April is National Donate Life Month focusing attention on the importance of organ and tissue donation in much needed medical transplants. Donate Life America and its partnering organizations feature activities throughout the month of April to bring awareness to the needs of those awaiting transplants, and how individuals can become involved in this issue.
We here at JAN think this is a good opportunity to discuss accommodation ideas for people who have experienced an organ transplant. According to data on organ transplants featured on the Website WebMD, the most commonly transplanted organs are the kidneys, liver, heart, pancreas, lungs, and small intestine. For those individuals given a new lease on life with their new organs, they often face significant challenges during their recovery. This not only includes time spent recuperating from a surgical procedure, but often a lifetime of managing medications they must take to keep their bodies from rejecting the new organ. Some of these medications have significant side effects. Many individuals who have undergone an organ transplant anticipate returning to their career after a successful transplant. An effective accommodation can make this possible.
The definition of disability was expanded when the Americans with Disabilities Act (ADA) was amended in 2008 so the ADA now protects a lot more people. As a result, individuals in need of organ transplants are probably entitled to accommodation under the ADA if they work for covered employers. An employer with an employee who needs an organ transplant might want to be aware of accommodations the employee might need before, during, and after a transplant.
Before The Transplant
An organ transplant is a medical procedure to replace a failing organ with a new, healthy one. Many transplant candidates have been managing a chronic illness for years before being considered for a transplant. For example, candidates for receiving a heart transplant may be experiencing cardiomyopathy, which is characterized by an enlarged heart and the weakening of the heart muscle. Liver transplants are typically needed for individuals with severe liver diseases such as cirrhosis.
Many individuals may have already requested and received accommodations from their employer at this point. However, being a candidate for a transplant may require some additional accommodations. In particular, while on the list for a transplant, the patient will require medical examinations in preparation for the surgery. These exams may be done at treatment centers some distance away from where the employee lives and works. According to the Equal Employment Opportunity Commission (EEOC), allowing for a flexible schedule so the employee can attend treatment appointments and/or permitting flexible use of leave could be an effective accommodation. In some circumstances, allowing the employee to work in an alternate location could also be an accommodation option.
During and After the Transplant
A transplant patient is usually put on a list and must wait for a period of time before he or she can receive an organ. This is a process that can take years, so the timing of the transplant is often unpredictable. Employers will want to work out leave arrangements ahead of time so the employee can focus on his or her treatment and recovery. After the transplant, there will often be a recovery time during which the employee will not be able to work. The doctor may also restrict the employee from driving so the employer may want to look into accommodations for driving.
When the employee does return to work, the employer may want to be aware of some limitations that may require accommodation. First of all, individuals who have received an organ transplant often have extensive follow up appointments that they must attend so the transplant team can monitor how they are faring with their new organ. These appointments will be necessary for the rest of the employee’s life. Again, an employer should be aware it may be necessary to consider schedule modification and/ or flexible use of leave as an accommodation so the employee can attend these appointments. In addition, the individual who received the transplant is likely to be taking medications that lessen the risk of the patient’s body rejecting the transplanted organ by suppressing the immune system. These are called immunosuppressant medications. With a suppressed immune system, the employee may need accommodations to help avoid infections.
Here are some ideas for accommodating an individual with a suppressed immune system:
- Allow employee to avoid work around infectious agents
- Provide the employee a private office with a computer keyboard, mouse, and telephone keypad that can be sterilized
- Limit the employee’s exposure to situations in which there could be at risk of infection
- Allow the employee to work from home
- Allow for flexible leave time
A suppressed immune system and the side effects of anti-rejection medications from a transplant may not be the only limitations that need to be accommodated in the workplace.
- Tremors – Some of the anti-rejection drugs can cause the transplant patient to have tremors. Although it covers a different impairment, JAN’s publication on Accommodations for Essential Tremors can be a good source for accommodation ideas.
- Increased risk of diabetes – One out of 10 patients who undergo an organ transplant develop Type 2 Diabetes. Here is a JAN publication on Accommodations for Employees with Diabetes.
- Increased risk of heart disease because of elevated cholesterol — Here is a publication from JAN with information about accommodations for employees with heart conditions.
- Increased risk of high blood pressure.
- Gastrointestinal problems – Here is a page from the JAN Website addressing accommodations for gastrointestinal issues.
- Patients may develop gout or have symptoms of gout worsened because of immunosuppressant medication.
- Anxiety and Depression – As with any major life changing event, undergoing a transplant procedure can contribute to symptoms of anxiety and depression. Here is a JAN publication on accommodating employees with mental health impairments.
With accommodations for individuals who have organ transplants, there is not a one size fits all solution. Not every transplant recipient is going to experience all of the limitations listed above. Over time, the transplant patient’s risk of rejection is lowered so the treatment team may reduce the level of medication he or she needs, and side effects will be reduced. As with any interactive accommodation process, a good source of information about what is needed is the employee who requested the accommodation. Medical documentation can also be useful from the employee’s treatment team. As always, you can contact JAN with your questions at (800)526-7234 (Voice), (877)781-9403 (TTY), or visit us on the Web at AskJAN.org.
“Donate Life America is a 501(c)3 not-for-profit alliance of national organizations and state teams across the United States committed to increasing organ, eye and tissue donation. Donate Life America manages and promotes the national brand for donation, Donate Life, and assists Donate Life State Teams and national partners in facilitating high-performing donor registries; developing and executing effective multi-media donor education programs; and motivating the American public to register now as organ, eye and tissue donors.”