General

Kidney Transplant Disparities

Kidney Transplant DisparitiesA new transplant allocation system designed to reduce kidney transplant disparities for ethnic patients on the waitlist. According to a research study just published in the June 2017 issue of Health Affairs, a kidney transplant allocation system that was implemented in 2014 by the United Network for Organ Sharing (UNOS) led to reduced imbalance in national kidney transplant disparities among whites, blacks, and Hispanics who were on the transplant waitlist. This new system resulted in a substantial increase in the kidney transplant rate for blacks and Hispanics in the months following implementation.

The research was conducted by an Emory team of investigators, with lead author Taylor Melanson, from Emory’s Laney Graduate School, and senior author Rachel Patzer, Ph.D., MPH, assistant professor of surgery at the Emory University School of Medicine and researcher at the Emory Transplant Center.

Kidney Transplant Allocation System

The new UNOS allocation system aimed to address the primary factor for determining a patient’s priority level on the kidney transplant deceased donor wait list; in other words, how long they have been waiting for a transplant. Minorities, on average, are less likely to complete the necessary medical evaluation to be placed on the national wait list for a transplant. Prior research has shown that this may be due to a variety of factors including poverty, limited dialysis facility staff to educate patients about transplant and physician bias.

Under the new allocation system, the starting point for calculating wait time was changed from the date of waitlisting to either the first regular dialysis date or the waitlist date, whichever was earlier. The change was expected to benefit minorities because they tend to spend more time on dialysis prior to being added to the waitlist than white patients.

Kidney Transplant Disparities Research Results

To determine the effect of the new kidney allocation system on inequality, the researchers examined 179,071 waitlisting records from UNOS from June 2013 to September 2016 and calculated monthly kidney transplant disparities among waitlisted patients.

Prior to the new allocation system, white patients were more likely to receive a kidney transplant (1.07 percent per month) than black (0.80 percent per month) or Hispanic (0.79 percent per month) patients. After implementation of the new system, the monthly rates changed significantly to 0.95 percent for whites, 0.96 percent for blacks, and 0.91 percent for Hispanics. Thus, average monthly kidney transplant disparities narrowed by 0.29 percentage points (rounded) for blacks compared to whites and 0.24 percentage points for Hispanics compared to whites, with both disparities becoming insignificant.

“The policy change appears to have at least temporarily eliminated racial and ethnic disparities in access to kidney transplantation for waitlisted black and Hispanic patients,” says Melanson. “This is a very positive achievement, but continued efforts are needed to address the disparities that exist prior to the waitlist, including the racial and ethnic differences in completing the medical evaluation process to be placed on the waitlist.”

Nearly 700,000 people in the United States have end-stage renal disease, with care for these patients costing Medicare $32.8 billion in 2014. Kidney transplantation is the preferred treatment for most patients with an end-stage disease because it offers longer survival, better quality of life and fewer hospitalizations than dialysis. Transplantation also costs about 65 percent less than dialysis annually.

“It will be important to do additional follow-up and monitoring on the effects of the UNOS policy to fully understand the longer-term consequences and maintain and improve on the disparity reductions,” notes Patzer. “If the disparity reduction is sustained, the kidney allocation system will serve as a valuable example of how health policy can be shaped to immediately reduce racial and ethnic disparities in our health care system.”

Learn more about kidney transplant at the Emory Transplant Center.

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Reminder to Transplant Patients and Families to Get Your Flu Shot

We would like to remind our patients and their families to take preventive action now, and if you have not done so yet, get your flu vaccine.We have officially embarked upon flu season. While employees and faculty of the Emory Transplant Center have been vaccinated against the flu, we would like to remind our patients and their families to take preventive action now, and if you have not done so yet, get your flu vaccine.

Because transplant patients have a chronic disease and/or are now taking anti-rejection medicine, they are at an increased risk of getting the flu. If you had your transplant more than three months ago, it’s time to roll up your sleeve and get protected. If you are not at the three-month mark, ask for the shot during your three-month follow-up visit.

Research has shown that flu vaccination is the most effective way to reduce complications and deaths related to influenza. Please take care of yourself, and make a commitment to get your flu shot to ward off the flu this year.

If you are a patient and have questions about the flu vaccination, please call us at 1-855-EMORYTX (366-7989).

Gifts from the Heart

event1National Heart Month would not be complete without Heart to Heart, Emory Transplant Center‘s annual fete for heart transplant recipients and candidates, which was on Feb. 20 at the Miller-Ward Alumni House. Sixty heart transplant recipients and eight patients waiting on the heart transplant list — all supported by their family members — celebrated life during the 27th annual Heart to Heart.

The celebrants were at Heart to Heart to show gratitude for their renewed lives made possible by their organ donor families. Each year, the event draws the newest heart transplant patients as well as those who have had their new heart for many years. Three recipients, Earnest Mitchell, Stephanie Harmon and Herbert Kuper were on hand to honor their organ donor families for their lifesaving gifts and meet up with many of their caregivers during the transplant process.

“I give honor and praise daily to my heart donor and his family,” says Mitchell, who was with his wife, Rhonda — newlyweds, really, since they married in 2014. “This date will always be bittersweet, because we understand that this time of celebration for us will always be a time of remembrance for them.”

Mitchell, a Stockbridge resident, is celebrating his one-and-a-half-year anniversary with his new heart. He is pictured above with transplant cardiologist, Rob Cole, MD, Assistant Professor of Medicine. After being diagnosed with heart disease in 2006 and then congestive heart failure in 2009, Mitchell and his wife began investigating treatment options for his weak heart. Little did they know that a heart transplant would be his only option for survival.

event3Mitchell was admitted to Emory University Hospital’s coronary care unit (CCU) for constant monitoring and medication to keep his heart functioning while he waited for his new heart. After 139 days in the CCU, he learned a heart was available. He received his transplant on Aug. 15, 2014.

Stephanie Harmon, from Summerville, Ga., received her new heart in Dec. 2015. A surgical first assistant in a Floyd County hospital, Harmon developed breathing problems after an illness in Dec. 2013. An emergency room doctor diagnosed her with heart failure and she was sent by life-flight to Emory Saint Joseph’s Hospital, where she spent the next two months hospitalized. She went home with an Left Ventricular Assist Device (LVAD), a surgically implanted, battery-operated, mechanical pump that sent blood coursing throughout her body.

Eighteen months later, on Dec. 19, 2015, Harmon received the call from the Emory Transplant Center that a heart was available. “I couldn’t believe it, I was in total shock and I couldn’t move,” says Harmon. “My husband instantly started packing our bags.”

Three month after receiving her new heart, Harmon is doing well. Although it is still too early for her to reach out to her donor family, she is very appreciative of the life-saving gift she received.

South African native turned Atlanta resident, Herbert Kuper, developed an abnormal heart rhythm after knee replacement surgery. Doctors determined he had cardiac amyloidosis, or stiff heart syndrome, where clumps of proteins called amyloids take the place of normal heart muscle.

event2Kuper was placed on the heart transplant list, and received his new heart on Feb. 16, 2015. One year later, he is doing well.

“I am so grateful for my heart donor and family,” he reports. “I am also very appreciative of the amazing doctors and nursing staff at Emory University Hospital and Emory Saint Joseph’s Hospital that cared for me while I was so sick.”

According to Dr. Cole, “As a heart failure and heart transplant specialist, it is important to celebrate the new lives of our patients each year because of a precious gift they received. It also is important to honor those families who gave selflessly at a time of tragedy for them.”

Putting the Care of Our Transplant Patients First

patients firstThe Emory Transplant Center is very grateful to our compassionate and dedicated employees and faculty who treat our patients with the highest level of care possible. We strive to deliver outstanding quality with every patient interaction every day. Sometimes, all it takes is a smile to make someone feel special. The Emory Transplant Center is proud to share some excellent patient and family comments we have received highlighting the care we give.

  • I love case coordinator Ms. Santiba [Johnson, kidney transplant coordinator]. She went out of her way to make sure I was informed, comfortable and had what I needed to make an informed decision.
  • I am extremely pleased with Dr. [James] Spivey and all of the personnel in the transplant center. They saved my life not just with the liver transplant, but also with all of the issues and meds that I had after the transplant. I was fortunate to be able to receive a transplant. No one believes that I was ever as sick as I was. Thank you! Thank you! Thank you, Emory!
  • I love the staff. I visit the Emory [outpatient] transplant clinic every month. Most of the people working there know me by name.
  • The nurses in the infusion area are all excellent. They are always friendly and have a great attitude. They make sure I’m ok.
  • All of my experiences have been over and beyond my expectations, whether small to me or large to me. My prescription refills after calling Emory is an ease and a joy. Please don’t change the warmth of the employees — they are Human and Real, and the Best. Hats off to Emory.
  • The staff has always been lovely to my family and me. Fast, efficient service with well explained process and services being done.
  • The heart transplant team is terrific. They have taken great care of me during the past 15 years.
  • Love the doctors, especially Dr. [John Paul] Norvell, and we love the front [desk] staff. It is a soothing atmosphere while waiting.
  • Wonderful staff at registration. Cheerful and genuinely sincere in making the patient and family feel at ease.

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Reminder to Patients, Friends and Family to Help Prevent the Flu

seasonal fluThe flu season is just getting started. Luckily, according to the Centers for Disease Control and Prevention’s (CDC) latest report for the 2015-2016 flu season, overall flu cases have been fairly low so far this year. But as the winter continues, the CDC estimates that flu cases will rise. Therefore, while Emory Transplant Center employees and faculty have been vaccinated against the flu, this is a good time to remind our patients, family and friends to take preventive action now, and if you have not done so yet, get your flu vaccine. The flu vaccine is the most effective way to prevent infection and the spread of influenza. It is up to 90 percent effective in healthy people less than 65 years old.

To learn more about the seasonal flu vaccine and a listing of frequently asked questions, visit Emory Healthcare’s seasonal flue vaccine page. Additional information about preventing the seasonal flu and the benefits of vaccination can found on the CDC’s flu prevention website.

Happy Holidays from the Emory Transplant Center

transplant-ribbonNo matter what your religious beliefs or cultural background, the holidays are a time to reflect on our extraordinary blessings and appreciate the love in our lives as we spend time with family and friends. The Emory Transplant Center has so much to be grateful for this season: our skilled faculty and staff, the excellence of our world-class transplant facilities, the satisfaction of helping our transplant patients, and most importantly, our donor families who have given the gift of life.

Without a doubt the Emory Transplant Center is one of the busiest transplant centers in the country, offering hundreds of patients in this area a chance at renewed lives. This only occurs through the benefits of organ transplantation each year. Without the selfless acts of kindness from donors and donor families, we wouldn’t have the wonderful stories of hope that we have every day. Please take a moment from your busy schedules this holiday season to salute these kind gifts.

Make your wishes known to your family and sign a donor card to become an organ donor.

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Mason Guest House Celebrates Two Decades of Service

transplant house 11-9For 20 years, the Mason Guest House (MGH) has offered a peaceful, caring retreat for transplant patients and their caregivers. By providing convenient, low-cost lodging close to the clinical services our patients vitally need, the MGH is a major contributor to Emory Transplant Center’s success as a leading center for transplantation. It is one of the big reasons why we consistently rank high for customer service and quality care.

“All the residents [at the MGH] have a common cause,” wrote one guest on a comment card after a recent one-week stay following transplant. “Our experience has been very positive. When you live outside the area, having a place that is close to the hospital and reasonably priced is truly appreciated.”

The Masotransplant people 11-9n Guest House booked its first guest on Oct. 2, 1995. Since then, about 25 guests occupy the home-away-from-home each night. Blakely Humber, a liver transplant recipient from Vienna, Ga. who is pictured at left with his wife at Christmas time in 2011, is the guest who has been coming to the MGH for the longest amount of time.

The MGH is closely tied to the evolution of solid organ transplantation here at Emory. Both the Mason Guest House and the Emory Transplant Center were created with significant financial support from the Carlos and Marguerite Mason Trust. The fund was created in the will of Marguerite Mason specifically to support transplantation in Georgia at a time when she could visualize the promise of this lifesaving procedure.

Transplant families from Emory University Hospital, Emory Saint Joseph’s Hospital, and Children’s Healthcare of Atlanta may reserve rooms at the MGH. The Tudor-style home has 15 private rooms with baths and three kitchens where guests may cook their own meals. It has a screened-in porch and gathering spaces complete with comfortable seating areas, a game area, an exercise room, and a music area with a grand piano and a guitar guests may play. Outside there is a garden and patio. It truly serves a home away from home for many of our patients.

Happy birthday, Mason Guest House!

For more information about the Mason Guest House, visit our website, or take a video tour below.

Site Visits Show Emory Transplant Center’s Patients are in Excellent Hands

GoldSeal_4colorSuccess in a transplant center is measured by many standards — high patient and graft survival rates, satisfied patients and quality care, to name a few — but Emory really does stand out
when national regulatory agencies come for required site visits. Three agencies, the United Network for Organ Sharing (UNOS), the Joint Commission (TJC) and the Centers of Medicare & Medicaid Services (CMS), visited the Emory Transplant Center (ETC) this year. Their hard work was evident in the positive comments we received from the surveyors.

For the first time in ETC’s history, the Joint Commission surveyed hospital-based outpatient clinics during their site visit in July – this included both the ETC’s Outpatient Transplant Clinics at Emory Saint Joseph’s Hospital and the Emory Clinic.

“The surveyor was happy with the nurses’ notes on a sample procedure stating, ‘This is the only chart I have ever read that has all the information I was looking for when a patient is being discharged from the clinic after a procedure.’ She was impressed.”, reports Joji Taganajan, nurse manager.

Our CMS re-certification survey was conducted the last week of April. The reviewers surveyed Emory’s heart, kidney, liver, lung, and pancreas programs, examining medical records for documentation of the multiple CMS conditions of participation, reviewing ETC policies, practices, and quality assessment and performance improvement (QAPI) programs. All five transplant programs were re-certified.

Additional good news came to the programs on July 13 in the form of letters from the UNOS Membership and Professional Standards Committee (MPSC). The MPSC reported results of its routine on-site review of the programs, conducted by the UNOS staff the week of January 26. The purpose of the survey, which is conducted every three years, is to review and analyze transplant program compliance with UNOS/OPTN (Organ Procurement and Transplant Network) policies. All ETC programs passed with scores between 92 and 100.

A heartfelt thank you goes out to all our transplant staff, faculty and leadership who provide our patients and families excellent clinical care on a daily basis, while achieving impressive quality outcomes and meeting the multiple federal regulatory requirements for transplant centers.

Emory Liver Transplant Program Appoints New Surgical and Medical Directors

Dr. Ram Subramanian

Dr. Ram Subramanian

Dr. Joseph Magliocca

Dr. Joseph Magliocca

There have been some exciting changes happening at the Emory Transplant Center – specifically within the Emory Liver Transplant Program. Just a little over six months ago, Dr. Joseph (Joe) Magliocca was appointed Surgical Director of the Liver Transplant Program. Dr. Magliocca joined Emory four years ago from Shands Hospital at the University of Florida. His research interests include liver preservation and perfusion with a goal of increasing the number of livers available for transplantation. He serves as an associate editor of the American Journal of Transplantation, the world’s most widely read peer-reviewed publication for transplant professionals. In addition, the American Society of Transplant Surgeons (ASTS) recently appointed him to serve on the PROACTOR Task Force (PROviding better ACcess To ORgans) to investigate ways to increase access to transplantation.

Meanwhile, Dr. James Spivey has stepped down as Medical Director of the Liver Transplant Program to serve as vice chair for clinical affairs in the department of medicine. Dr. Spivey will continue work as a transplant hepatologist, and provide both administrative guidance and clinical expertise at the Emory Transplant Center. In his new role, Dr. Spivey will work closely with chair Dr. David Stephens, Emory Medicine’s senior departmental administrative leadership and the division directors on strategic initiatives and will manage clinical faculty issues.

As a result of Dr. Spivey’s new role, we are proud to announce that Dr. Ram Subramanian has been appointed new Medical Director of the Liver Transplant Program. He has a dual role as both a transplant hepatologist and an intensivist. He began his career at Emory in 2007 and currently is the physician liaison for the abdominal transplant midlevel provider group. His clinical interests include inpatient care before and after liver transplantation, and his research is focused on critical care issues related to hepatic failure and liver transplantation.

While we have come a long way over the past decade, the Emory Liver Transplant Program continues to take steps to improve outcomes for patients, increase the donor pool, develop better surgical and medical techniques that improve quality of life, and create policies and procedures that increase productivity and efficiency in our program. We look forward to guidance under our new leadership.

Emory Transplant Center Celebrates National Minority Donor Awareness Week

multi-ethnicAugust is a good time to honor our minority donors who make the benefits of transplantation possible. National Minority Donor Awareness Week, celebrated annually on August 1-7, is a nationwide observance to honor the generosity of multicultural donors and their families, while also underscoring the critical need for people from diverse communities to become organ donors.

The Emory Transplant Center is committed to bringing attention to the critical need for organ donors. The need for minority donors is especially profound.

2014 Statistics:

  • 58% of individuals on the national organ transplant waiting list were comprised of minorities (this number includes Blacks, Asians, Hispanics, American Indians, Pacific Islanders and people of multiracial decent)
  • 32%
of all deceased donors were minorities
  • 42%
of all those receiving transplants were minorities
    (Source: U.S. Department of Health & Human Services)

We would like to honor minorities who have been donors, and encourage others to register as donors. A greater diversity of donors may potentially increase access to transplantation for everyone. For more information, please visit organdonor.gov and “Why Minority Donors Are Needed.”