Louisville’s Human Organ Transplant Program Stagnates As Lexington’s Grows

Financial and operational stresses at Jewish Hospital likely to be taking a toll on one of the headline partnerships between the Hospital and the University of Louisville. Increasing dependence on Medicaid patients and a blossoming load of uncompensated care may be blocking access for the medically indigent and recipients of color for at least some solid organ transplants such as heart and liver.

Since the middle 1980s when I came to Louisville, Jewish Hospital has branded itself as a high tech “Heart Hospital.” It promotes the early adoption of high-technology. Indeed, a few years ago it received a special designation as a heart hospital in Kentucky from U.S. News & World Report that it would not have received had it not had a cardiac transplant program. In the middle 1990s, the University of Louisville formally shifted the private practice activities of its cardiologists to Jewish Hospital. The transplant surgeons at Jewish, to my knowledge, all have formal University faculty appointments. Jewish Hospital and the University of Kentucky Hospital are the only two hospitals in the state with a Certificate of Need (CON) for adult human solid-organ transplantation. (The University of Louisville does not own this CON for transplant.) Accordingly, this high-profile program is both important for, and a marker of the institutional health of both Louisville institutions.

For this and for other reasons, I have been writing about Kentucky’s transplant programs for the last few years. Most medical schools with a major clinical medical center consider having a transplant program as an important part of their service profile. I became concerned that although in the 1990s through 2010, Jewish Hospital performed the most such organ transplants in Kentucky, that a steadily-growing UK program overtook our own as early as 2010. My academic pride was injured. My concern included that a weakening Jewish Hospital was losing the resources or the will to continue this important program. It is after all an expensive undertaking. Continue reading “Louisville’s Human Organ Transplant Program Stagnates As Lexington’s Grows”

Kentucky to the World Presents Louisville Native, Dr. Sander Florman.

Noted transplant surgeon to speak March 12.sander-florman

Dr. Florman, a graduate of St. Francis School and University of Louisville Medical School, will share the fascinating story of his journey from growing up in Louisville, to rebuilding the transplant program in post-Katrina New Orleans, and to leading the Recanati/Miller Transplantation Institute at The Mount Sinai Medical Center in New York City.

Kentucky to the World (KTW) showcases highly successful individuals with strong Kentucky connections who are seldom seen or heard here.  Dr. Florman’s work as the Director of the Transplant Institute at Tulane University in New Orleans earned him recognition as one of New Orleans Magazine’s “People to Watch”. He was twice named “Health Care Hero” by New Orleans CityBusiness and was chosen as one of Gambit Weekly’s “40 Under 40.” He was recognized by Louisiana Life magazine as one of Louisiana’s “Top Doctors” and “Best Doctors” in 2007-2009. Florman is the author of nine book chapters and more than 75 publications.


Continue reading “Kentucky to the World Presents Louisville Native, Dr. Sander Florman.”

Who Pays for Human Organ Transplantation?

In response to a recent article in these pages about human organ transplantation in Kentucky, it was alleged that the University of Kentucky Hospital accepted Medicaid as payment for solid organ transplantation but that the Jewish Hospital program did not. I interviewed a number of individuals with first-hand knowledge but was unable to dispute the assertion that the source (or lack thereof) of a patient’s health insurance makes a difference in who receives an organ— not only here in Kentucky but nationwide. I recently obtained comprehensive payer-specific information from the United Network for Organ Sharing (UNOS)– the government-sponsored organization that regulates and oversees virtually all organ transplants performed in the U.S. The short answer is that there is a considerable difference in the payer-mix for solid-organ transplantation between Jewish Hospital and the University of Kentucky (UK). In 2013– the last year for which a full 12 months of reporting is available– Medicaid beneficiaries made up 6.4% of all transplant recipients at Jewish and 15.9% at UK. These figures can be compared to the national proportion of 8.7% Medicaid beneficiaries. It cannot be said that the Jewish Hospital program does not accept Medicaid beneficiaries altogether. Additional details and commentary concerning local and national transplant programs are presented below. Frankly, I had not encountered such data before and I think it will be of general interest to many. Continue reading “Who Pays for Human Organ Transplantation?”

Twenty-six Years of Human Organ Transplantation in Kentucky.

A few days ago I wrote once more about human organ transplantation in Kentucky. No sooner had my bytes hit the ether than a long inked piece featuring the latest hand transplant at Jewish Hospital appeared in the Courier Journal. The article had earmarks of the “press-release” method of media access including a big front page color photo of the surgical suite and the patient. There is no doubt that reattaching limbs to their original owners (or to a new host) represents a spectacular technical accomplishment. Such operations usually make the news somewhere. Continue reading “Twenty-six Years of Human Organ Transplantation in Kentucky.”

Financial Status a Barrier to Organ Transplantation But Not Donation.

It is easier to give than to receive in the transplant world.

organ donationIn a comment added to a recent article about the current financial status of Catholic Health Initiatives (the parent company of KentuckyOne Health) it was alleged that Jewish Hospital in Louisville did not accept Medicaid patients for organ transplantation. Because of the seriousness of this allegation, I was reluctant to allow it to stand without further comment. I therefore did some research and elicited comments from involved parties. The results trouble me and highlight yet another major example of the disparity of access to health care in our inherently unfair non-system, dividing Americans as it does by socio-economic status. In the case of transplantation, the operational result is particularly ugly, because the weight of government regulation and community has given us a morally indefensible result analogous to the rich stealing organs from the poor. I call this an example of the “Reverse Robin Hood” nature of America’s National Health System! Neither Jewish Hospital nor UofL are responsible for this situation, but have benefited from it. Continue reading “Financial Status a Barrier to Organ Transplantation But Not Donation.”

UofL Hires New Director for Bone Marrow Transplant Program.

One program or two?

I had not planned on writing quite so soon about bone marrow transplantation, but in doing my background work on U.S. News & World Report’s designation of the James Graham Brown Cancer Center as a regional high-performing cancer program, I learned that the Center has just recruited a new director for their bone marrow transplant program. Dr. William Tse is an experienced clinician and academician, was recruited from West Virginia University, and will begin in Louisville in early November. This was a fast, high-priority recruitment for the University of Louisville and the Brown Cancer Center following the loss of several clinical and research faculty faculty to the University of Kentucky, and a requirement for a minimal number of specifically-trained physicians to retain essential accreditation. Bone marrow transplantation, part of the growing field of cellular or stem-cell therapy, currently plays important part in the treatment of leukemia and other malignant diseases, and of inherited genetic disorders. Cellular therapy comprises a prominent part of the University’s commercial research portfolio.

Things looking up?
I had the opportunity to speak with one of the program’s current physicians who is optimistic about the future of the program. Although I was not given the updated procedure numbers for the two programs, I am told that they are on the way back up, as are are the numbers of clinical research protocols planned. Here is a chart updated with numbers of bone marrow transplants in 2013 as reported to the state. Continue reading “UofL Hires New Director for Bone Marrow Transplant Program.”

Crunch Time for UofL Bone Marrow Transplantation Program.

bmt-ky-1999-2012For the 30 years in which I have been associated with the University of Louisville, it’s bone marrow transplantation program has been a feather in its cap and that of the James G. Brown Cancer Center. The University of Louisville Hospital holds the Certificate of Need (CON) for adult bone marrow transplantation in Louisville – one of the tiny handful of programs that other local hospitals could not take away or did not want. Therefore I was concerned when I began to hear of doctors-lounge gossip that the program was going through a difficult patch. Unfortunately, a review of publicly available information validates my concern. Continue reading “Crunch Time for UofL Bone Marrow Transplantation Program.”

Does Donating a Kidney Increase the Risk of Kidney Failure For a Living Donor?

How good are we doctors in conveying the concept of risk to our patients and our community?

I recently met someone who donated a kidney to a person who was not a relative. My impression was that the recipient was previously a stranger, but I did not press that issue. I was overwhelmed by the staggering generosity of that gift. I am embarrassed to say that I do not know how I would respond if I were asked to donate.

Shortly afterwards in the impossibly large volume of medical journals that crosses the desk of even a retired physician, and proving the hypothesis that a person only sees what they are prepared to find, I noticed a research paper estimating the risk of kidney failure in a donor following the removal of one of the normal pair. The risk does not appear to be zero. I want to use that paper as a base to continue writing about conveying the results of medical studies and of risk to the public.

Why did Mother Nature Give Us Two Kidneys?
In medical school, and in common public wisdom, it is universally recited that we only need one of our two kidneys to live. That is true. As it happens though, there is little or no information about whether we would live as long or as well! It is known that as people age, there is an expected gradual decline in kidney function. It happens sooner and faster in people with hypertension, diabetes, and so on. It is reasonable to speculate that if starting out from a half-normal position, that a single remaining kidney might run out of steam sooner without it’s helpmate. The best way to definitively settle the matter would be to randomly divide in half a group of people who had committed to donate, only allow one group to do so, and then follow the lives of both groups to see if the donors develop kidney failure more frequently than the donor wanna-bees. I do not see that experiment happening, but the information would be relevant to a person deciding whether or not to donate. Continue reading “Does Donating a Kidney Increase the Risk of Kidney Failure For a Living Donor?”

Harvesting Organs From the Poor. The American Way.

More sophisticated than whacking someone over the head and stealing their organs.

The papers and media are full of talk about former Vice President Dick Cheney’s recent heart transplant. There was much discussion about whether at age 71 he was too old, or whether he took advantage of special privileges to jump the line of thousands of others hoping to receive this potentially life-extending procedure. I am not prepared to comment on most of that: whether you call it an organ-allocation process or rationing, some will always consider themselves lucky, and others losers. I wish Mr. Cheney well.

Organ transplantation is often considered one of the triumphs of modern medicine. It has also made a lot of money for hospitals and doctors who do the procedures. Think of all the ads and press coverage we hear as hospitals seek to enhance their prestige and to attract other customers. The year I worked in Congress, Washington was attacked by lobbyists seeking to gain advantage in the national system of allocating donated organs. As much as these highly paid armies spoke of fairness, better outcomes, more equitable distribution, and the like; all of us staffers knew they were just fighting over the money. It was a cynical business. Continue reading “Harvesting Organs From the Poor. The American Way.”