Doctors at the new USC Transplant Institute work together to improve patient outcomes
Cynthia Herrington, M.D., says lung transplant patients come in gasping,
and “you transplant them and you give them their life back.”
By Sara Reeve
Cynthia Herrington, M.D., is passionate about the patients she is trying to help. As the founding director of the new USC Transplant Institute, she is working to integrate different organ transplant programs into a seamless administrative unit that will ultimately improve patient care.
“Transplantation is not something we do to improve someone’s lifestyle,” she says. “This is something we do because the patient is dying. All of our transplant patients are dying – that’s why they need the transplant.”
USC has a long history of organ transplantation at both USC University Hospital and Childrens Hospital Los Angeles. Currently, USC offers transplantation for heart, lung, liver, kidney and pancreas.
Herrington, who came to USC from the University of Minnesota in 2009, is associate professor of clinical cardiothoracic surgery at the Keck School of Medicine and surgical director of pediatric thoracic transplantation at Childrens Hospital Los Angeles.
“As a thoracic surgeon, I just connected with lung transplant patients, because when you think about it, trying to breathe is a horrible way to die,” says Herrington. “These patients come in and they are gasping, and you transplant them and you give them their life back.”
RUNNING OUT OF TIME
For Robbyn Foxx, of Venice, Calif., it seemed like the end of the line. Unable to breathe, Foxx, who suffered from cystic fibrosis, knew she was dying.
“I was really running out of time,” Foxx says. “I think I had between 48 and 72 hours.”
But it was not the end for her. She came to USC University Hospital, where doctors performed a living-related lobar transplant.
Five years out from her transplant, Foxx is thankful for the lifesaving intervention. The toys in her living room are a testament to the more recent and happy change in her life. “And now we have a two-year-old,” she says. “He’s very two!”
The living-related lobar lung transplant was pioneered at USC University Hospital in 1990. In this complex surgery, two individuals each donate the lower lobe of one lung. These two lobes are then implanted into a patient, providing relatively normal lung function. Other living donor surgeries performed at USC include kidney and liver transplants. USC University Hospital and Childrens Hospital Los Angeles are the only medical centers in Southern California that perform both live donor lung and liver transplants.
At USC, administration of organ-specific programs had been run separately for years, but at a physician retreat held by Keck School Dean Carmen A. Puliafito, M.D., M.B.A., in 2009, discussions arose about the possibility of integrating the practices. With the university’s acquisition of USC University Hospital and USC Norris Cancer Hospital in April 2009, clinical leaders carefully examined how different programs could be strengthened and patient care improved.
“We were operating in silos,” Herrington says. “Each program operated independently of other programs, and there was a loss of collaboration. It really just made sense that in the process of the rebirth of these hospitals, this program would be getting some attention and some changes would be made.”
An idea that began a slow rise in popularity about 10 years ago, the institute model has gained momentum recently for transplant programs. By combining administrative functions that are applicable across the different organ transplant systems, the institute model promises increased efficiency, better communication among physicians, more timely response to patient needs, and, ultimately, better patient care.
“The institute gives our patients the best chance for the best outcome,” says John Donovan, M.D., assistant professor of clinical medicine at the Keck School and physician who specializes in liver transplants. “As transplant physicians, we are now able to better share the clinical knowledge and expertise that crosses the traditional boundaries between experiences in heart, lung, kidney and liver transplantation.”
Coordinating business and administration aspects of the institute is the job of transplant administrator Mike Donnell, who has extensive experience in the management and organization of transplant programs. Donnell emphasizes the overall care offered at the USC Transplant Institute.
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ORGAN DISEASE MANAGEMENT
“We should be recognized as an organ disease management center,” he says. “Transplantation is just the end treatment of that care continuum, and really, a very miniscule number of the total population ever gets to transplantation. The fact is that there is an organ shortage, so for us, the real win is if we can intervene earlier and keep those patients from ever needing a transplant.”
The shortage of healthy organs available for transplantation is never far from the minds of the doctors and staff of the USC Transplant Institute. According to the Scientific Registry of Transplant Recipients, more than 7,000 patients die every year across the country – or 19 per day – while waiting on the list for an organ donation.
“One thing we always have to be cognizant of is the wait list mortality,” Donnell says. “We know that while we have patients on the wait list, some of them are going to die. Our goal needs to be to reduce that, diminish that number as much as we can. One of the things about having an integrated, multidisciplinary transplant institute is, collectively, we should be able to do a better job caring for patients both before and after transplantation.”
With the move under one administrative umbrella, one thing that hasn’t changed for the doctors and staff of the USC Transplant Institute is the commitment to the organ donor. Institute staff and doctors work with the university’s organ procurement partner, OneLegacy, to match donated organs with the best-matched recipient.
“Whether it’s a live donor or a cadaveric donor, they have given us a gift,” says Donnell. “The USC Transplant Institute gets to be the steward for that gift for a very short period of time. But our responsibility as the steward of that gift is to be sure we are giving it to the next best steward that we can find.”
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TOP ONE PERCENT
That commitment to the donor is exemplified by the USC Heart Transplant Program, which has been recognized for exceptional patient outcomes by the independent health care ratings organization Health Grades. The program was ranked among the top 1 percent of hospitals in the United States that perform heart transplants. Bringing together all solid organ transplants under one administrative umbrella encourages USC Transplant Institute doctors and staff to share information about best practices that will help all departments while improving patient care.
“I am confident that bringing together multiple disciplines and different expertise, and utilizing best practice principles, will help to improve the transplant service line for our medical center,” says Mark Barr, M.D., co-director of cardiothoracic transplantation and associate professor of surgery at the Keck School of Medicine. “Organ transplant programs have a huge potential halo effect for an academic medical center in terms of teaching and research. Support for transplantation encourages the development of end-stage organ failure programs and the development of subspecialty liaison services, such as transplant infectious disease, that will benefit everyone here at USC.”
As the USC Transplant Institute continues to grow and develop, Herrington expects great things to happen, such as an increase in the number of transplants performed and the addition of a larger research component. But she is adamant that the institute is building on already strong transplant programs at USC whose outcomes are a testament to the hard work and determination of the staff and physicians.
“A lot of the care and talent was already here,” says Herrington. “The surgeons are amazing here and the medical doctors are amazing, and the staff that takes care of the patients, the coordinators, it was all here. This is going to create an infrastructure and bring everyone together so we can take that next step to be an even larger and even better program.”
For more information about the USC Transplant Institute, visit http://www.uscuniversityhospital.org/uscuh/services/transplant-programs or call 1-800-USC-CARE.