How Speech-Language Pathologists have a role to play in the Organ Transplant Team 

Jessica was drawn to this role for several reasons: having prior knowledge about the Speech-Language Pathology team, perks of a part-time role and shorter commute with her young family, and most importantly, the caseload. She was interested in the complexities of this patient population, increased reliance on instrumental swallowing assessments, and ultimately, the room for growth as a clinician under these conditions.

As one of few SLPs working with transplant patients in Canada, Jessica shared some factors an SLP should consider with this population. She sees many lung transplant recipients because of the high rates of dysphagia post-operatively, as well as the risk for silent aspiration. Another consideration specifically with this population are the instances of gastrointestinal issues, such as reflux and delayed gastric emptying, that may be pre-existing or emerge post-operatively. There is a strong emphasis to examine not just the oropharyngeal swallow, but downstream function in order to have a better understanding of the entire swallow and initial phases of the digestive system. 

In most cases, dysphagia does resolve in the first few weeks to months, however SLPs certainly play a role in assessing, treating and managing these patients. She also works with patients who have had heart transplant surgeries that may have resulted in laryngeal nerve injury, patients with liver transplants who have an encephalopathic picture, and other transplant cases such as liver or kidney, who may have dysphagia secondary to prolonged intubation, intensive care unit stays, and other comorbidities. A large part of Jess’s caseload includes taking patients for videofluoroscopic swallowing assessments to objectively evaluate their swallow function in order to guide their management and make appropriate recommendations to the patient and team.

Like any job, both highs and lows exist. For Jess, highlights include the interprofessional nature of the job, getting to know patients and supporting them through their transplant journey while improving their quality of life post-transplant. However, the unfortunate lows include complex cases, especially when donor organ rejections occur. 

When asked what advice she has for SLPs interested in working in this field, she recommended networking with others currently in the field and keeping current with literature. While there aren’t a large number of open positions, the hope is that with growing programs, a growing allied health team will accompany this movement. Case in point, Jess recently transitioned from a part-time to a full-time role on the transplant unit, and with this, she plans to carve out some time for a quality improvement project, retrospectively collecting data to look at current practice in evaluating oropharyngeal dysphagia in lung transplant recipients and comparing this to the literature. She received an SAC research grant and is being supported by the TRI Swallowing Rehabilitation and Research Lab on this endeavour.

Last year, Jess attended the 2023 ASHA Convention held in Boston. This was driven in part by her motivation to meet SLPs world-wide working with the transplant population and learn from their experience and share her own. In one word, she described the experience as "chaos", but a good type of chaos! The convention was crowded, busy and action-packed; with too much to see and learn in too short of a period of time. One big take-away Jessica had from the convention was a talk on a tracheostomy Green Light tool, from Maine Medical Centre. While more relevant to the ICU caseload, this clinical tool helps guide clinicians in assessing and treating patients with tracheostomy tubes. Since returning from Boston, she has put this knowledge to good use and enhanced her patient care by incorporating elements of the tracheostomy Green Light Tool. Find more information at Knowledge Connection.

Jessica shared that while she would go to ASHA again, she also wanted to advocate for attending Canadian conferences such as the Speech and Audiology Canada (SAC) Conference, especially for newer clinicians. All in all, it sounds that if the opportunity allows, conferences are an excellent way of enhancing one’s learning and meeting new people.