Pre-transplant Social Worker

• What do you need to know and have to prepare for

a kidney transplant?

• You need to plan now – you never know when

you will receive the call

Overview of the psychosocial issues:

• Your ability as a patient to manage the

responsibilities and independence of transplant

• Patient’s access to medication coverage

• Issues concerning returning to work or school

• Capability of patient’s network of social supports

• Patient’s accessibility to follow-up care

Finances and Medication coverage

• Upon your discharge from the Hospital:

• You will leave St. Mike’s hospital with a prescription for

your post transplant medication

• You must be ready to pay for your post-transplant

medications upon the day of your discharge

• Cost of transplant medications: $1,300-$3,000/month

Finances and Medication coverage

• Medication insurance

• Private company / employment benefits

• ODSP / OW

• Trillium Drug Program – vital that this be applied for

and updated yearly, even if you do not need to use the

program immediately

• There is NO funding / assistance for ongoing

medication coverage through the Transplant Program

• Older than 65-ODB coverage

Medication coverage cont’d

• Obtaining medication coverage involves TIME.

• If the private insurance is not 100% then you MUST apply

for Trillium Drug program

• Trillium Drug Program – may take up to 5 weeks for

approval.

• Anyone that does not have 100% coverage through

Private Insurance and/or does not receive OW/ODSP

benefits MUST apply for Trillium Drug Program.

Finances and Medication coverage

• Financial impact

• Leave from work,

• help at home,

• Caregiving for young children or elderly parents

• Transportation

• Post-transplant 2x/weeks visits for the first month at

St. Michael’s Hospital

• OW/ODSP may provide Medical Transportation for

post transplant visits

• Medication- Trillium deductible

What is your role post-transplant?

• You are responsible to manage your kidney transplant

and independence of life with transplant:

• Show up for f/u visits (2x/week first month at St. Mike’s)

• Do regular BW – Importance of Blood work when less

appointments at St. Mike’s

• Take your medication on a regular basis

• Maintain a healthy lifestyle with a transplant

• There is usually a “void” after receiving a transplant-

missing dialysis team; missing friends etc.

Your Support Network:

• Whom do you consider your support person? • Family member, extended relative, good friend, good

neighbor

• Important for Emotional and Practical Support

• Emotional - unpredictability of the call, drastic

change in your life

• Practical Support- transportation, be with you for

f/u visits post-transplant; assisting at home

• Support person - may need to take time-off work

on routine clinic days

Which one of you forgets to take medications at

times?

• Skipping medication now while on dialysis it is never right

– but it is not a life and death matter

• What do you think it will happen if you skip doses of post-

transplant medications?

Minimizing the Human Error:

True or False?

• I feel well therefore, I think I am doing well.

• I feel fine so I can just stop taking my

medications

Mistakes in thinking:

• How do you know you are doing well from a

kidney perspective?

Another mistake in thinking…

• Nothing happened last month when I skipped a

dose of transplant medication so….

• Do you ever skip or do not take medications when

you feel well?

• Do you ever skip or forget to take medications

when you are sad?

Another mistake in thinking…

• Dialysis treatments vs. post-transplant meds

• Lack of signs/symptoms when skipping

medications

• Who will forget more to take meds:

• A person that is in pain or a person with a

kidney transplant and not in pain?

• Humans do better at taking meds when they see

immediate relief

• Do never self-medicate

Memory…The beauty of growing older…

• Blister pack

• Reminder calls

• Cell phone alarm

• Build a support systems- what works well for you

• Associate one task with another i.e brush your

teeth with taking medications etc.

• Importance of support person – to let you know or

speak with transplant team about this

Emotional Well-being post-transplant

• Post-transplant medication may affect your mood

• Do not attribute your worsened mood to your

recovery only

• Sometimes depressive like feelings creep up on

you and you may not be aware

• Inform your family members if you do not

appear/sound like your usual self

• Depression/Anxiety part of life-let us know;

Psychiatry and SW support post-transplant

• Mental Health affects your medication adherence

Advance Care Planning

• Initiating conversation about:

• SDM and POA

• Whom do you want to make health care

decisions for you in the event that you are

not able to do so for yourself

• SDM-a person you trust will follow your

wishes and values

• It can be verbal and in writing

Recent Changes to the Renal Transplant Workup

Life post-transplant

• Goal-setting for the future

• Transition from “unhealthy” and “disabled” to

“healthy” and “able”

• Disability definition in On by MLTHC

• Support services sometimes stop

• Expectation is that the patient resume normal

life activities

• Improve overall quality of life beyond the

medical issues

Your role in receiving a Kidney transplant

• Have medication coverage in place

• Take your medication regularly as prescribed

• Show up for regular BW and follow-up visits post-

transplant

• Transportation and time-off work

• Have a support system in place

• Plan now - do not wait until post-transplant

• Call this SW if you need help with any of the

above.

Thank You

Questions?