Compassion Creativity Competence Commitment Collaboration

compassion creativity competence commitment collaboration

Message from the Director

Organ transplantation has had a remarkable journey over the past 30 years, and staff and patients at University Hospital have been participants every step along the way. What seemed impossible in the 1970s has become one of the greatest achievements of modern medicine. Thanks to scientiﬁ c discoveries, organ transplants were transformed from operations of questionable beneﬁ t into highly successful procedures that save lives. The success rates for most transplants today are close to 90%, and patients facing death from organ failure are restored to good health. More than 4,000 transplants have been performed at University Hospital and Children’s Hospital of Western Ontario. The rewards to recipients have been great.

None of this success is possible, however, without donated organs. Unfortunately, the demand continues to exceed the supply. This gap will widen even more because of the prevalence of diseases that destroy organs and tissues, for which the only current solution is organ replacement. We are proud that the organ donation rate in the London region is the highest in the province and amongst the highest anywhere in Canada – almost double the provincial and national averages. But that is still not enough to meet the need. That is why the staff and researchers in the Multi-Organ Transplant Program dedicate their energy and resources to ﬁ nding solutions. Organs from other species, tissue regeneration, and stem cells are all possibilities. An extensive group of scientists at LHSC and our research institutes – Robarts Research Institute, Lawson Health Research Institute, and the University of Western Ontario – are continually searching for ways to improve patient outcomes.

The task is huge, but not insurmountable. We know what has to be done. We must succeed if we are to fulﬁ ll the mission of our Transplant Program – to save lives and relieve human suffering.

Inside… A Chronology of Transplantation in London....2 Caring for Patients...... 5 A Glimpse of Staff Accomplishments...... 9 Dr. William Wall Director, Multi-Organ Transplant Program Dedicated to Research and Innovation...... 11 Our Commitment to Increasing Awareness...... 14 Multi-Organ Transplant Program Staff...... 19

1 A Chronology of Transplantation in London compassion The fi rst transplants performed in London were kidney new immunosuppressive transplants in the late 1950s and 1960s. It was trailblazing drug. He headed a work, but the science of transplantation was too poorly Canadian study that understood at that time to make organ transplants examined its effective- worthwhile. The kidneys failed to function and patients ness in kidney recipients. survived for mere months. The challenge of conquering Cyclosporine proved to rejection was so great that it led one of the leading be a quantum leap in the scientists of the day, Macfarland Burnet, to make the management of organ following comment about organ transplants: “On the recipients. The success whole, the present outlook is highly unfavourable to of kidney transplants success.” immediately jumped to Dr. Calvin Stiller But the daunting task did not deter Dr. Calvin Stiller 80%, and other organ transplants such as liver and who was appointed to the staff of University Hospital heart, previously abandoned because of dreadful when it opened in 1972. Dr. Stiller was the leader and results, were started again with enthusiasm. University the driving force behind the effort to establish kidney Hospital was part of that exciting tidal wave of activity. transplantation at the hospital. He was the visionary who In addition to kidney transplants, livers were started in knew that some day not only kidney transplants would 1977, hearts in 1981, intestines in 1988, and lungs in 1989. be successful but all variety of other organ transplants The fi rst bone marrow transplant in London was done in would be successful too. His efforts, along with the 1989 to treat a patient with leukemia. That patient is pioneering efforts of others, were rewarded when a alive and well today. Cyclosporine became the most completely new drug – cyclosporine – was discovered signifi cant advance in the history of transplantation. in the late 1970s. It was a novel compound that worked The decade of the 1980s ushered in a new era. More at a specifi c site in the immune response to prevent drugs that act differently on the immune system were rejection. Through Dr. Stiller’s infl uence, University discovered and they provided even better control Hospital was selected in 1979 as one of only a few over rejection. Surgical techniques were refi ned, and centres in the world to conduct clinical studies with this

Growth of Transplantation in London 250

200 kidney-pancreas bone marrow 150 multi-visceral heart-lung liver 100 kidney Number of transplants

1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004

1957-73 2 better ways to preserve organs were discovered, them had their transplants almost 25 years ago. When thereby maximizing the chance that they would LHSC’s 500th heart transplant was done in 2003, our function perfectly in the recipients. Patients beneﬁ ted centre had performed more heart transplants than enormously from these advances. Transplants that had any other centre in Canada. Our longest-surviving been largely unsuccessful or too risky became not only kidney recipient is celebrating 33 years of health after successful, but routine. her transplant in 1973. In 2004, combined kidney-

Through a cooperative effort by pediatric and pancreas transplantation was added to the list of transplant specialists at the Children’s Hospital of transplants performed here. This combined transplant Western Ontario and University Hospital, Ontario’s fi rst treats patients with diabetes whose kidneys have liver and heart transplants in children were performed failed because of their diabetes. Now, 4,300 transplants in London in 1984. In 1993, Canada’s fi rst pediatric liver- have been performed in London. bowel transplant was performed at Children’s. The program steadily expanded and includes Sarah who, at the age of 6 months, received an unusual combined transplant of liver, bowel, stomach and pancreas. She is in the Guinness Book of Records as the world’s youngest multi-visceral transplant recipient. Dedicated staff at the Children’s Hospital in the Pediatric Critical Care Unit, 7th fl oor Pediatrics ward, and Pediatric Medical Day Unit care for our young recipients and their families. Our pediatric liver transplant recipients have a 93% long-term survival and they enjoy an excellent quality of life.

Canada’s longest surviving liver and heart recipients Dr. Neil McKenzie, Canada’s most experienced received their transplants at University Hospital. Both of heart transplant surgeon. compassion Tossa Vollrath, our ﬁ rst kidney-pancreas recipient, with Dr. Patrick Luke (left) and Dr. Anthony Jevnikar.

3 The development of transplantation as a specialized The use of living donors is another option to increase ﬁ eld of medicine produced the need to educate and the number of kidneys and livers available for transplant. train individuals who would dedicate their careers to In 1993, surgeons at LHSC were the ﬁ rst in Canada to transplantation. More than 60 doctors from Canada take a piece of liver from a mother and transplant it into creativity and around the world have received their transplant her infant son. Seven years later, in another Canadian education at LHSC. (See page 20 for a complete list first, that technique was extended to adult recipients of fellows.) In many cases, they have subsequently by taking the larger right half of the liver from a living established themselves as leaders in transplantation. donor and transplanting it into an adult recipient. The heart, kidney, and liver programs are accredited for fellowship training with the American Society of Transplant Surgeons. Six fellows are currently being trained here. Transplant “Firsts” at LHSC

Creativity and innovation have been a hallmark First liver transplant in Ontario (1977) of the Program from its inception. As one means of First heart transplant in Ontario (1981) addressing the shortage of donated organs, surgeons Canada’s fi rst heart-lung transplant (1983) at LHSC have split livers from deceased donors into two so each part could be transplanted into separate First pediatric liver transplant in Ontario (1984) recipients, suitably size-matched for the grafts. First pediatric heart transplant in Ontario (1984) World’s fi rst successful liver-bowel transplant (1988) Canada’s fi rst parent-to-child living donor liver transplant (1993) World’s youngest multi-organ recipient (1997) Transplants, 1973 - 2005 Canada’s fi rst adult-to-adult living donor kidney 1,720 liver transplant (2000) liver 1,369 bone marrow 535 heart 532 lung 48 heart-lung 47 multi-visceral 16 intestine 11 kidney-pancreas 8 islet cell 5

TOTAL 4,291

Dr. Jack Sharpe, Dr. Eric Shepherd, and Dr. Phil Hayman together have contributed 90 cumulative years of kidney transplant surgery to this centre.

4 Caring for Patients

The Walter J. Blackburn Multi-Organ Transplant Unit

Long before “patient-centred care” was a commonplace phrase, the unique needs of transplant recipients, regardless of the type of organ transplant, were identiﬁ ed as special. This concept led to the design of Canada’s ﬁ rst Multi-Organ Transplant Unit at University Hospital. Walter Blackburn and his family generously contributed to the costs of construction. The Walter J. Blackburn Transplant Unit was opened on August 31, 1987 by Dr. Stiller and Ontario’s Premier David Petersen. It has bustled with activity ever since that day. Robert Gordon was appointed Manager of the Program the year after it opened, and he continued in that role for the next 16 years.

Thousands of organ recipients have been cared for by a dedicated team that takes great pride in attending to the needs of patients. Staff – including nurses, physicians, pharmacists, psychologists, physiotherapists, social workers, and dieticians – work together to provide patients with the best possible A dedicated team cares for patients before and after transplant surgery. care. The Program has four Transplant Nurse Practitioners who have advanced education at the Patient self-care is a primary focus during recovery. Master’s level. Functioning as integral members of Patients attend education sessions to learn about the transplant team, they also have additional roles in their medications and how to adjust to everyday life education and research. after transplant. With the help of videos, which were Many recipients are critically ill with organ failure developed by our transplant pharmacist Kathy before their transplants, and they are managed in Denesyk, patients learn about immunosuppressive the Intensive Care Unit (ICU). Heart and liver recipients medications and their speciﬁ c drug regimen. In spend varying amounts of time in the ICU immediately 2002, the Canadian Society of Hospital Pharmacists following their surgery. The superb care provided awarded this project with the Novopharm Award for by the ICU staff is directly responsible for the New Programs in Patient Counselling. good outcomes in the most critically ill patients. The Physiotherapy Clinic, generously supported Most patients leave the hospital between by a donation from Dr. William Kostuk (transplant 1 and 3 weeks after their surgery. Clinical cardiologist), is geared to restoring the physical health pathways were developed to streamline care of recipients as quickly as possible. Individualized and facilitate early discharge. They eliminate exercise programs enable patients to progress quickly unnecessary diagnostic and laboratory tests and during recovery. creativity involve patients in many aspects of their recovery.

“Just a note to thank all the staff of the Transplant Unit for the wonderful care I received when I had my liver transplant in October 2004. From the PSAs, nurses, doctors, social workers, everyone was just awesome…. The staff in the Unit always kept me informed of what was going on, and they were there to help me when I needed it. Now that I am on the road to recovery, the staff in the Outpatient Clinic are right on top of things to make sure everything is running smoothly.” -Ron Simpson 5 competence

Transplant Outpatient Clinic The Outpatient Clinic, which has nearly 5,000 visits each year, ensures excellent ongoing care for transplant recipients following discharge. The Clinic coordinates visits, blood tests, and diagnostic tests. Many patients are enrolled in clinical studies, which require specifi c monitoring according to defi ned protocols. In addition to regularly scheduled visits, the Clinic also operates on an informal, drop-in basis. Computers ensure that all patient records are up- to-date. Physicians, Nurse Practitioners, and other members of the transplant team assess all test results that are sent to our Clinic, and contact patients as necessary to adjust drug doses, enquire about Paul Myers, RN, fi elding phone calls in the symptoms, and provide medical advice. Outpatient Clinic.

Once patients return home, doctors in their From 1985 until 2005 when it closed, nearby Mount own community provide medical care, including St. Joseph provided a peaceful, healing atmosphere regular blood tests to monitor organ function and the for thousands of patients who sought treatment at levels of anti-rejection drugs. Our Program is indebted UH. The Sisters of Mount St. Joseph opened their doors to countless community specialists and family to countless transplant patients and their relatives practitioners who provide diligent and timely care who needed an affordable place to wait, rest, sleep, for our patients. Also, our transplant specialists travel and share stories with other patients and families. In to distant communities, like Sudbury and Windsor, to addition, many service clubs – the Kinsmen, the Lions service transplant clinics. Foundation, David Foster Foundation, Hope Air, and the Starlight Foundation – have provided support and ﬁ nancial assistance to transplant patients who have had to travel long distances for treatment at University Hospital.

Nancy Howes, Physiotherapist, works with a heart transplant recipient in the L.P. Kostuk Physiotherapy Clinic. Dr. Andrew House in the Clinic. 6 Transplantation and Immunogenetics Laboratory The success of transplants, especially kidneys, are important in avoiding organ rejection. Dr. Howson depends on tissue matching of donors and recipients. retired in December 2005, and Dr. Ted Ball was The Transplantation and Immunogenetics Laboratory recruited from the Cleveland Clinic to direct the lab. at LHSC, under the direction of Dr. Bill Howson for 32 The Laboratory is accredited by the American Society years, performs tests that “type” donors and recipients of Histocompatibility and Immunogenetics. and measure antibody levels (crossmatching) that

Resources in the Transplant Unit The Shirley Peel Nursing Conference Room year with update days and seminars, organized by our opened in 2001, thanks to a generous gift by Mr. Bill Transplant Program Educator. The Transplant Unit has Peel. It has been a tremendous educational addition a dedicated education fund to assist our nurses who to the Unit. Textbooks and nursing journals keep our attend education courses and transplant meetings. staff up-to-date with the latest in transplant nursing Our nurses and coordinators present topics at these theory and practice. The Conference Room offers meetings that highlight nursing care and unique needed space for daily nursing reports and staff patient education strategies. meetings. Clinical education is offered throughout the

Ongoing clinical education is a vital component for our transplant staff. competence

7 commitment , a state-of-the- creativity White Family Transplantation and Transplantation White Family compassion commitment competence collaboration Our Credo Nurse Lindsay Gibbons checks a patient’s report with Grant Fisher, Transplant Recipient with Grant Fisher,report Transplant Coordinator, and Jane Van Bilsen, Manager. Coordinator, and Jane Van In 2004, the In 2004, art transplant operating room, was opened at the was opened operating room, art transplant thanks to a $1.165 million gift from University Hospital, the Blackburn Costley-White, Richard Group and Annabelle White (grandchildren Sarah White and Blackburn). It was designed and equipped of Walter and minimally invasive cally for transplantation speciﬁ donors can have their kidney surgery. Living kidney access techniques, allowing removed using minimal and discharge from hospital in one speedy recovery has the most or two days. This large operating room patient monitoring up-to-date video equipment and procedures for use devices. Our surgeons can record as educational tools. Minimally Invasive Surgical Suite Invasive Minimally 8 was was opened was opened 1954 - 1998 Dr. Lazarovits Andrew Andrew Lazarovits Library Lazarovits Andrew Dr. C.Y. Lung Patient Education Centre Lung Patient C.Y. Dr. The Novartis Pharmaceuticals Canada. Foundation, the Canadian Transplant Association, and Association, Foundation, the Canadian Transplant MedicAlert. Computer access allows patients to stay in touch by e-mail with friends and family at home. The C.Y. Education Centre is generously funded by the Dr. Lung Memorial Fund, Astellas Pharma Canada, and place for patients and their families to read literature on transplantation, to gather information from the internet, of and to attend patient education classes. Sources information include pamphlets and newsletters of the Kidney Foundation of Canada, the Canadian Liver opened in the Transplant Unit in 2001. It provides a Unit in 2001. It provides opened in the Transplant The awarded the Medal of Research Excellence by the the Medal of Research awarded in 1998 at the Kidney Foundation of Canada. He died age of 44. molecule that prevented organ rejection by uniquely organ rejection by uniquely molecule that prevented system. He led a team of altering the immune Institute that at LHSC and Robarts Research researchers (CD45 monoclonal antibody), developed an antibody c immune cells disarmedwhich targeted and speciﬁ Lazarovits was rejection. Dr. responsible for organ at University Hospital to honour the memory and honour the memory Hospital to at University of our most distinguished of one accomplishments Andrew transplant specialist Dr. staff. In 1996, kidney headlines with the discovery of a Lazarovits made A Glimpse of Staff Accomplishments

Many of our staff have made contributions to Jane Van Bilsen, Manager of the Transplant Program, transplantation of such signifi cance that they have was President of the International Transplant Nurses been deemed worthy to hold the highest offi ces in Society from 2001-2002. Michael Bloch, Transplant national and international transplant organizations. Donor Coordinator, has worked in the Transplant Their appointments recognize their leadership skills, Program since 1972. In 2003, he received the Lifetime their knowledge, and their dedication to trans- Achievement Award from the Canadian Association plantation. Eight of our staff have held the offi ce of of Transplantation for his outstanding commitment President in Canada’s various national transplant and dedication to transplantation. Dr. Stiller was the organizations. Many serve on the editorial boards of Chief of Transplantation from 1972-1996. He received prestigious journals, including Liver Transplantation the Canadian Society of Transplantation’s Lifetime (Drs. Marotta, McAlister, and Wall); Annals of Thoracic Achievement Award in 2003 to recognize his previous Surgery (Dr. Novick); Canadian Journal of Surgery and and ongoing commitment to the fi eld. In 2005, Evidenced Based Surgery (Dr. McAlister), and Journal Dr. Jevnikar was awarded the Medal for Research of Heart and Lung Transplantation (Dr. Menkis). The Excellence by the Kidney Foundation of Canada for addition of specialized staff to the Transplant Program his outstanding work in the fi eld of kidney disease and has been steady for 20 years. Increasing numbers of transplantation. transplants and different types of transplants have required the recruitment of personnel with special and creative skills.

Staff Member Position Society Year Dr. David Hollomby Chair Organ Transplantation Committee, 2003-present Canadian Council for Donation and Transplantation Dr. Anthony Jevnikar President Canadian Society of Transplantation 2002-2004 Dr. Vivian McAlister President Canadian Organ Replacement Register 2001-2004 Ms. Corinne Weernink President Canadian Association of Transplantation 2003-2004 Ms. Jane Van Bilsen President International Transplant Nurses Society 2001-2002 Mr. Michael Bloch President Canadian Association of Transplantation 2001-2002 & 1987-1988 Dr. Vivian McAlister President Canadian Society of Transplantation 2000-2001

Dr. Alan Menkis President International Society of Heart and Lung Transplantation 1997-1999 Dr. Alan Menkis President Canadian Society of Transplantation 1999-2000 Dr. Robert Zhong President International Society for Experimental Surgery 1998-2000 Ms. Jane Drew President Canadian Association of Transplantation 1998-1999 Dr. William Wall President International Liver Transplantation Society 1995-1997 Dr. Neil McKenzie President Canadian Society of Transplantation 1988-1989 Dr. Calvin Stiller Councillor International Transplantation Society 1983-1990 commitment

9 collaboration

Dr. Marotta joined the liver program in 1997. joined the liver program Dr. Marotta In 2003, a state-of-the-art symposium entitled In 2003, a state-of-the-art Dr. Ghent (left) has been a hepatologist in the liver transplant program at UH from its inception. at UH from liver transplant program Dr. Stiller organized “Ethics, Justice, and Commerce in Commerce Justice, and organized “Ethics, Stiller Dr. in congress, held A Global Issue”. The Transplantation: ethical meeting on the was a comprehensive Ottawa, transplantation. In 1998, specialists in issues surrounding every continent travelled to London microsurgery from techniques developed by to study the transplant Dr. Zhong, Director of Experimental Surgery. Zhong, Director of Experimental Dr. “Internationalon Cell-Based Therapies: Symposium to Clinical Immune Tolerance” From Stem Cell Biology Quim Madrenas, Organized by Dr. was held in London. presented scientists from Europe and North America of stem cells in the most exciting prospects for the role transplantation during this two-day symposium.

10 LHSC’s 1000th liver transplant recipient. Dr. of the pediatric Paul Atkison, Director transplant program, with Randi Bonokoski, with Randi Bonokoski, transplant program, 1991 Transplantation – Myth & Reality: A multi-disciplinary approach to patient care and future trends in – Myth & Reality: A multi-disciplinary approach to patient 1991 Transplantation transplantation on Small Bowel Transplantation 1991 Second International Symposium Microsurgery 1998 International Society for Experimental Therapies: From Stem Cell Biology to Clinical Immune Tolerance 2003 International Symposium on Cell-Based International and National Transplant Meetings in London Transplant International and National Patient Monitoring of the Transplant 1977 International Symposium on Immunological on Anencephalic Donors 1987 International Consensus Conference Transplantation 1988 First Canadian Symposium on Multi-Organ LHSC’s transplant specialists have organized many LHSC’s transplant specialists have Two the associated with intimately scientists process. national and international conferences that have globe. In 1989, attracted experts from around the Dr. Zhong is internationally his research recognized for Dr. Quim Madrenas, skills. In 2001, Dr. and microsurgical Institute, was associate at Robarts Research research Chair in Transplantation. Research a Canada awarded in determining has been instrumental His research how cells – T cells – initiate the rejection specialized white Transplant Program have received special recognition special recognition have received Program Transplant Dr. of Health Research. Institutes by the Canadian Chair a Canada Research awarded Robert Zhong was Surgery in 2004. and Experimental in Transplantation collaboration the Tcells,whichinitiate rejectionprocess. of thosesignalsisamethodpreventingactivation foreign proteinsofatransplantedorgan.Interruption ofTcellsmeetthe when receptorsonthesurfaces Transplantation, isstudyingthe“signals”thataresent treatment. transplants, nopatientwouldbedeniedthislife-saving be usedwiththesamesuccessashuman-to-human especially notinthefuture.Iforgansfrompigscould still notbeenoughtomeetthedemand,nowand available humanorganwasdonated,therewould to theshortageofdonatedorgans.Evenifevery “transgenic” pigorganscouldbetheultimatesolution pig, itshouldbeeasiertoovercome rejection.These into humans.Byintroducinghumangenesthe from geneticallymodifi ed pigsfortransplantation White isinvestigatingthefeasibilityofusingorgans Novartis-Stiller ChairinXenotransplantation.Dr. million. andconducted research projectstotalling$34 journals have publishedmorethan200articlesinscientifi c past fi ve years,membersofourTransplant Program progress withseveralmorereadytostart.Duringthe Currently, morethanadozenclinicaltrialsarein investigated invarioustrialsatUniversityHospital. of organtransplantation. Program tremendouslyinpushingforward thefrontiers benefi cial forourpatients,andithasassistedthe Research Institute.Thisassociationhasbeenextremely of MicrobiologyandImmunology,ortheLawsonHealth Institute, TheUniversityofWestern Ontario’sDepartment scientists havecrossappointmentsatRobartsResearch the laboratorytobedside.Manyofourclinician- enabled ustomovemanyinnovationsquicklyfrom research andclinicalinvestigation.Thisapproach administration understoodtheimportanceofbasic Transplant Program.Fromthebeginning,ourhospital research hasbeenanenduringtrademarkofour Dedicated toResearch andInnovation Dr. Madrenas,theCanadaResearch Chairin In 2000,Dr. DavidWhitewasappointedthe Virtually everynewimmunosuppressanthasbeen A closeassociationbetweenpatientcareand 11 are trainedinDr. Zhong’smircrosurgery laboratory immune systemandproducetolerance. rejection drugscanbeusedtoinhibittherecipient’s howanti- to scientistsinourProgramdetermine from theNationalInstitutesofHealthwasawarded Jevnikar andDr. Wall. William In2002,$1.3millionUS Transplant StudiesunderthedirectorshipofDr. Anthony Ontario), fundswereusedtoestablishtheCentrefor Research Institute,andtheUniversityofWestern industry andinstitutionalpartners(LHSC,theRobarts way partnershipinLondonamongstgovernment, to preventorganrejection.Bydevelopingathree- $1.2 millionannuallyfora5-yearperiodtostudyways Challenge Fundawarded theTransplant Program transplant. drug regimenthatisgivenonlyatthetimeof as partoftheirownbodybytheuseaspecial whereby patientsacceptthetransplantedorgan rejection. Theultimategoalistodeveloptolerance, He studiesnewdrugsandhowtousethemprevent histechniques. South America,andAustraliatolearn United States,andEurope,asfarawayAsia, each year. Manycomefromacross Canada,the Between 12and14research studentsandfellows In 2000,theOntarioResearch andDevelopment compassion human tissues or stem cells will be used as a source human tissues or stem cells will be used as a source of insulin-producing cells for transplantation. Headed effort is currently White, a major research by Dr. investigating each of these possibilities. The principle is to develop a way to transplant aim of the research insulin-producing cells without the requirement for the patient to take immunosuppressive drugs to prevent team is developing rejection. In addition, the research a new technique for performing islet transplants that eliminates the need for infusing the cells into the portal vein, as this process can be damaging to the transplant. from genetically engineered plants may prevent the plants may prevent engineered from genetically may also and they of Type 1 diabetes, development Jevnikar rejection. Dr. in preventing transplant be useful studying how rejection injures has also been and this may lead to ways of transplanted tissue, resistant to injury. making organs more 12 Dr. Zhong and his team performing an experimental kidney transplant at the University of Western Ontario. of Western kidney transplant at the University Islet transplantation has become a reality for some In the future, there may be exciting ways to be exciting ways there may In the future, Islet Laboratory Canadians who have diabetes since the Edmonton protocol Program developed a successful Transplant has Program to transplant islets. Our Transplant developed facilities at the Stiller Centre to provide a sterile, clinical grade laboratory to prepare and process pancreatic tissue for islet transplants. Right now, only a handful of the many thousands of Canadians with Type I diabetes can have this treatment because there are so few pancreases available to be used as a source of islets. This restricted availability of deceased human donor pancreases makes it inevitable that in the future non-human (pig) islets or genetically engineered produce new biopharmaceuticalsproduce and drugs useful leading a has been Jevnikar Dr. for transplantation. genetically altered plants capable team that created amounts of biopharmaceuticalof producing huge Some of these drugs cient way. drugs in a cost-effi compassion laboratory willhousethemostadvancedmicrosurgery researchers. be adaptabletothechangingneedsofindividual will encourageinteractionandcollaborationyet Centre isanopenenvironmentworkspace,which occurs whenresearchers worktogether, theMailing research benefits fromthenaturalcommunicationthat dedicated totransplantresearch. Recognizingthat nearly 10,000squarefeetoffl oor spaceforscientists Mailing familyinmemoryofMatthew,willhave facility, madepossiblebya$500,000giftfromthe Pavilion atUniversityHospital.Thisstate-of-the-art be locatedonthe4thfl oor oftheLegacyResearch Centre forTranslational Transplant Studies,whichwill have partneredtoestablishtheMatthewMailing The HospitalandtheLawsonHealthResearch Institute discoveries topatientcare,i.e.translationalresearch. research, buttotheapplicationoffundamental always hadastrongcommitmenttonotonlybasic Matthew MailingCentre forTranslational Transplant Studies Core facilitieswillbecentrallylocatedandthe The Transplant ProgramatUniversityHospitalhas the Centre hasbeenreceived from RocheCanada, AstellasCanada,Wyeth Pavilion. Inadditiontothegiftfrom the Mailing family,generous supportfor Pharmaceuticals, LoisVanKerkhoven (inmemory ofBriarLockhart),and The MatthewMailingCentre willbelocatedintheLegacy Research Keith andMaureen Smith(inmemory oftheirson,Nathan). 13 throughout theworld. ability torecruitskilledresearchers from Canada and transplantation studies,butwillalsoenhanceour current scientistswhoarefocusedontranslational to becompletedin2007,willnotonlyconsolidate novel strategiesforTypeIdiabetes.TheMailingCentre, and theirapplicationtotolerance,develop transplanted tissue,tostudynewbiopharmaceuticals stem cells),todevelopmethodsminimizeinjury of organsandcellsfortransplantation(including techniques. Thegoalsaretofi sources nd alternate evaluation ofoptimalimmunosuppressionandsurgical the worldstandard forpre-clinicalmodelsandthe Unit. immediately adjacenttotheMulti-OrganTransplant the translationalfocus,centrewillbelocated housed withintheLegacyPavilion.Inkeepingwith networktiedintotheroboticsgroup,also informatics The entirefacilitywillbelinkedbyasophisticated transplant facilityintheworld,directedbyDr. Zhong. We anticipatethattheMailingCentrewillset creativity

London Ottawa Kingston Hamilton Toronto

2004 2003 With a recipient’s family, we now have the help of

awareness initiatives, including a national calendar awareness initiatives, including a Day. Annual golf and a Donor Family Recognition tournaments – the Nathan Smith Memorial, Deiter’s Golf Classic, and the Love Memorial, Brian DeVries – have been Matthew Mailing Memorial Tournament and raising funds invaluable in promoting awareness The following are a for patient care and research. that c examples of initiatives and events few speciﬁ donation in contribute to the high rate of organ Southwestern Ontario. It has organized a wide variety of projects and annual of projects and a wide variety It has organized Race to bonspiels and “A including curling activities has Brady Raceway. Mr. at the London Fair Save Lives” of these events, championing the presided over many need for organ donation. delivering an important message transport trucks Ontario. These “moving as they travel throughout the public to consider donation encourage billboards” Donor recognition has card. and to sign a donor for the Committee for the past also been a priority with the City of London, a several years. Working of Life” has been planted at the Forks of the “Garden those who Thames in downtown London to honour been planted at have donated. A white pine has also to the Carrie the front of University Hospital thanks in memory of Newman Fund, and it is lit each Christmas hope to those those who have donated while offering helped sponsor who remain waiting. This Fund has 2002

14 Year

2001

2000 1999 Bill Brady 5.0 0.0 20.0 15.0 10.0 30.0 25.0

The London region has one of the highest donation of the highest donation region has one The London Donation Rate (per million population) by Region in Ontario, 1999-2004 Donation Rate (per million population) by Region Committee, chaired by Corinne Weernink, is an Weernink, Committee, chaired by Corinne Program. integral part of the Multi-Organ Transplant association that has been very effective in educating association that has been very effective huge effort put the public. There has also been a who Program by members of the Transplant forward awareness engage in many activities to increase and the success about the need for organ donation Donor Awareness of transplantation. LHSC’s Organ involvement with many community corporations, an involvement with many community and the critical need to donate organs. This need to donate organs. This and the critical the groundwork for the hospital’s organization laid rates not only in Ontario but also in Canada. Bill Brady, also in Canada. only in Ontario but rates not and dedicated most well-known one of London’s Stiller International Dr. with citizens, founded Transplant International in was instrumental in 1984. Transplant to the success of transplants drawing media attention Our Commitment to Increasing Awareness Increasing to Commitment Our creativity overcome anybarriers atthehospitallevel.Tailored to understanding aboutthedonation processandhowto from Clarica.Thesessionsfocusonprovidingaclear Ontarioasaresultofgenerouscontribution Northern and program forcommunityhospitalsinSouthwestern of thesubject.Thestudentsinvariablydiscussdonation transplantation andcometoathoroughunderstanding students exploremanyfacetsofdonationand family discussionbrochure.Usingreal-lifecasestudies, include ateacher’sguide,video,CD,poster, and many questionsoftheseyoungadults.Theresources educationalexperiencethatansweredthe a formal students andstudentsurveysidentifi ed theneedfor Life…Many Gifts−wasdevelopedbecauseourco-op Grade 11students.Thiseducationalprogram−One a unitofstudyondonationandtransplantationfor secondary schoolsspendanaverageof160hours Ontario since1998.Co-opstudentsfromlocal education” withsecondaryschoolsinSouthwestern A ClearProcess toOrgan Donation Secondary SchoolCurriculum:OneLife…ManyGifts Cooperative EducationProgram A teamofLHSCstaffhasdevelopedaneducational Transplant staffandeducationspecialists developed Our Transplant Programhas beena“partnerin Michael Bloch,CorinneWeernink, MahmsRichard-Mohamed, andJennifer- [back] from theTrillium GiftofLifeNetworkin thedonorcoordinator’s offi Anne Meneray,Transplant DonorCoordinators, work withBarbVan Rassel 15 hospital staff. transplant recipientswho tell theirpersonalstoriesto donation. Anintegralpartofthisprogramincludes donor management,nursingcare,andconsentfor about donoridentifi cation, braindeathdeclaration, each hospital,theemphasisisonprovidinginformation provincial implementation. – arecontinuingtopromotethiseducationaltoolfor teacheratCentral SecondarySchool) Dusky (aformer Cate Abbott,MahmsRichard-Mohamed, andRodger health care.Thedevelopersofthisinitiative–Dr. Wall, those thatinspire,advocate,andenableeducationin received theTed FreedmanAward, whichrecognizes communications inhealthcare.Thecurriculumalso to theTransplant Program inrecognitionofoutstanding Association ofCanadapresentedtheHygeiaAward audience. In2002,theHealthCarePublicRelations with theirfamilies,therebyreachingasecondtarget increasing awarenessamongtheirfellowclassmates. They organizeschoolassembliesontransplantation, recipient care,andresearch inahealth-care setting. about donorissues, in theProgram.Theylearn ce.

competence credit: Steve Martin, London Martin, Steve credit: presented. The Medal recognizes this most presented. The Medal of human compassion remarkable example life to others. It has been – giving the gift of Canadian transplant adopted by many it to their own donor programs, which present ceremonies. families at special Transplant Gift of Life Association has partnered with Gift of Life Association has partnered Transplant LHSC to sponsor many awareness events, including a donor quilt that honours organ and tissue donors. Communities outside of London have formed their own committees to promote greater awareness. They Group, Windsor include Sarnia Organ Donor Awareness Care Support, and the and Cardiac Organ Transplant Group. Sudbury Awareness promoting greater awareness about organ donation. promoting greater awareness about Two remarkable women, Janet Brady and Heather their liver transplants at LHSC, who both received Fisher, Games. In 2003, both Janet co-chaired the 2005 World the Queen’s Golden and Heather were awarded contributions to Jubilee Medal in “honour of exemplary make London a better community.” a Donor Recognition Evening when living donors when living Recognition Evening a Donor are honoured, and the Medal is and donor families 16 at the World Transplant Games in London. Transplant at the World Liver recipients Janet Brady and Heather Fisher won gold Liver recipients LHSC’s Organ Donor Awareness Committee is LHSC’s Organ Donor Awareness The City of London hosted the 15th World Transplant Transplant World The City of London hosted the 15th In 1997, LHSC’s Organ Donor Awareness Committee Awareness Organ Donor In 1997, LHSC’s Community Partners 2005 World Transplant Games Transplant 2005 World Donor Medal indebted to many partners who have helped with various awareness campaigns over the years – recipients and their families, donor families, and other volunteers as well as corporate sponsors, such as Astellas, Clarica, Hoffmann-La Roche, Novartis, and Many local businesses and organizations Wyeth-Ayerst. have collaborated too, including Scotiabank, Bell Canada, A&P stores and Canada Post. The London Games from July 16-24, 2005. More than 1,000 organ Games from July 16-24, 2005. More in athletic recipients from 48 countries participated the Internationalevents during nine days. Endorsed by compete at a Olympic Committee, organ recipients the success of very high level. The Games highlight to the shortage transplantation, and draw attention largest event of organs for transplant. It is the world’s asked William a London artist, to design a Johnson, be given to donor families. medal that could the lifesaving gift, and The Medal recognizes and permanentserves as a tangible reminder that their loved ones to the donor families the lives of others. saved and enhanced Program hosts London’s Transplant Each year, competence families, butalsothosewhoarewaitingforatransplant. volunteers includemanytransplantrecipientsandtheir getting outthemessagethat“transplantswork.”Our hasbeenvery successfulin andSarnia, well asWindsor cities asfarawaySudburyandSaultSte.Marie Over theyears,Londonregion,whichincludes towards thecauseofdonationandtransplantation. Recipient Gallery Recognizing theContributionsofourVolunteers Lynne, double lung Many volunteersgenerouslygivetheirtimeandeffort Susan, heart-lung transplant, 1995 transplant, 1994 transplant, 1995 Ernie, heart Clive, kidneyrecipient (2000) with his donor, dadMatthew with hisdonor, with his donor, sisterJackie with hisdonor, Curtis, liverrecipient (1999) transplant, 1994 Bart, cornea 17 credit: Mone Cheng for numerouscommunityawarenessprojectsaswell. at LHSC;manyofthesepatients’faceshavebeenused Recipient Gallery.TheGalleryisonyear-rounddisplay the messageintoschools,andparticipatinginour speaking abouttheirpersonalexperiences,bringing our “movingbillboard” campaign,sellingmerchandise, Their volunteerworkisequallydiverse-frominitiating Max, liver&bowel transplant, 1982 transplant, 1994 transplant, 1993 Nisbet, liver Jane, liver Mike, bonemarrow Heather, kidney Heather, Bill, liver&heart transplant, 2001 transplant, 1989 transplant, 2002 commitment

Promotional Merchandise

The Organ Donor Awareness Committee has developed an extensive merchandise line, from shirts of all descriptions to caps, key chains, umbrellas, and cards. One of our pediatric liver recipients designed a “transplantasaurus”, which was the concept for a children’s beanie baby. Our ﬁ rst t-shirt, featuring the slogan “Don’t take your organs to heaven… Heaven knows we need them here” has proven to be a favourite, with requests coming from across Canada and other countries too. Volunteers have been a tremendous help as they sell the merchandise, but also keep track of our inventory and sales. All proceeds go towards initiatives that draw attention to the need for donor organs.

Many of our volunteers devote hundreds of hours to the Transplant Program.

Our Transplant Website

Our award-winning website provides up-to-date has a special section for children. An interactive human information about London’s Transplant Program as body allows elementary students to learn about each well as general information about donation and organ and why it is needed for transplant. The website is transplantation. Information includes statistics, media www.lhsc.on.ca/transplant. articles, patients’ newsletters, and awareness events. It

18 Multi-Organ Transplant Program Staff

Director Manager Dr. William Wall Ms. Jane Van Bilsen

Administrative Support Nurse Case Manager Patient Care, Outpatient Clinic Ms. Peggy Allman (living kidney) Mr. Paul Myers Ms. Renay Ross Ms. Diane Smith Pediatrics Clinical Trials Research Nutrition Dr. Paul Atkison Ms. Patsy Burns Ms. Lynne MacArthur Ms. Cathy Fraser Ms. Dale McIntyre Pharmacy Ms. Valerie Giles Ms. Sue Skopelianos Ms. Kathy Denesyk Ms. Linda Hamilton Ms. Nancy Jevnikar Patient Care, Inpatient Unit Physiotherapy Ms. Mary McCutcheon Ms. Sharon Acton Ms. Tracy Fuller Ms. Nancy Avery Ms. Nancy Howes Data Management Ms. Heather Bartholomew Ms. Cathy Clark Ms. Sheri Bencich Research Ms. Faye Brekelmans Dr. Caigan Du Information & Resources Ms. Michelle Carter Dr. Shengwu Ma Ms. Cate Abbott Ms. Cara-Lee Coghill Dr. Joaquim Madrenas Ms. Anne Cribben Dr. Wei-Ping Min Islet Laboratory Ms. Diana Deraad Dr. Peta O’Connell Ms. Pam Gallant Ms. Melanie Dodds Dr. Huo Wang Mr. Craig Hasilo Ms. Sarah Dusky Dr. David White Mr. Justin Leushner Ms. Jody Elliott Dr. Zhuxu Zhang Ms. Jennifer Marsh Ms. Terri Fleet Dr. Robert Zhong Dr. Jamie Melling Ms. Lindsay Gibbons Dr. David White Ms. Billie Jo Green Research Assistant Ms. Erin Hedges Ms. Kathy Rycroft Medicine Ms. Monica Hill Dr. Paul Adams Ms. Carolyn Ingram Social Work Dr. Jim Brown Ms. Heather Kelly Ms. Kelly Ariesen Dr. Larry Chow Ms. Deborah Kuhar Ms. Lee Anne Breaton Dr. Cameron Ghent Ms. Amy Lidington Mr. Steve Turner Dr. Anthony Hodsman Ms. Christy Masse Dr. David Hollomby Ms. Linda May Surgery Dr. Andrew House Ms. Beth Montesi Dr. Joseph Chin Dr. Kang Howson-Jan Ms. Monika Nowak Dr. Bob Kiaii Dr. Anthony Jevnikar Ms. Selena Nyland Dr. Patrick Luke Dr. William Kostuk Ms. Marlene Puff Dr. Vivian McAlister Dr. Mark Levstik Ms. Tina Ramsey Dr. Neil McKenzie Dr. Paul Marotta Ms. Lisa Rice Dr. Richard Novick Dr. Norman Muirhead Ms. Janice Shine Dr. Doug Quan Dr. Peter Pﬂ ugfelder Ms. Elizabeth Smith Dr. Mackenzie Quantz Dr. Faisal Rehman Ms. Patsy Ste Marie Dr. Stuart Swinamer Mr. Tony Swanson Dr. William Wall Nurse Practitioners Ms. Sherry Szucsko-Bedard Ms. Jennifer Cross Ms. Tram Trinh

commitment Ms. Cheryl Dale Ms. Shelley Tubman Ms. Jan Hoffman Continued… Ms. Sandy Williams

19 collaboration Transplant Lab Transplant Edward Ball Dr. Dave Beaune Mr. Coles Rob Mr. Gougoulias Tom Mr. Ms. Jamie Hooper Bill Howson Dr. Leckie Steve Mr. Ms. Mary Michel Ms. Lucy Milinow Ms. Deborah Pullen Ms. Kim Richeleau Ms. Marg Zeale Liver and Kidney Maroun Aboujaoude (Lebanon) Sami Asfar (Kuwait) David Bigam (Canada) Matthew Brown (United States) Jonathan Fryer (United States) Anand Khakhar (India) Vivian McAlister (Ireland) Peter Metrakos (Canada) (Australia) Deborah Verran 20 Transplant Education Transplant Anne Mac Belford Ms. Cheryle Fellows Transplant Al-Ghamdi Ibraheem Dr. Al-Qutub Adel Dr. Housawi Abdulrahman Dr. Nguan Christopher Dr. Sinan Abdul-Hamid Dr. Tanaka Hideaki Dr. Kerri Robertson (Canada) Andre Roy (Canada) Sakai (Japan) Yoshi Abdul-Hamid Sinan (Syria) Edward Solano (Canada) John Sommerauer (Canada) David Stell (England) Francis Sutherland (Canada) (Japan) Hideaki Tanaka Douglas Thorburn (Scotland) (China) Hongji Yang (Turkey) Azade Yedidag Liam Gawley (Ireland) David Grant (Canada) Richard Hart (Canada) Winston Hewitt (Canada) Diederick Jalink (Canada) Nagappan Kumar (India) Mark Levstik (Canada) Luo (China) Yigang Jean-Noel Mahy (Canada) Richard Mimeault (Canada) Michael Moser (Canada) Nacdet Ozcay (Turkey) Doug Quan (Canada) Liver Ibraheem Al-Ghamdi (Saudi Arabia) Mohammed Al-Ghamdi (Saudi Arabia) Adel Al-Qutub (Saudi Arabia) Mohammad Al-Sofayan (Saudi Arabia) Nimer Assy (Israel) Paul Atkison (Canada) Vahakn Shahinian (United States) Vahakn Laxmi Sharma (India) Anne Hall (Canada) Abdulrahman Housawi (Saudi Arabia) Kevin McLaughlin (Scotland) Christopher Nguan (Canada) Faisal Rehman (Canada) Faisal Sanai (Saudi Arabia) Dorothy Thompson (Canada) (China) Fen Wang Kidney Ken Beasley (Canada) Neil Boudville (Australia) Laura Gregor (Canada) Kojiro Kodera (Japan) Simon Ledingham (England) Arnaud Painvin (Canada) Mackenzie Quantz (Canada) David Sandler (Russia) Stuart Smith (Canada) Dario Del Rizzo (Canada) Garg (Canada) Avi Kenneth Gehman (Canada) Javed Hayat (Pakistan) Mark Jones (England) Bob Kiaii (Canada) Heart and Lung Imtiaz Ali (Canada) Kassem Ashe (Canada) Colin Campbell (England) Transplant Coordination (recipient) Coordination Transplant Fisher Grant Mr. Ms. Mary Anne Henry Ms. Kathleen Larkin Transplant Coordination (donor) Transplant Michael Bloch Mr. Drew Ms. Jane Meneray Ms. Jennifer-Anne Richard-Mohamed Mahms Mr. Ms. Corinne Weernink In 2003, LHSC administration was organized into Clinical Business Units (CBUs). The Transplant Program resides Program resides into Clinical Business Units (CBUs). The Transplant In 2003, LHSC administration was organized is the Vice-President and Ms. Judy Kojlak is the Director. in the Surgery CBU: Ms. Bernadette MacDonald Transplantation at LHSC at Transplantation Clinical Fellows Trained in Organ in Organ Trained Clinical Fellows Multi-Organ Transplant Program StaffProgram Transplant Multi-Organ collaboration compassion creativity competence commitmentcommitment collaboration N O Stiller I Centre T heart A E pancreas V R A O N C

N L I

A Matthew Mailing Centre for Matthew liver & Institute Translational Transplant Studies Transplant Translational C

I 339 Windermere Road www.lhsc.on.ca/transplant H bone marrow Robarts Research N London, Ontario, Canada N6A 5A5 Ontario, London, I C © 2005 Multi-Organ Transplant Program Transplant © 2005 Multi-Organ L Multi-Organ R University Hospital, London Health Sciences Centre London University Hospital, CLINICAL CARE CCLINICAL A E S EXCELLENCE Transplant Program Transplant kidney E intestine Lawson Health RRESEARCH & INNOVATION Research Institute Research University of Western Ontario Western