There’s no question that the offering of an organ for a transplant—a kidney, liver or a pancreas—is a priceless gift. As a transplant social worker at Einstein Healthcare Network, Danielle D'Aguanno, LSW, MSW, is on a mission to ensure the gift reaches its fullest potential.
D’Aguanno specializes in working with transplant patients. It’s her job to help patients know what to expect before the transplant, support them emotionally while they wait, and supply them with the information and assistance they require after the implant, so that that gift can keep on giving.
Patients can be very ill to start with, and their pre-transplant illness poses its own set of issues. Even after the transplant occurs, challenges persist, in the short term and sometimes longer. There can be emotional highs and lows for both patient and caregiver, recovery can take a while … and then there is the lifetime commitment to taking immunosuppressant drugs, without which the body might reject the transplanted organ.
It can all be a bit complicated. But that’s where D’Aguanno comes in.
“I think the social worker’s role is sort of uniting the medical team and the patient’s team, bringing them together,” says D’Aguanno. “The social worker is a liaison, and has an understanding of what’s expected and anticipated. We are there for the patient. We provide counseling and crisis intervention, as well as helping them get back to their lives, transitioning them back into the community—get them back to being independent.”
How long the social worker remains involved depends on the patient.
“I meet with them before the transplant, initially for their evaluation,” says D’Aguanno. “Then if there’s no need, I might not meet with them again until after the transplant. We have patients that we’ve worked with very, very closely pre-transplant and it continues post-transplant until their issues are met … and that might not be for a very long time.”
"We are there for the patient. We provide counseling and crisis intervention, as well as helping them get back to their lives, transitioning them back into the community—get them back to being independent."
Caregivers, too, often require a lot of assistance. Many patients require the aid of a caregiver before a transplant. Liver disease in particular can lead to a loss of brain function, a condition known as encephalopathy, and that can lead to confusion on the part of the patient. A caregiver fulfills a crucial role in those circumstances. “That can be mild or really severe,” says D’Aguanno. “They absolutely need someone to check in on them, for safety reasons but also to be sure they’re taking their medication.”
Even after the transplant, severe demands might be placed on caregiver time and emotions. Patients might not be mobile for a while. They might be severely weak and fatigued. They could need someone to drive them to medical appointments. In the early going, patients might be so fatigued as to easily be confused, so they need a caregiver to accompany them to doctor visits as another set of ears, to be sure medical information and advice is understood.
To help both patients and caregivers through the process of recovery and independence, Einstein hosts a monthly support group. She also provides patient education and support at doctor visits and by phone. D’Aguanno does all she can to help patients work toward the day when they can take full advantage of that special gift of life. And for transplant social workers, it’s more than a job. It takes on the dimensions of a mission.
D’Aguanno discovered her particular calling in college when someone mentioned social work as a possible field for her, she recalls, “and I looked into it. Then I went for my master’s degree in social work. In the second year of my master’s program, my field placement was at Fox Chase Cancer Center, and I really liked that. Then when I graduated, I was looking at medical jobs just in dialysis—and I went into dialysis and I loved it. The transplant field was kind of buzzing then. That’s how I fell into transplant.”
D’Aguanno, who says she always wanted to help people, knows she made the right decision.
“I’m very passionate about what I do,” D’Aguanno says. “Realistically speaking, someone died for someone to get this gift of life, unless it’s a kidney and someone was a living donor. I feel like you have to treat it as a new opportunity, a second chance at life. It’s their new birthday.”