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Organ Transplant Rehabilitation

Our specialized organ transplant rehabilitation program is the only one of its kind in Canada that is dedicated to the special needs of patients recovering from a recent heart, lung, renal and or liver transplant.

Referrals & Admissions

Inpatient Admission Criteria

  • Medically stable with no significant fluctuations in medical status within 72 hours
  • Motivated to participate in rehab, has active rehab goals
  • Patient's cognitive abilities and state of mental health support participation in active rehab
  • Able to participate in active rehab therapy 5 to 7 days a week
  • Able to sit unsupported for a minimum of 30 minutes
  • Pre-admit applications for surgical patients are accepted
  • Requires at least a 7-day length of stay

Special needs accommodated include the following:

  • Intermittent oxygen therapy/home oxygen
  • Tracheotomy (must by corked)
  • Intermittent tube feeds (PEG tube only)

Transfer Checklist and Key Notes

To help ensure accurate assessment, please provide the following information about the patient, prior to, or upon admission:

Patient Profile

  • Allergies
  • Anti-coagulation profile (recent blood work; Coumadin/Fragmin doses: up to 4 days)
  • Diet information with orders including formula, rate, # hours of feed, water flushes
  • Medication Administration Record (MAR)
  • Prescribed Activity levels for upper and/or lower (weight bearing; restrictions), (order to be signed by physician)
  • Special needs (egs. infusion therapy, oxygen, Ostomy)
  • Wound management orders
  • Follow up specialist appointments


  • Behavioral assessment/management (if applicable)
  • Consult reports
  • Discharge summary
  • ECG/Echocardiogram (if applicable)
  • Infection control screen results (MRSA, VRE, and others)
  • Lab results (most recent copy)
  • Names and contact information for all physicians, surgeons specialists
  • Other tests results (including video fluoroscopy)
  • Physician acute care admission report
  • Surgical procedures and dates of surgery
  • X-ray, CT/MRI (if applicable)
  • Social Work summary
  1. For seamless continuum of care, please ensure patients have had the following arranged before, or upon transfer:
    • Clinical follow-up appointments
    • Diagnostic (acute) appointments
    • Transportation for off-site tests/treatments
  1. St. John’s Rehab is a rehabilitation facility and does not have the following services:
    • emergency services
    • mechanical ventilation, total parenteral nutrition, and nasogastric feeding
    • dialysis service
    • isolation or secured units

Outpatient Referral Forms

Download our Outpatient Referral Form on our referral information page.

Please include all relevant medical/therapy reports with your application

Outpatient Admission Criteria

  • Has active rehab goals and is able to participate and tolerate increasing amount of rehab therapy.
  • Has adequate cognitive communication abilities for rehab.
  • Has a reliable means of transportation.

Woman looking at herself in a mirrorProgram Details

By providing an intensive program of therapy, education and support tailored to the individual needs of transplant recipients, our dedicated rehabilitation professionals can enhance functional outcomes and the health and wellness of patients. Rehabilitation from organ transplants also includes education about diet, exercise, proper use of medication as well as social and psychological support.

The integrated model of care between St. John's Rehab and UHN is supported through patient and team consultations using telemedicine technology and joint research and education inititatives.

Program backgrounder

St. John's Rehab at Sunnybrook Health Sciences Centre is dedicated to specialized rehabilitation. Our organ transplant rehabilitation program is the Canadian leader in rehabilitation for recipients of heart, lung, renal, liver and other transplants.

  • The program was developed in partnership with University Health Network (UHN) and is the only specialized transplant rehab program in Canada.
  • The integrated model of care between St. John's Rehab and UHN is supported through patient and team consultations using leading-edge videoconferencing technology and joint research and education initiatives.
  • The individually customized program consists of assessment, treatment and support focused on the whole person - body, mind and spirit.
  • Our multidisciplinary team of rehabilitation professionals develops goals and timelines with each patient and keeps in close contact with them and their families. This helps achieve maximum recovery, independence and quality of life.
  • Rehabilitation includes education about diet, exercise, proper use of medication, activities of daily living, as well as social and psycho-social support.
  • Once discharged, patients can benefit from a seamless continuum of care by being referred to our outpatient rehabilitation program.
  • Our highly skilled multidisciplinary rehab team includes physiotherapists, occupational therapists, nurses, speech-language pathologists, physicians, pharmacists, physiatrists, dietitians, social workers, psychologists and spiritual care.

Location and contact

Organ Transplant Rehabilitation Program

St. John's Rehab
285 Cummer Avenue,
Toronto, ON M2M 2G1

Phone: 416-226-6780
Fax: 416-226-5406

Refer a patient

Referral question? Contact:

Central Booking (Inpatient Programs)
416-226-6780 ext. 7300