Pre-transplant coordinators ‘literally on call for something every single day’Jan. 28, 2021, 9:45 AM
by Matt Batcheldor
Emily Sandhaus’ phone rings in the middle of the night. The voice on the other end tells her a donor heart is available, and it’s in El Paso, Texas. She should pack a bag and report to the Emergency Department at Vanderbilt University Medical Center. A car will take her team to Nashville International Airport, where they will board a charter plane to recover, preserve and transport the heart back to VUMC for transplant.
For Sandhaus, RN, this is real life. And this is the job she signed up to do on the weekends. Her weekday job is being one of two heart pre-transplant coordinators for the Vanderbilt Transplant Center. Along with “work husband” Chris Schwartz, RN (who also recovers organs on the weekends), they are at the forefront of the largest heart transplant program by volume in the world, with a record 148 heart transplants in 2020.
“Chris and I are literally on call for something every single day of the week, 24/7,” Sandhaus says with a laugh.
Adds Chris, “We lean on each other pretty hard.”
Sandhaus and Schwartz work closely with transplant patients — from the moment they are considered a candidate, through their stay on the transplant list, to the phone call telling them that a donor heart has been accepted for them.
They are some of the first people that patients with advanced heart failure meet when they are referred to VUMC for transplant consideration. The process generally starts when Sandhaus and Schwartz review a patient’s medical records with Kelly Schlendorf, MD, MHS, medical director of Vanderbilt’s adult heart transplant program, to decide whether a consultation in the transplant clinic is appropriate.
The next steps for a patient are a pre-transplant visit, a detailed evaluation consisting of multiple tests and consultations, then discussion at the “big meeting” — the selection committee meeting at which the whole transplant team of transplant cardiologists, surgeons, anesthesiologists and nurse anesthetists, nurse practitioners, transplant coordinator, social workers, pharmacists and others convene to determine whether a patient is suitable for heart transplant listing. Once patients are approved for transplant and placed on the waiting list, the pre-transplant coordinators are regularly in touch with them during and between regular clinic visits until transplant.
“We get to follow these patients from the very beginning of their journey, when death may be knocking at their door, all the way through transplant, when many are given a second chance at life,” Sandhaus said. “Most of the medical issues that these patients have had, they didn’t ask for…. It just kind of happened to them.”
It takes well more than 100 people to make a transplant happen, including pre- and post-transplant coordinators, organ procurement coordinators, preservationists and operating room staff in addition to bedside nurses, cardiologists, surgeons and providers from a multitude of other disciplines including infectious disease and psychiatry.
“Emily and I wear many hats in the program between pre-transplant and waitlist management,” Schwartz said. “We see these patients when they first step in the door, they’re often scared out of their head and they don’t know what they’re getting into. And we’re hopefully able to guide them through the process smoothly and try to put their minds at ease — let them know we’ve got their backs. And then us being able to hop on the airplane and get this organ for them. It’s a pretty cool thing.”
VUMC added Schwartz’s position in 2018 in response to quickly expanding volumes of heart transplants. Just in Sandhaus’ time at VUMC, the number of transplants has grown from about 75 a year to last year’s 148.
According to Ashish Shah, MD, chair of Cardiothoracic Surgery and surgical director of the adult heart transplant program, Schwartz and Sandhaus deserve a lot of credit for the program’s growth.
“Emily and Chris are tireless and insightful,” he said. “Their devotion to the patients and this program is extraordinary. Frankly, this is difficult work — physically and emotionally. And yet they bring a professionalism to the job that we should all aspire to.”
Schlendorf agrees, noting that “their passion for the job is palpable and infectious.”
The program’s growth means Sandhaus and Schwartz are busier than ever. Starting in March, due to the COVID-19 pandemic, they began working full-time from home, meeting patients virtually instead of in person. Though COVID has changed workflows, the number of heart transplants has not slowed during COVID. Rather, it has steadily increased. The heart transplant team transplanted four hearts in one 48-hour stretch in August, a new VUMC record.
“We’ve had some growing pains but, thankfully, I couldn’t ask for a better partner or a better team,” Sandhaus said. “Chris and I are on the same wavelength and we are a well-oiled machine.”
“I am so blessed today to be part of a team that is the best in the world,” Schwartz said.