The Vanderbilt Transplant Center has emerged over the past five years as an international leader in solid organ transplantation. In calendar year 2022 alone, 625 life-saving heart, liver, kidney, lung and pancreas transplants were performed.
Among the fastest-growing programs has been Vanderbilt’s heart transplant program, which performed a combined total of 429 transplants during the past three years, more than any other center in the country. Key to the success of the program has been commitment to a multidisciplinary effort that involves physicians, nurses, social workers, pharmacists and others, some of whom travel across the state of Tennessee and beyond to care for patients with advanced heart failure who may need transplants and to recover donor hearts for patients awaiting transplant.
In addition to its heart failure clinics on the main campus, Vanderbilt now sees patients with advanced heart failure at more than eight clinic locations across the state as well as several locations in neighboring states. The physicians and nurses who staff these clinics provide care to patients within their own communities and collaborate with local physicians to identify patients who may be sick enough to need transplant.
Mark Wigger, MD, director of Heart Failure Outreach, and nurse practitioners Donna Harmon, APRN, and Michelle Parker, APRN, have been members of the advanced heart failure outreach team for years and now spend much of their time traveling between Vanderbilt clinics in Cookeville, Crossville, Knoxville, Chattanooga and Jackson, Tennessee, to name a few.
“Our advanced heart failure outreach is Vanderbilt’s opportunity and responsibility to reach patients who may not otherwise have access to state-of-the-art therapies,” Wigger said.
Harmon added, “On some days, the extended commute can become long and tiring; however, when I see hope come alive in patients’ and families’ eyes — some of whom have lost hope — I am reminded of the importance of extending our expertise beyond the walls of Vanderbilt’s main campus.”
The outreach team also travels to Northern Alabama and will start traveling to Evansville, Indiana, for outreach later this spring. “The dedication of these individuals, many of whom spend several days on the road each month, has been critical to our ability to help more patients,” said Kelly Schlendorf, MD, section head of Heart Failure and Transplantation and medical director of the adult heart transplant program.
Equally impactful as the outreach clinics have been the team’s relationships with referring providers from even farther away — including Minnesota, Pennsylvania, Illinois and New York — who often send patients to Vanderbilt for transplant consideration. “Some of these patients come to Vanderbilt because they’ve been considered too high risk for transplant at other centers,” Schlendorf said. “Others are on the waitlist for transplant at other centers but have been waiting for months — and sometimes years. They come to us hopeful for shorter wait times.”
At the center of this heart transplant program is a tireless organ recovery team. In 2022, these teams traveled more than 100,000 miles to bring life-saving hearts back to Vanderbilt. Using remarkable organ preservation techniques and devices, hearts from as far away as Puerto Rico and Portland have been successfully transplanted at VUMC.
“This team has been able to accomplish something that was thought to be impossible five years ago,” said Ashish Shah, MD, professor and chair of Cardiac Surgery.
Last year, the organ recovery team added Stephen DeVries, PA-C, only the second physician assistant in the country certified by the Association of Organ Procurement Organizations (AOPO).
“Steve is one of most experienced clinicians in this emerging field,” Shah said. “His presence in Cardiac Surgery allows us to explore even more innovative ways to expand the donor pool, better educate our trainees and potentially define a new role for advanced practice clinicians nationally.”
Shah said Vanderbilt’s organ recovery teams have been successful for two main reasons — the use of innovative organ preservation techniques and the experience in using organs that many other centers are unwilling to use.
Vanderbilt uses the TransMedics Organ Care System (OCS), which uses the organ donor’s blood to perfuse the heart during transit to the Medical Center. The system makes it possible to preserve donor hearts for anywhere from five to nine hours, significantly longer than was possible using the more traditional method of placing a non-beating heart on ice and then rushing it to Vanderbilt for transplant.
Even more remarkable, starting in 2020, VUMC began using machine perfusion technology and other methods to start performing DCD (donation after circulatory death) heart transplantation.
DCD heart transplants represent a new frontier and are very different than conventional procedures. Conventional donors have hearts recovered while they are still beating, preserving them in cold solutions to protect them during transport.
A DCD transplant is far more complex; here the hearts are allowed to stop and the patient is declared dead. Teams then recover and resuscitate these organs so they are useable. Vanderbilt has been a world leader in successfully using DCD heart donors.
“For Vanderbilt to be the benchmark program for DCD heart procurement and transplantation in the United States is really special,” DeVries said.
In calendar year 2022, 48 of 141 heart transplants were performed at Vanderbilt using DCD organs.
Shah and Schlendorf acknowledge that the Vanderbilt Heart Transplant Program is entering a new era. While total volume of transplants may increase and decrease from year to year, the expectation has been established that Vanderbilt will be a key thought leader and driver of innovation. Perhaps more importantly, this spirit of innovation is driven by all the members of this team in an authentic effort to save lives.
“The heart program is a wonderful example of how innovation saves lives,” said Seth Karp, MD, H. William Scott Jr. Professor, chair of the Section of Surgical Sciences and director of the Vanderbilt Transplant Center. “There is no team in the world more successful at implementing new technologies to benefit patients.”
