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Health Care Transplantation: Giving a chance at new life

Transplantation: Giving a chance at new life

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Medical history was made earlier this year, thanks to the team at the Fort Worth Transplant Institute at Plaza Medical Center of Fort Worth.

The clinic is one of three transplant centers in the city, along with Baylor All Saints Medical Center at Fort Worth and Texas Health Harris Methodist Hospital Fort Worth.

Plaza’s transplant team and the National Kidney Registry SWAP program formed a record-breaking kidney-swap chain that involved 68 people, 34 living donors with 34 patients, across 26 member centers. The previous record was 30 in a transplant swap chain.

Transplanted kidneys can come from living donors, either related or unrelated to a recipient, or from a deceased donor. According to the National Kidney Foundation, about 100,000 people are waiting for a kidney, with the average wait time at 3.6 years to get an organ from a deceased donor. That’s why transplant programs, including the three in Fort Worth, encourage living donor transplants.

The wait time is shorter, which is crucial to a patient on dialysis. A living-donor kidney is healthier, can be quickly transplanted, and can work well right away, making the recipient’s hospital stay shorter. Kidneys from living donors also last longer after transplantation than kidneys from deceased donors, an average of 15 or more years compared with 8 to 10 years.

On the list for a cadaver donor, Rick Poe might have waited 11 years for a new kidney. Through the record kidney swap, Poe, 64, of Bedford, received a transplant in four months.

Dr. George Rofaiel, surgical director of the Fort Worth Transplant Institute, was the transplant surgeon in the record-setting transplant chain.

“This system allows us to combine the best of human generosity with the best science that there is,” Rofaiel said. “Seeing Mr. Poe and others do well is what makes us all keep doing the work that we do.”

Plaza has started a new kidney-swap chain, with one person registered and five more being evaluated.

“It’s exciting,” Rofaiel said. “I don’t know how people come to these decisions to donate a kidney to a total stranger. It’s amazing generosity.”

Plaza Medical Center

Fort Worth Transplant Institute has one of the fastest-growing kidney transplant programs in Texas. In 2013 when the program started, 13 kidney transplants were performed. In 2014, there were 40. So far this year there have been 22 transplants, with 52 people on the wait list and about 400 more being evaluated to get on the list.

“It’s a fairly new program with a brilliant history,” said Dr. Sridhar Allam, medical director and transplant nephrologist. “We are growing rapidly. We do transplant patients at a very high rate, probably the highest in the country. So far, our outcomes are 100 percent.”

Starting a transplant program is one of the most challenging projects in health care, Rofaiel said, from the amount of resources that must be put together to the surgeons and other team members that must be assembled.

“We started from scratch. We did not come with a cookie cutter plan for the program. We built it from the ground up,” Rofaiel said. “One of the reasons for our success is that we didn’t have a preconceived perception of how we were going to do it. We went for it. We consider every patient a member of the family and every organ as if it’s the last transplant we’re ever going to do. The outcomes we have here are nothing but phenomenal. The thing we do that’s different here is how much effort we put into every single patient and every single organ that we can offer.”

Every donor offer Plaza receives is carefully evaluated, says its team.

Most transplanted kidneys, both at Plaza and across the nation, come from deceased donors. Plaza is one of three transplant programs in Texas that successfully transplants kidneys from the family of deceased pediatric donors under age 5. The youngest donor offer came from a four-month-old baby.

“We look at every donor offer we get,” Allam said. “We do some challenging transplants, including pediatric. Not all surgeons are willing to do these. We have done nine pediatric donor transplants and every one is doing great.”

Baylor All Saints Medical Center

Established in 1984, Baylor’s transplant services are led by Dr. Goran B. Klintmalm, chairman and chief of the Annette C. and Harold C. Simmons Transplant Institute, one of the largest adult transplant centers in the United States. Transplants it performs include heart, kidney, liver, lung, islet cell and combined kidney/pancreas.

Baylor is one of only a few hospitals in the country whose surgeons and physicians have performed more than 7,300 organ transplants, including more than 3,100 liver transplants. Transplant surgeries are done at two locations, Baylor University Medical Center in Dallas and Baylor All Saints in Fort Worth. More liver transplants are done at the two hospitals combined than anywhere else in Texas.

Baylor’s Fort Worth program started in 2002 and does kidney, liver and pancreas transplants.

“What we saw was a need for our Tarrant County patients,” said transplant surgeon Dr. Tiffany Anthony, director of living kidney transplantation.

“Fort Worth people are not Dallas people, I have learned,” she said. “They want to be taken care of in their community. Baylor recognized that.”

Since the program’s inception, it has performed 1,043 kidney transplants (113 of these from living donors), 371 liver transplants and 57 pancreas transplants, 48 of which were kidney/pancreas transplants.

Anthony joined Baylor three years ago. She is the hospital’s first and only attending female transplant surgeon and one of about 40 female transplant surgeons worldwide. Despite its being a wide-open field for women, few take up the specialty.

“It’s clearly still a new specialty. And for women, it’s a lifestyle problem,” Anthony said.

Transplant surgeons, as well as the entire team, work long hours, day and night, she said.

“The number of women going to medical school is about equal now to men. But women in general will choose more lifestyle-friendly specialties,” she said. “Any doctor will tell you, you give up your fair share of personal time to do this job. But the rewards are great. Whether a liver, a kidney or a pancreas, a transplant completely changes a person’s life. We’re essentially giving years back and saving them from imminent death. The reward as a surgeon is getting to see that immediate change in their life.”

According to Anthony’s colleagues, she’s been known to spend the night with patients, often sleeping on the floor, taking them for walks, overseeing their care and comforting them.

“I’m a new generation of physicians and I’m a female,” she said. “Patients are scared from the get-go. People are afraid of the unknown. Transplantation is high stakes. I feel like being here for the patient is very important. In transplant, we follow and know these people their entire life and frequently are involved in their end-of-life decisions.

“A lot of times, people have this image of surgeons operating on a person and then moving on their way. I was drawn to this because of the high acuity in transplant, the technical difficulty of it, and the lifelong relationships you make with your patients.”

Texas Health Harris Methodist Fort Worth

Re-opened in January, the kidney transplant program at Texas Health Harris already has 17 people on its waiting list and is ready to perform its first kidney transplant.

The first recipient will make history, not only as No. 1 in the revived program but also as the hospital’s 1,000th kidney transplant patient.

“We will soon have our first lucky patient,” said transplant surgeon Dr. Tariq Khan, the program’s new director. “We are excited to be back here.”

Texas Health Harris’ kidney transplant program dates to May 1986 when Dr. Robert Sloane performed the first transplant. During his 30-year tenure from 1975 to 2006, Sloane performed 7,955 overall operations, developed a Level II trauma program and started the kidney transplant program.

In 2011, after 999 kidney transplants had been performed, the hospital closed the program, primarily because the surgeons had retired, Khan said. Texas Health Harris renewed and restructured the program in 2014, hired a new team (a few staffers remain from the former program) and expanded the unit’s space from 1,930 square feet to 4,705 square feet.

Khan said Texas Health Resources, the parent company of the hospital, and the hospital’s administration understand the need and the importance of the program to the community.

“There is a need in Tarrant County for this. Our goal is to take full care of patients in the area. It shows how committed Harris is to restarting the transplant program and also making it flourish,” said Khan. “Harris doesn’t look at health care as a business model. They could have shut the program down forever but remained committed to this program even though it took time to rebuild it.”

Khan said an additional benefit of the renewed program is that patients have all their care available under one roof.

“This is a very good addition to the hospital because it’s a one-stop for the patient,” he said. “They get very familiar with the facility and the staff. After the transplant they are affiliated with this program for the rest of their life. They know where to go and who to call. People want to continue their care here and Harris provides that continuum of care. This space was built for that.”

Next on Khan’s wish list is the launch of a pancreas transplant program.

“Transplantation is still relatively new. We’ve gotten very good at it,” he said. “Health care has come a long way but we’re still learning. We’ve learned a lot but there’s always more to learn, always some new technology or technique to make the process better.”

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