Expanding transplant pharmacist presence in pretransplantation ambulatory care

The presence of pharmacists on multidisciplinary transplantation teams is well established.1 The mandates outlined by the Centers for Medicare and Medicaid Services (CMS) and the Organ Procurement and Transplantation Network/United Network for Organ Sharing bylaws have resulted in nearly universal care of a transplant recipient by pharmacists, ranging in intensity from peripheral involvement to in-depth hands-on care.2,3 The training and qualifications of pharmacists working in transplantation have been described elsewhere, with the current majority of pharmacist involvement centered on hospitalization in the immediate postoperative period.1,4 It is becoming evident that the presence of a pharmacist is needed in the ambulatory care setting. Studies involving solid organ transplant recipients who received care from a pharmacist demonstrated increased medication adherence, improved outcomes, and advanced opportunities for revenue in posttransplant ambulatory care clinics.5,–8 One area gaining interest is the presence of pharmacists in the pretransplantation ambulatory care setting. The most common area of pharmacist involvement in the pretransplantation setting is in the patient selection committee. The conditions of participation outlined by CMS regulations for transplantation programs require that pharmacists are among the panel of multidisciplinary clinicians who present their recommendations of a potential transplant recipient’s candidacy.3 Due to time constraints as well as full-time equivalency constraints, the methods by which each pharmacist arrives at his or her respective recommendations can range from a chart review to a face-to-face clinic visit to evaluate the pharmacologic and nonpharmacologic risks related to transplantation. An in-depth review of the risks evaluated by a transplantation pharmacist was presented elsewhere.9