 I'm Kristin Whitney from the University of Maryland Medical Center. Joining me today is Dr. Silke Niederhaus, Clinical Associate Professor of Surgery at the University of Maryland School of Medicine. Dr. Niederhaus specializes in kidney transplantation, pancreas transplantation, and laparoscopic single port donor nephrectomy at the University of Maryland Medical Center. She's also received a kidney transplant herself, bringing a unique perspective to the field of transplantation and indosuppressant management. Thanks for joining me today, Dr. Niederhaus. Thanks for having me, Kristin. Absolutely. And that kidney transplant that you received was from the University of Maryland Medical Center, the most recent one. The most recent one. Yeah, number two in 2019. So I'm hanging in there so far. Alright, that's wonderful. Well, thank you again for joining me. And thanks for all of you watching at home. Please let us know that you're watching by giving this video a like or liking our Facebook page so you can catch all of our future videos. So Dr. Niederhaus COVID-19 has changed our world in so many ways. How has the virus affected organ transplantation? Well, I think in the beginning, all of the transplant centers were very concerned and very cautious about, you know, is it okay to put people on immunosuppression to admit them to the hospital? How likely will everything spread? And so I think a lot of centers in the beginning said, let's take it slow. Let's take it easy. Let's cut back on transplanting our highest risk patients, pick the safer recipients that are healthier, that more likely are able to recover from a severe infection. But in the meantime, since about August, you know, data shows that transplantation is actually on par with last year. So overall, while there have been significant changes made in how we do things, we're not doing too badly. Great. And are transplant recipients at a greater risk for contract, contracting COVID-19? Well, I think it's a twofold question that you're really asking there. I think the chance of catching the virus goes up and down depending on what you do in life and where you go. I think if you pretty much stay at home and you're as safe as you can be, then your chance is really no higher of catching it than other people. However, the chance of getting significantly more sick from the virus, if you get it, definitely is a concern for transplant patients. And are living donors at a greater risk for contracting COVID-19? No, not at all. They don't have any risk factors at all. They're probably among the healthiest people in the country. So I'm not too worried about that patient group. That's wonderful. In our introduction, I mentioned the Singapore donor nephrectomy. Can you give us an explanation of what that is? Sure. A lot of people these days are familiar with laparoscopic surgery, which some people refer to as chopstick surgery, where we use really long, thin instruments through tiny little holes that are a half inch or less size in the abdomen that heal up really nicely. They cause less pain and allow people to recover from surgery better. And then also the incisions look nicer. Single port donor nephrectomy, you have to remember that the kidney is a rather decent sized organ, right? It's bigger than my fist is for my kidney. And so to extract it, we cannot pull it out through an incision of a quarter inch. However, if we use the umbilicus or the belly button as our incision, because the umbilicus is an indented area, we can use the part going down across and up as our incision and maybe extending it up and down just a little bit. And but however, when it heals, it looks like the incision is completely hidden inside the umbilicus or inside the belly button. So some people refer to it as incision less surgery, which is somewhat of a lie. However, people really like it because the result cosmetically is very appealing and the recovery from surgery is quite nice when your incision is you know, the size of a Band-Aid. Absolutely. I understand that UMMC transplant is taking extra precautions to ensure patient safety during the pandemic. Can you share with me some of those extra steps that UMMC transplant has been taking? Sure. In the beginning, we changed around what we do for immunosuppression for some time, but now we figured out that actually, it's quite okay to give people normal immunosuppression code calls. All of our transplant recipients before they undergo transplantation are tested for COVID-19 to minimize the chance that they have an infection going into the operation. And then our transplant floor where our in patient transplant recipient stay is a COVID free floor. So if any transplant patient contracts COVID either outpatient or you know, inpatient, which I don't know that that's really happened that much. Those patients then are roomed in a different location so that you know, there's no transmission from patient to patient for COVID-19. The other thing that we've done a lot more of is telemedicine, both for our transplant evaluations and for our follow up visits after kidney transplantation to keep people home as much as possible. So that's a great lead into my next question. I was going to say that the transplant center at UMMC has been offering telehealth medicine appointments for some years now, but I was hoping you could provide a little insight into how and why those appointments came came about and why they're now more important than ever. Yeah, I think transplantation is a highly specialized field of medicine and surgery. And so we have many, you know, people in need of transplantation who don't live close to Baltimore City, right? The people come from all over the state of Maryland and even from out of state. And in some cases, that's quite a long distance to drive. And while we can't do surgery on you at home, you know, if you're in Western Maryland, for example, we can make your life much easier by visiting with you online, meeting you and discussing whether transplantation is a surgical option at all without having to make a trip to Baltimore. And so for many years, we've seen patients for evaluation via telemedicine. But now that we really want to minimize, you know, one on one interactions in small exam rooms as much as possible and minimize travel, it makes really good sense for us to even after transplant visit with our healthy transplant population, face to face, as you will, over, you know, a platform like Zoom or another one. And that works quite well because people can voice their concerns to their physicians, physicians can electronically prescribe medications that then get, you know, either sent to your home or that you can pick up at your local pharmacy. So it's quite easy to do. It avoids a lot of travel. And honestly, I hope that, you know, it'll stay here for the future. Great. And are there some transplant patients that are better suited for telemedicine visits than others? Is it for new patients or just existing patients? Yeah, at the moment, we do a little bit of both. I think we try to offer telemedicine whenever we're able to. Obviously, in order to do telemedicine, you have to know a little bit about computers and you have to have a computer and internet access. If you, you know, are against those things, then it'll be difficult to do telemedicine. The other patients that are telemedicine is difficult to do with our patients that either speak foreign languages only and need an interpreter. And then the other group of patients that we still like to see in person are patients with really more complicated issues where an in person physical exam is really invaluable and necessary. So what does the what does a telemedicine appointment look like when it's happening? Well, it looks a little bit like this. Right here, right? You get a doctor on the camera or the phone. The beauty that as a physician I found for telemedicine appointments is there are just about no interruptions. And the time that's assigned to you and your physician is basically the time you get to spend with your physician. And that's something that, you know, in medicine has been a very rare event in recent years for a physician to spend a significant amount of time in the room talking to a patient or a patient and their family if you wish to have your family with you. And so that's been really quite a rewarding thing to see. And on the physician side, we usually have two screens open, we put your, you know, picture and on one side, and then we have our record our medical record documentation on the other side and we type as we go. So, wonderful. And you mentioned previously, you know, having a computer or a smartphone, is the technology needed for telemedicine challenging to use? Well, I think it depends on who you ask, Kristen. I think if you ask my seven year old, he'd be like, well, this is easy, no big deal, right? I think if you ask people that are more my parents generation that are not as tech savvy that, you know, are not used to using computers for many things. It's a little more difficult. But in principle, you get an email and in that email, there's a link. And if you click the link and follow those instructions, then, you know, on you go. And it's not rocket science, but it can be unfamiliar to some people. Wonderful. And I'm sure one of our nurse navigators would be more than happy to assist any patients with challenges that they're having in that area. Oh, absolutely. And this is something that actually happens a good bit where, you know, it takes a minute or two for people to log on. And if there are difficulties, you usually can expect a phone call from either one of our nurses or from one of our assistants to talk you through the steps and get you where you need to go. Dr. Neeterhouse, are telemedicine visits covered by insurance and Medicare and Medicaid? Absolutely, they are. So that is not something you'd have to worry about at all. And if someone has a telemedicine appointment scheduled, but they're unfamiliar with the process, are they able to have some assistance? Absolutely. Yeah, definitely. We have, you know, nurse coordinators that work with us and you can contact them for any questions that you have. And then generally whoever scheduled the appointment usually that would have been sent to you by email. You feel free to just email them back and say, Hey, I have a question. And there's usually a phone number there too. So you have multiple different ways to get a hold of people. Wonderful. Well, thank you again, Dr. Neeterhouse. And we did receive some questions from the audience on Facebook. Matilda from S6 asks, I'm awaiting a transplant. Could I get COVID-19 for my donor? That's pretty unlikely, Matilda, for two reasons. One, resurgence are used to dealing with other infectious diseases that occur in the donor population. And so we're very suspicious of, you know, donors who present with COVID symptoms and donation doesn't occur instantly as soon as the patient dies, but usually we have the chance to test them or they would have been tested on hospital admission. And even if that test is negative and we have some increased suspicion, we can do further testing before we recover the organs or as we recover the organs. And then while they're being transported, we can run those tests. And before we do them transplant, we definitely have, you know, more than one test result on our hands to reassure us that indeed, yes, this is not COVID or we have another explanation for the fever. And if we're worried about it, you know, we're going to either tell you and say, hey, there's this risk or we're going to say, we're not going to do this transplant and we might send you home, which is very disappointing. But trust me, if your team sends you home after you've been called in, it's not a transplant you would want. Yeah. Rodney from Baltimore asks, I'm on the transplant wait list. Will the coronavirus make my wait longer? Well, Rodney, I don't think so at the moment. I think it really depends on how healthy you are otherwise and how well you keep up to date with all your testing. I think if you get all your testing up to date, then your weight will be what your weight will be. But the best thing you can do to cut your waiting time short is to go around and start a living donor campaign for yourself, because waiting times are increasing every year anyway, because as more people develop kidney disease and are listed for kidney transplant, those times are always going up. So finding a living donor will be the best thing you can do. And we are doing living donor transplants even during COVID-19. Wonderful. And our last question that we received from the Facebook audience was Leonore from Prince George says, I have a sister who lives out of state and needs a kidney transplant. I want to be her donor, but I'm not even sure where to start with the process since COVID-19 has shut down so much. Sure. The beginning of becoming a living donor usually starts with filling out a survey or a questionnaire or just letting your sister know that you're interested in being her donor. And then generally, once you fill out the survey or questionnaire and send it in to the living donor coordinator team, they will guide you through the process step by step. And you can find those surveys or questionnaires on our website and University of Maryland. Yes, I think that's umm.edu slash transplant. You can find that. And also, you're able to find additional information about transplant services at that website. Again, it's umm.edu slash transplant. Dr. Neeterhouse, thank you again so much for your time today. I really appreciate you joining me again to our audience at home. We've been speaking with Dr. Silky Neeterhouse on transplant in the age of COVID-19 at the University of Maryland Medical Center. Thank you for all of you watching. And if you have any additional questions about transplant, please leave them in the comments below for Dr. Neeterhouse.