Eligibility for Kidney Transplant is dependent upon an egfr <20.  Historically, the egfr was obtained using a race-based calculation of egfr for Black/African American patients.  Research suggests that using a race-based variable in calculating egfr (a component of kidney function), could disadvantage Black/African American candidates with chronic kidney disease by as much as 16%. UNOS, (United Network for Organ Sharing) is the regulatory body that oversees transplant centers across the country.  A new policy eliminated the use of race based egfr calculations for Black/African American Kidney Transplant candidates to improve this inequity.  This policy change requires transplant programs to assess their patients on the waiting list who identify as Black or African American to see if they would be eligible to receive a time adjustment with using a race neutral egfr calculation. 

Melanie Nicholson is one of our Pre Kidney Transplant Coordinators and has been the nurse to take responsibility for assessing each patient on our waiting list for kidney transplant at TGH. She is an Extraordinary Nurse and has been an outstanding role model for patient-centered care in assessing our patients on the waiting list.  She has worked tirelessly to reach out to care providers, search care everywhere, and utilize ehealth to find labs that would give a patient extra wait time and get them to transplant more quickly than they would have otherwise.  She has taken great care to ask probing questions, to provide education to patients, social workers, and provider offices.  She shows compassion to patients and spends as much time as they need on the phone to help them better understand the policy change and how this change affects them.  She also educates them on kidney transplant and assesses for understanding.  The time she has invested to ensure she is finding the oldest dated labs that qualify under this requirement has been astounding.  She pays attention to detail, performs her work with integrity, and has demonstrated true patient advocacy. 

Through Melanie’s work to assess our waiting list, she has identified 156 eligible patients who have received a time modification. As a result, 37 patients have been transplanted because of the time modification adjustments since the beginning of this project in April of this year.  Melanie has found as much as 8.5 years of additional wait time.  This has made a profoundly positive impact on our patients, their families, and our program.  Patients have cried with joy and gratitude when Melanie calls them to let them know that they have received sometimes years of additional waiting time and they can expect to be transplanted imminently.

Transplant is truly the gift of life and Melanie exemplifies all the qualities of a DAISY Nurse and, as her manager, I am honored to nominate her for this prestigious award.  Not everyone would be as thorough and dedicated to ensuring that each patient gets the time and attention they deserve to get as much waiting time as they qualify for.