answer was simple: “I was determined not to let it overcome me or define me” Those words stuck with me over the many years of caring for him. It was a powerful lesson to pass on to other kidney patients to help them adjust their perspective on living with chronic kidney disease. Brian’s legacy goes beyond the bricks and mortar of our new space. How he lived his life was an inspiration to all the health professionals

We thank his wife Pat and family for allowing us to share this story about Brian. Our deepest sympathy to the family and our heartfelt gratitude. To read more about Brian’s exceptional life visit www.humphreymiles.com as published by the Globe and Mail June 10 to June 19, 2023. 15

Mark Your Calendar…. RN’s and Allied Health Professionals The St. Michael’s Hospital Kidney Transplant Program presents

KIDNEY TRANSPLANT SYMPOSIUM Wednesday, June 19, 2024 Li Ka Shing Knowledge Institute

Stay tuned for more details!!! 16 This newsletter is sponsored through an unrestricted educational grant from Astellas Canada.