Message from Atul and Mike

Humar,AMikes Headshot

Dear Colleagues,

Welcome to the Toronto Transplant Institute. We are proud to introduce a new activity report called “Transplant in Motion”. This monthly report will highlight developments and news across participating institutions within the Transplant Institute, including the University Health Network, the Department of Immunology, St. Michael’s Hospital and the Hospital for Sick Children.

Over the next 3-5 years, we will focus on a number of initiatives.

Examples of Identified Education Priorities:

  1. Further education of fellows by overseeing the AFC Diploma Certification training at UHN, SMH and HSC.
  2. Support innovation in education by awarding cross institutional grants for educational programs which place an emphasis on collaboration across disciplines and programs.
  3. Improve organ donation through High School Outreach Initiatives. This collaboration is with TGLN and involves transplant physicians and coordinators.
  4. Extend the Training Program in Regenerative Medicine (TPRM) with its existing online components, workshops, speakers, summer program and funding for graduate students and post-doctoral fellows.
  5. Continue yearly educational initiatives: Principals of Immunology course, Epidemiology training course (SPICE&B) and the MOT student training program.

Examples of Identified Clinical and Research Priorities:

  1. Establish dedicated and comprehensive transitional care programs and clinics to aid transitions from pediatric to adult care.
  2. Joint Living Donor recognition events every 1-2 years among three transplant programs.
  3. Kidney ex-vivo clinical trial as a combined effort between UHN, HSC and SMH.
  4. Development of standardize risk templates for utilization of exceptional distribution donors.

Our first activity report celebrates our first Education Innovation Competition, pays tribute to two of our own leaders in transplant and recognizes the hard work and dedication of transplant students. At the bottom of each story there will be a comment box for feedback. Just as stories are posted, specific questions to the transplant community will be posted. This is an opportunity for you to connect with other members.

As you move along the top toolbar you can learn more about who we are and what we do. You can also view highlighted publications in research and innovation, learn what’s happening at each site through the latest media coverage and connect to the community through our events listing.

Like all great publications, the work posted is from a team of dedicated professionals. With your contribution we can develop an informative report. To make this happen, we want to hear from you, we want to know your story and highlight the research that matters to you. Here’s your opportunity to share what you have to offer.

How can I post my information?

You can connect with Sarah Ferguson, MOT’s Education and Communications Coordinator by email at or by phone at 416-340-4800 ext: 5278

Sarah will develop regular communication pieces through interviews with all staff in the transplant community. Please send her your information and she will work with you to post it in a timely manner.

If you wish to share “Transplant in Motion” with a colleague or friend please point out the “Subscription” bar at the top right side of the page. Once they have signed up, they will receive their first report the following month.

We hope that you enjoy this month’s activity report and are inspired to be a part of the growing conversation in transplant.

Dr. Atul Humar, MD, MSc, FRCPC
Director Multi-Organ Transplant Program University Health Network
Director Toronto Transplantation Institute University of Toronto
Dr. Michael McDonald, MD, FRCPC
Director of Education for the UHN Multi-Organ Transplant Program
Director of Education Toronto Transplant Institute

Preventing Post-Operative Delirium in Transplantation

Delirium-Logo1Did you know?

40% of hospital acquired delirium may be preventable but often goes unrecognized.
“Although it’s not uncommon for healthcare professionals to manage post-operative delirium, there is always opportunities for prevention and better treatment,” says Joanna Lynch, a Psychiatric Nurse Coordinator for the Multi-Organ Transplant Program at Toronto General Hospital (TGH).

Joanna and the Consult-Liaison Psychiatry team from UHN are working with staff and patients to create awareness around post-operative delirium. They do this by performing ongoing delirium training for team members across UHN, including constant observers and chart audits on specific units to provide feedback on teams’ delirium assessment and management.

“Since delirium is a medical emergency, treating the underlying cause of delirium whether that is an infection, trauma, or hypoxia is a critical first step. Here’s what staff can do to detect delirium earlier,” says Lynch.

First, use the Confusion Assessment Method (CAM) tool and the Policy & Procedure Manual  Clinical – Delirium Prevention & Management on the UHN intranet.

Second, the Delirium Prevention and Management webpage has a variety of educational tools including a delirium resource list, CAM assessment tool, e-learning, Twitter account and Mobile App.

Third, ensure safety-decrease risk of falls, verbal de-escalation strategies if patient becomes irritable. Use 15 non-pharmacological management strategies which include (but are not limited to):

  1. Therapeutic communication- acknowledge patient’s feelings, speak clearly and slowly, use interpreters when necessary, ensure call bell within reach
  2. Promoting healthy sleep pattern (Provide periods of uninterrupted sleep)
  3. Psychosocial support – provide reassurance, encourage family participation, maintain continuity of care, frequent interactions
  4. Provide familiar objects, orient about equipment and routine
  5. Decrease or increase environmental stimulation’s according to patient needs
  6. Reassess medications
  7. Monitor vital signs, blood work, and bowel/bladder functioning
  8. Inter professional team approach
  9. Teach patient and family symptoms to report
  10. Ensure patient has hearing aid in if usually worn
  11. Ensure glasses are brought in and available to patient
  12. Immobility  – ambulate or active range of motion
  13. Monitor medications – make sure patient is on the least number, the right drug and the lowest dose
  14. Make sure patient is hydrated
  15. Assess for pain and treat as required

“Even though staff mange delirium every shift, it is important for patients and families to be aware of symptoms and report changes in behavior to their clinical care provider to ensure early detection,” says Lynch.

Here are 6 helpful tips to work with families of patients with delirium.

  1. Explain what delirium is, use simple terms such as: It is a condition that may cause patients to be confused in their thinking. Delirium is a physical problem (a change in the body) than can alter one’s psychological state (change in how the mind works).
  2. Try not to be upset about the things your loved one might say
  3. Limit the number of visitors that see your loved one until delirium resolves
  4. Provide your loved one with support and reassurance
  5. Take care of yourself
  6. Provide them with patient and family education delirium brochure for further information: -Delirium (What delirium is, the signs and symptoms, how it can be treated, how friends and family can help, and where to find more information or resources.)-How You Can Help Prevent Delirium in the Hospital, to loved ones of patients what delirium looks like and what they can do to help. Accompanying poster, How You Can Help Prevent Delirium in the Hospital, can also be ordered through the Printing Department.)

“After managing a patient with delirium, one last important step for staff is to reduce their own stress” says Lynch. “Participating in the debriefing process if a critical incident occurs, not taking behaviors personally, taking care of your physical and mental health, and remembering that you are not alone. The prevention and management of delirium is a team approach.”

If you would like more information or assistance contact the UHN Delirium Champions in your program or area. They provide support related to screening prevention and management of patients who are experiencing delirium.

Celebrating Excellence in Transplant

Susan Ng and Joanna Lynch were recipients of a scholarship at the annual Nursing and Health Professions Staff Scholarships and Awards presentation on May 11, 2015.

Joanna was awarded the Frances K. Falconer Nursing Scholarship, and Susan won the Marianne Johnston Scholarship Fund.

Here’s how they will be applying their scholarships to advance their careers in transplant.

Susan NGJoanna


(Left to right- Susan and Joanna)

Susan Ng- “I am fortunate to work with great nursing leadership on the Multi-Organ Transplant Unit and I am interested in advancing my nursing practice. This scholarship will be applied towards my graduate studies this fall in the Master of Nursing Program at the University of Toronto.”

Joanna- “This scholarship will be applied towards my continuing education at Ryerson University in the Master of Nursing Program. I am exploring how to best utilize evidence-based interventions to prevent delirium and the processes to aid in early identification of delirium on post-operative transplant recipients.”