In the Lab with the Transplant Techs

Thanks to the development of almost miraculous immunosuppressive drugs, organ transplants have become a treatment option for more and more patients. And the increasing number of transplants has created a greater need for human leukocyte antigen (HLA) technologists – the technologists who perform histocompatibility tests.

Dr. Neal denHollander, the director of the Histocompatibility Laboratory at Toronto Medical Laboratories in Ontario, is well aware of this need – he conducts informal polls as he travels to labs and conferences across North America, and every lab director he meets needs HLA technologists. DenHollander even confesses to poaching technologists from other labs around the world, his most recent arrival being from China.

The Job

Since an organ can become available at any time, HLA technologists must be willing to be on call 24 hours a day, seven days a week. If an organ becomes available during the night, the on-call tech must come in, even if s/he has already worked a regular day shift.

It takes 10 to 12 hours to do a work-up, which includes processing the donor organ and comparing it to patients on the waiting list. The first three hours involve typing the donor organ. After typing, the technologist makes the first eliminations (those with incompatible blood types) from the recipient list. The technologist evaluates the remaining potential recipients based on organ/body size, presence of chronic disease (e.g., if an organ donor has a certain condition, such as cytomegalovirus, then the organ should only be transplanted into someone who already has this condition), HLA type, history of sensitization, and previous transplants.

If there is an exact match – which is extremely rare – that person gets the organ. Otherwise, the technologist rechecks her/his own assessment of "good" and "bad" candidates, then provides the transplant surgeon with names from the waiting list, ranked in order of closeness of the match.

The transplant surgeon makes the final decision about who gets the organ. The decision considers factors such as length of time on the waiting list, closeness of the match, and patient acuity.

During the day shift, the technologists process the blood samples of individuals on the transplant waiting list (each patient on the transplant waiting list has her/his blood tested four times each year and an additional time following each sensitizing experience, such as a blood transfusion or pregnancy). The technologists also do HLA typing for bone marrow transplants (BMTs) during the day. All of the technologists' work is checked three times: by themselves, by the charge tech or supervisor, and finally by denHollander.

One Lab

DenHollander holds a PhD in immunology. His background includes inventing a vaccine for cattle against tick diseases (currently being used in Australia) and a vaccine against cocaine addiction (he sold the patent to the University of Toronto for the whopping sum of C$1).

DenHollander's lab is responsible for performing HLA testing for several areas in Ontario: the Greater Toronto Area, most of the area around Kingston, and the far north. The majority of denHollander's technologists have a Bachelor's degree in addition to their medical laboratory technology diploma. All of the technologists are certified in Canada and most are also certified (as is the lab itself) through the American Society for Histocompatibility and Immunogenetics (ASHI). Part of the requirements for the lab maintaining accreditation involves successfully analyzing blind samples sent by ASHI.

So how do you become a technologist in denHollander's lab? You must have at least two years of experience as a medical technologist. You must be willing to do call. You must have stamina and a high level of stress tolerance from the outset, as your interview with denHollander will be long and grueling. First, a two-hour oral interview checking your knowledge of hard science and your interpersonal abilities. Then a written test – the secrets of which we shall not reveal here, but let's just say it's guaranteed to be stressful. Next a hands-on exam, with questions like, "How many blood cells are on this slide?" The technologists that are hired are given one year of in-lab training before denHollander "sets them loose on a patient."

DenHollander describes the work as being very high-pressure and high-stress, because any mistake has very serious consequences. Nonetheless, the turnover is very low. The technologists are constantly learning and constantly being challenged. As denHollander says, "Today's technology had not been invented two years ago." Financially, because of the overtime, the technologists earn more money than the average tech. And the lab walls are decorated with pictures of the recipients – a constant reminder that they are saving lives every single day.

What could be more rewarding than that?

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