Many thanks to Erin Wells & Evgenij Potapov for coordinating the content for this month's issue.

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In the eye of today's social hurricane, perception wavers. This month's issue liquidates the cyclonic pattern by offering a serene movement for change. Erin Wells discusses leadership during a flood of fears, while Monica Horn empathizes with diverse perspectives. Contributions from Jill Giordano, Kathryn Carpenter and Dawn Christensen reveal the storm-lashed issues involving the social work "Expectrum," as Evgenij Potapov and Schmid Daners forecast fresh wind cross shore. Kirsten Diegel radars the use of albumin and prealbumin, and Melissa Cousino shows the microburst of an at-risk population during transition.

As we look to Nice without staring into an eclipse, we prepare for the mistral winds that lay ahead.

Vincent Valentine, MD
Links Editor-in-Chief


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Leadership in Tough Times

Erin Wells, BSN, RN, CCTC, CPN

"Find your voice and inspire others to find theirs" - Stephen Covey
The recent weeks and months have certainly been a challenging time for many communities around the world. We are being inundated on a daily basis with messages of divisiveness, fear and intolerance. We find ourselves struggling to remain positive and focused as many of us are working with an increasingly culturally diverse and medically complex patient population. I had an idea for a completely different article topic, but found myself coming back to the quote above and the events that have unfolded in the United States and around the world recently. The make-up of our multidisciplinary teams is reflective of the wonderful diversity we see in our patients. Read more →


ISHLT 2018 Call for Abstract Submissions

The ISHLT 2018
Abstract Submission Site

October 24, 2017
11:59PM EST

The ISHLT 2018 Call for Abstracts available in two electronic formats:

2018 Call for Abstracts PDF Brochure

2018 Call for Abstracts Flipbook

ISHLT Call for Nomination to the Board of Directors

links imageMaryl Johnson, MD, Chair of the Governance Committee, invites the nomination of qualified ISHLT members to serve as Directors on the ISHLT Board of Directors. There are four open positions for Director on the ISHLT Board of Directors. Completed nomination packets must be submitted to the ISHLT HQ Office by 5:00 PM US Eastern Time on Friday, September 15, 2017. Nominees desiring to be favorably considered for a Director position should have had significant involvement in and service to ISHLT. Additionally, nominees should have demonstrated ability to think strategically, work effectively within a collective decision-making body, and have knowledge of or experience with organizational governance. Read more →

Call for ISHLT Links Editor Applications

The International Society for Heart and Lung Transplantation (ISHLT) is seeking an enthusiastic, creative and innovative individual to become the new Editor of the monthly ISHLT LINKS newsletter. After 7 years of exceptional and dedicated service as Editor, Vincent Valentine's term will be expiring in April, 2018. Applicants for the Editor position must be members in good standing of the ISHLT and should submit a letter of interest by October 2, 2017. Read more →


From the Transition Trenches: Working with an At-Risk Transplant Population

Melissa K. Cousino, PhD

links imageAs a pediatric psychologist working in solid organ transplantation, I was thrilled to see the Journal of Heart and Lung Transplantation recently highlight the important topic of transitioning from pediatric to adult transplant care with thoughtful recommendations for practice as described by Putschoegl and colleagues [1]. Across other solid organ transplant populations, transition to adult care has been found to be associated with adverse health outcomes, including increased graft loss and mortality [2,3]. This underscores the value of transition-focused clinical programs with concurrent study of their efficacy [1]. However, it is important to highlight that it may not simply be the physical transfer to adult care that poses the greatest risk. Read more →

Albumin and Prealbumin: Caution Before Use

Kirsten Diegel, RD, LDN

links imageAs a transplant Registered Dietitian my role is to optimize a patient's nutritional status before, during and after their transplant. In fact, nutrition plays a role in whether or not a patient can be listed for lung transplant. Currently, the International Society of Heart and Lung Transplantation (ISHLT) guidelines for lung transplantation identify Class II or III obesity (body mass index [BMI] ≥35.0 kg/m2) as absolute contraindications to lung transplant and "Class I obesity (BMI 30.0-34.9 kg/m2), particularly truncal (central) obesity and progressive or severe malnutrition" as relative contraindications to transplant [1]. While ISHLT does not specify which parameters to use to identify progressive and/or severe malnutrition, I find that physicians and surgeons focus their attention on serum albumin and serum prealbumin levels as an indicator of nutritional status. Read more →

The Social Work "Expectrum"

Jill I. Giordano, MA, MSW, LCSW
Kathryn Carpenter, LCSW, CCTSW, CCSW-MCS

The position of the Social Worker (SW) on the multidisciplinary team (MDT) is mandated by the Centers for Medicare & Medicaid Services (CMS) for Medicare-approved transplant centers. Similarly, The Joint Commission designates the SW as a necessary team member. The role of the SW on the multidisciplinary heart failure treatment team is to provide comprehensive social work services to patients and families across the spectrum of advanced therapies-from the date of initial referral, through hospitalization, and then during the lifespan of the patient and their support network. According to our professional organization, the Society of Transplant Social Workers (STSW), define this specialized role as "...providing patient education and emotional support, responsible for referrals to community agencies, coordinates patient care with other team members and assists with concrete services." Read more →


Monica Horn, RN, CCRN-K, CCTC
Jacqueline Szmuszkovicz, MD

Recently, a colleague shared that during a heart transplant information session a family member of a transplant candidate exclaimed in frustration, "You medical people just don't understand how this feels!" Such expressions of despair may happen at any time throughout the transplant process: at the time of a devastating diagnosis of a life-threatening condition for which the only intervention left to offer is transplant, while waiting many months for a donor organ, during surgical procedures or when dealing with complications of "transplant life" in spite of strict medical adherence. The distress can be overwhelming. Transplant teams must have the resource structures to reach out with supportive care and therapeutic direction for transplant families to develop the skills to navigate the twists and turns of life. Read more →


A New Format for MCS Continuing Education

Dawn Christensen, MS, CRNP

links imageHow do you document mechanical circulatory support (MCS) specific continuing education for the members of your MCS team? Is there anything out there providing an interactive environment designed to challenge both novice and experienced MCS providers? How do we make this type of continuing education available to more MCS providers? These are questions that should be part of each program's review process; whether for regulatory review or quality improvement. MCS specific continuing education traditionally consisted of two options; training sessions provided by, and most likely promoting, a manufacturer's specific device, or conference attendance - spending endless hours sitting in a large-scale lecture type environment with relatively little audience interaction. Read more →

Fresh Wind Cross Shore

Evgenij Potapov, MD, PhD
M. Schmid Daners, PhD

Today, there is only a small number of main players who dominate the LVAD market and develop new devices, or rather improve existing devices, and promote their implementation in clinical practice. The most important papers in the area of LVAD research are comparisons of the two main types of devices from studies supported by larger companies. However, no breakthrough devices have been presented for a long time and the clinical results of the new devices are not remarkably better than those of the previous models. We are sure that the companies are interested in new developments, but such changes only slowly find their way into clinical practice, as we see in the example of transcutaneous energy transfer. Read more →


Update from MCS Academy 2018

Diyar Saeed, MD, PhD
Palak Shah, MD
Jennifer Cook, MD

The Core Competencies in Mechanical Circulatory Support (MCS) began in 2012 under the leadership of David Feldman, Andreas Zuckermann and Jeffrey Teuteberg. Since then and due to continuous positive feedback from conference participants, the academy has been an extraordinary source for education. Traditionally, the academy takes place one day prior to the ISHLT meeting. This course provides a concise review of clinical knowledge and outlines the essential professional skills for candidate assemment and longitudinal support for mechanical circulatory support patients. The course is primarily designed to be of benefit for clinicians and allied professionals who are in the early stages of their careers. The course also, provides an update on the current state of the field for more established providers. Read more →

To All Inundated by Mother Nature

It's the Water, Not the Wind

Vincent Valentine, MD

links imageWe can all remember Hurricane Katrina that rocked the Gulf Coast in August 2005. With winds nearly 125 mph and a category 3 rating, the storm brought catastrophic damage as predicted. Massive flooding caused many families to be relocated leaving their homes, jobs, friends -life-behind. There was a record of over 1,800 deaths from lack of food, water and medical care. Despite this tragedy, many were unprepared for the sudden blow of Hurricane Harvey that hit over 6 million people in Houston, Texas August 2017, exactly 12 years later. This category 4 Hurricane was conceived in the largest medical industrial complex in the United States, yet the response to rescue and assessment of medical practice has been thunderstruck. Many patients are unprepared for the treatment and diagnosis they receive when they enter a hospital. For patients, the circumstance can spring up like a hurricane causing a downpour of worry and uncertainty. So, how do you prepare for the unpredictable? Read more →


The Discovery of Carbon Dioxide and Oxygen

Vincent Valentine, MD

links imageIn the Editor's Corner of the last two issues, we moved 300+ years into the 18th Century as Natural Philosophy evolved during the Renaissance. The Great Thinkers Copernicus, Kepler, Galilei and Newton challenged Aristotelian and Ptolemaic thoughts as well as the Catholic Church compelling us to gaze beyond the outer limits and into the heavens. From Newton to Werner with truly an international effort, though a bit Eurocentric, with many others not mentioned; the foundations of science and chemistry were laid as earlier scientists look away from the sky to describe the laws of nature and study the earth and its crust. This spawned the evolution of science, particularly chemistry and its separation from alchemy. In this issue, we will be further enlightened by the great discoveries and the importance of such discoveries for patients of the ISHLT from leading figures from Europe, especially France and England as we peer inward and down to the elements. Read more →


Vincent G Valentine, MD

Editorial Staff

"All the world is full of suffering. It is also full of overcoming."
— Helen Keller

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Disclaimer: Any opinion, conclusion or recommendation published by the Links is the sole expression of the writer(s) and does not necessarily reflect the views of the ISHLT.