Patients come in for transplant work-up, and there are many outcomes of that week of investigations. Not everybody who has a transplant work-up will actually end up having a transplant. And some of the reasons why they may not have a transplant are that they might be well enough – too well – at the moment to have a transplant, and it’s not warranted at this time; otherwise they might have found something as part of the tests, so maybe a cancer that’s not amenable to transplant, or some other organ problem that precludes them from having a transplant. And sometimes they're just too sick – they’re not well enough for the transplant, and they wouldn't survive a transplant operation and all the assault that that would have on their body.

So that’s quite a complex situation for a nurse to be in, because you're here in a transplant unit where you’re hoping that most people will get a transplant, and not everybody does. The transplant work-up patients – whilst often they’re very well patients, physically – psychologically they have a lot of emotional issues going on, and as a nurse you have to be there for them and help them through that. So that can be quite difficult, because I think working on a unit like this, the highs are where people can get their transplant and they go home, and they get better and you see them recover, and you see them have a new lease of life, them and their families. And when they don’t get a transplant, it's often end of life care, and that’s the complete opposite of what you’re aiming to do in a transplant unit, but it’s also a very rewarding aspect of nursing – because it’s the last thing you can do for somebody and it's a very privileged position to be in.

There are some people who decide that transplant’s not for them, even though they’ve been offered the choice to have a transplant. I think it’s a massive decision to make, it’s a very big operation to go under. There are loads of risks associated with it, and sometimes those risks outweigh the benefits that they think a transplant might give them, and they’d rather just carry on as they are for the time being and take their chances with other types of treatment, rather than having a transplant. It’s quite a scary decision for them to make.