Many thanks to Kirsten Diegel & Jill Giordano for coordinating the content for this month's issue.

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Spotlight, look, see, medicine, art, World. NHSAH, Movement, ECMO, platoon, brigade, warning, mix, sweep, change, donor, allocation, prepared, preparedness, no show, appointments. Special, interest, ISHLT, travel, scholarship, complex, multidisciplinary, team, communication, lost art, depersonalized medicine, robotic, imprecision. France, physics, motive force, heat, Fourier transformation, Carnot cycle, Carrell, anastomosis, pumps, transplantation, extracorporeal life support, a full circle, propulsion, VAD, ECMO, bridge. In bridge, no trump is an option and nothing trumps success.

Happy Valentine's Day!

Vincent Valentine, MD
Links Editor-in-Chief


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Looking and Seeing: Lessons about Medicine from the World of Art

Stephanie Pouch, MD

I recently read that visitors to the Louvre spend an average of fifteen seconds examining the Mona Lisa. Fifteen seconds. I was initially shocked and wondered how this could be enough time to take in the coloration, contouring, shadowing, and meaning of the painting. I have admittedly not yet visited the Louvre, but I assume that the large crowds play a significant role in museum throughput. Nonetheless, the "Mona Lisa fifteen seconds" made me think about the principles of looking and seeing; concepts that were taught in my college art history classes, but which have also resonated with me as a physician. The Merriam-Webster dictionary states that to look is to "ascertain by the use of one's eyes," while to see is to "perceive by the eye" [1]. While the difference between the two may seem semantic at first, in the world of art, looking and seeing are intrinsically different actions. Read more →


Early Mobilization and ECMO: It Takes an Army

Jacqueline Smith, PT, DPT

"Alone we can do so little; together we can do so much." - Helen Keller
If you asked me 8 years ago when I was applying to graduate school to become a physical therapist what patient population I would want to work with, I most likely would have responded with, "The Philadelphia Eagles." Yet, here I am 8 years later working with the most critically ill population and collaborating with a great team of medical professionals to make the impossible, possible. At any given day in the Temple University Hospital Respiratory ICU, you can find an army of medical professionals parading medical equipment down the hallway. This army includes: physical therapy, occupational therapy, mobility aide, respiratory therapy, a perfusionist, and of course, a nurse. We have come together as a group to attempt to master early mobilization while on Extracorporeal Membrane Oxygenation (ECMO). Read more →

WARNING: Do Not Combine

Jenny Au
Kirsten Diegel, RD, LDN, CNSC

Managing immunosuppressant medications can be difficult, even for those with years of experience in the transplant field. Each patient can respond differently to medications for an assortment of reasons, and special considerations need to be made for a variety of factors, such as renal function. Immunosuppressant medications can be affected by other traditional drugs as well as nutrients and herbal supplements. The effect can be an increase or decrease in blood concentration of the medication depending on the drug, nutrient, and/or herbal supplement. For this reason, it is imperative that both pre- and post-transplant patients inform their healthcare providers of all medications and herbal supplements they are using. Below is a chart summarizing common herbal supplements and their effect on various medications used in a transplant recipient. Read more →

Sweeping Changes to the New Donor Heart Allocation...How Can I Prepare?

Emily Stimpson, MSN, RN, CCTC

links imageIn 2017 there were 3,244 heart transplants performed in the United States according to the Organ Procurement and Transplantation Network (OPTN). Currently there are 3,999 people awaiting heart transplant as of January 29, 2018 per OPTN website. Unfortunately, there are more people waiting for donor hearts than there are organs available. With longer waiting times and increased mortality on the heart transplant waiting list, the Thoracic Organ Transplantation Committee was charged to propose modifications to its current allocation policy. Currently the donor heart allocation is operating on a 3-tier system. Recently it has been announced that heart allocation will go to a 6-tier system. Read more →"

But They Don't Always Come to Appointments!

Nicole Dubyk
Pamela Combs, PhD, RN

"But they don't come to all of their appointments," is an occasionally heard statement in selection meetings when discussing patient candidacy for VAD implantation. Psychosocial factors, like adherence to medical appointments, form evidence of whether the team typically feels a patient is an "ideal candidate" for VAD therapy. This week, I wondered how much weight should be placed on a patient's attendance record. Gravlee et al. (2016) stresses the importance of candidate selection and warns healthcare teams to exercise caution in offering VAD therapy to patients who have a history of appointment non-adherence. Consistently attending clinic appointments is viewed as a strong predictor of how adherent a patient will be to other key aspects of VAD therapy-anti-coagulation, driveline management and follow up medical visits to name a few. Read more →


Monica Horn, RN, CCRN-K, CCTC
Donna Guadiz, BSN, RN, CCRN, CCTC
Debbie Dechant, BSN, RN, CCRN

Although natural disasters have occurred since the beginning of time, they still catch us off guard. Reflecting back on this last year, there were many such catastrophic events including hurricanes, floods and fires. Even if not directly involved in one of these nature events, there may be consequences for those nearby as well. Some may draw strength and composure from past experience. The positive vibes from the old Girl and Boy Scouts' motto, "Be Prepared," or the seasoned ICU charge nurses' catchphrase, "Always Have Plan-B," may be overshadowed by the hospital unit late-shift recollection of the "night that wouldn't end." It was a busy Friday for the transplant coordinator. Both of her shared-role colleagues were out due to unavoidable schedule changes. Leaving work an hour late, she noticed a news alert on her phone about a fire in the general direction of her home. Read more →


Early Bird Registration Deadline Fast Approaching

Don't miss your chance to Save Big by taking advantage of the $150 Early Bird Discount on registration fees for the ISHLT 38th Annual Meeting and Scientific Sessions in Nice, France this April. Discount ends on February 22. Between February 23 - March 12, registration fees are $150 higher so don't delay, register today!

ISHLT Lifetime Achievement Award: Call for Nominations

The ISHLT Lifetime Achievement Award is bestowed annually by the Board of Directors on an individual whose lifetime body of work has:

  1. made a significant contribution toward improving the care of patients with advanced heart or lung disease
  2. engaged in pioneering work that improved the care of patients with advanced heart or lung disease OR
  3. is representative of outstanding dedication and service to the Society

The awardee will most commonly be a current or former ISHLT member of senior stature within the profession. Non-members who are meritorious may be considered on a case by case basis as long as clear justification is provided concerning why a non-member should be considered.

ISHLT is actively seeking the nomination of those individuals thought to fit the above criteria. All engaged members of the Society are asked to consider submitting a nomination form for those they feel are worthy of this honor. You can access the nomination form using the link below:

All nomination forms must be submitted by 5:00 PM US Eastern Time, March 1, 2018. Upon its completion, a copy will be automatically sent to

Spanish Translation of ISHLT Guidelines NOW AVAILABLE!

Based on the 2016 Strategic Plan, ISHLT is working to translate a number of Standards & Guidelines documents into other languages. As part of this ongoing effort, we are pleased to announce that we now have the Spanish translations of two documents available on the JHLT website.

The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: A 10-year update (Guidelines) J Heart Lung Transplant 2015; Vol 35, No 1.

A consensus document for the selection of lung transplant candidates: 2014 - An update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation (Consensus Document) J Heart Lung Transplant 2015; 34:1-15.


ISHLT International Traveling Scholarship Report

Mrinalini Krishnan, MD

links imageAs a member of the International Society of Heart and Lung Transplantation (ISHLT), I was awarded the ISHLT Traveling Scholarship and granted the opportunity to visit Brazil and learn about Chagas cardiomyopathy and heart transplantation from the team at the Heart Institute (InCor), University of São Paulo Medical School. First described by Brazilian physician Dr. Carlos Chagas over 100 years ago, Chagas disease is a fascinating entity that has afflicted 6 million people in Central and South America. Generated by the protozoan parasite Typanosoma cruzi and predominantly transmitted by the reduviid bug through fecal contact with mucous membranes or breaks in the skin, this disease is credited for 300,000 newly reported cases each year. Read more →

The Complex Multidisciplinary Team Involved in Heart and Lung Transplantation

Javier Carbone, MD, PhD

links imageThe management process for heart and lung transplantation is very complex, with transplantation teams comprising heart and lung surgeons, cardiologists, chest physicians, critical care specialists, and other clinical specialties. Many other professionals are involved in the direct care of patients including specialists in infectious diseases, internal medicine, pediatrics, and clinical immunology. Examples of other clinical services include the nephrology department, where the patient undergoes apheresis for desensitization. Nurses perform specialized tasks related with distinct procedures of transplantation. Transplant nurses also provide specialized nursing care, support, and education for patients and their families throughout the transplant process. Pre- and post-transplantation activities (preparation for surgery and discharge) are relevant. Read more →


The Lost Art of Medical History

Daniel Dilling, MD

links image"Hello Mrs. Anderson, I'm Dr. Dilling, one of the pulmonologists on our lung transplant team. It's great to meet you and your family." We have some of the usual introductory chatter and I ask them what they understand about the reason for this referral. I swivel my chair around to the computer consul in the exam room and enter my sign-on password. I click on her name in the patient roster. I turn to her and her family and say, "what we are going to do today is to talk about your medical history and the story of your lung disease. I'm going to be typing on the computer some of the things you tell me while we are talking (because I have to) but I am listening. So... tell me your story". I sometimes start my new patient appointments this way. Thankfully, I'm a good typist! (I think that typing was the most important class I took in high school. Read more →



(adjective) - treacherous, disloyal and deceitful


Out of France and the Science of Heat to Extracorporeal Support and Transplantation

Vincent Valentine, MD

links imageLet's warm things up about our upcoming ISHLT meeting in France by exploring some of the early 19th century ideas about heat. Not so much what heat was thought to be, but instead how heat behaves with the "Laws" it follows. This is important because of the central role heat plays among nature's many forces, i.e. motive, magnetic or electrical force. Let's be sure to stay away from all the recent heated topical news in the workplace related to perhaps, the Descent of Man or Men of Power, or more aptly named - Man and His Nature and those "Laws" not followed. Heat is important because it is ubiquitous. Whenever one force is used to produce another, almost without exception heat will be produced. Heat has important characteristics. Think about electromagnetism exemplifying the interrelationships among forces like a generator. Read more →


Vincent G Valentine, MD

Editorial Staff

"The algebraic sum of all the transformations occurring in a cyclical process can only be positive, or, as an extreme case, equal to nothing."
— Rudolf Clausius, on the Second Law of Thermodynamics

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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.