Transplanting Hope: Team Pushes Envelope for Living Donations
By Michael Seringer
So many liver failure patients have no hope of a transplant because there is a paucity of organ donors. One key mechanism to expand the donor pool is to use living donors, often a family member, but occasionally an unrelated altruistic individual. The Transplant Center at UT Health San Antonio is a leader in this new transplantation technique, becoming one of the top two programs in the U.S. for living donor liver transplants, giving new hope to many with this disease.
Tarenjeet Klair, MD, assistant professor/clinical of surgery and surgical director of Live Donor Liver Transplantation, leads a team that will surpass 50 living donor transplants this year, with outstanding outcomes. His innovative approach saves the lives of those liver transplant patients who otherwise would not have a donor.
This novel approach to liver transplantation has its roots in the history of the transplant program. “Innovation in the past is really what’s made innovation in the future possible,” said Glenn Halff, MD, former director of the UT Health San Antonio Transplant Center.
Dr. Halff paused when asked about training at University of Pittsburgh under Thomas E. Starzl, MD, PhD, who performed the world’s first successful liver transplant and pioneered the incremental use of azathioprine and prednisone to prevent graft rejection.
“He was an amazing individual,” said Dr. Halff, the Dielmann Chair in Transplant Sciences. “I learned a lot beyond just surgery. His approach to creativity and continually improving everything he did each time was really a philosophical learning experience for me.”
Dr. Halff was part of a new generation of surgeons Dr. Starzl trained to take organ transplants from the experimental to the mainstream. These surgeons took their knowledge and highly developed skills throughout the world, establishing transplantation centers modeled after what Dr. Starzl had built.
Luckily for South Texas, J. Kent Trinkle, MD, world-renowned cardiothoracic surgeon, and J. Bradley Aust, MD, PhD, founding chair of the Department of Surgery in the Joe R. and Teresa Lozano Long School of Medicine, recognized the need for a comprehensive transplantation program in the region. They enlisted Dr. Halff and other talented surgeons to get the program off the ground. It wasn’t long before UT Health San Antonio Transplant Center—an academic center focused on saving lives, providing hope for the hopeless, built on fostering innovation—was born.
The Right Leaders at the Right Time
Dr. Trinkle’s leadership acumen was crucial to building the Transplant Center. A charismatic figure whose influence is still felt decades after his death in 1998, Dr. Trinkle possessed a legendary sense of humor that could instantly diffuse a tense situation and lift the spirit of a room. Jennifer Milton, MBA, chief administration officer at UT Health San Antonio Transplant Center, believes Dr. Trinkle’s humor was laced with lessons that left an enduring legacy.
“People always bring up Dr. Trinkle’s lessons or things he had said in the past,” Milton said. “It really brings a sense of peace to the decision making.”
Next to join the team in 1995 was Francisco Cigarroa, MD, a pediatric transplant physician at Johns Hopkins Hospital. The core values of medical innovation, putting the team above individual honors, and patient-centered care that Drs. Trinkle and Halff promoted resonated with Dr. Cigarroa, who wanted to move his family closer to relatives in South Texas. Dr. Cigarroa was hired during a Christmas break visit so rapidly that he did not even tour the campus before signing.
Dr. Cigarroa created the pediatric solid organ transplant program at UT Health and was elected to the National Academy of Medicine for his efforts at the university. He also served as president of UT Health San Antonio and then chancellor of the UT System.
Making Innovation Routine
From the beginning, the UT Health San Antonio Transplant Center advanced learning through innovation. Dr. Trinkle pioneered organ transplantation in South Texas, distinguishing UT Health San Antonio as a leading transplant center.
“He did the first lung transplant and combined heart-lung transplant in the region and the first lung transplant in the world for pulmonary hypertension,” said Dr. Cigarroa, the current director of the transplant center, the Carlos and Malú Alvarez Distinguished University Chair, and Ashbel Smith Professor in Surgery. “He really brought a tremendous amount of international recognition to pulmonary and heart transplantation here in San Antonio.”
Dr. Halff followed Dr. Trinkle’s history of firsts by performing the first liver transplant in South Texas in 1992, delivering on the promise to establish a comprehensive transplant center that Dr. Aust and Dr. Trinkle had made years earlier. UT Health San Antonio Transplant Center rapidly expanded as the number of transplant surgeries quickly increased, supported by a collaborative culture and dramatically improved patient outcomes.
“Dr. Halff’s leadership set a strong foundation for sustainable success,” Dr. Cigarroa said. “He created a culture of excellence and had a knack for recruiting great people.”
Building a Team without Boundaries
It is notable that the 5,000th solid organ transplant at UT Health San Antonio Transplant Center was performed by an all-woman team during the program’s 50th year, Dr. Cigarroa said.
“You are seeing the next generation of transplant surgeons coming on, and they are absolutely gifted,” Dr. Cigarroa said. “They are full of energy and innovation. Dr. Klair exemplifies that new generation, with his extraordinarily successful living donor liver transplants. With innovation comes risk, and UT Health has always been ready to take those risks.”
Milton said, “Our job is to allow them to use their innovative strengths to come up with new answers and share the wisdom we have learned. This is true of our nursing and allied health leaders at every level of care such as nutrition, social work, nursing, pharmacy and many others. We develop and deliver best practice care.”
A comprehensive transplant center has many moving parts, all of which must be aligned and focused on patient care to succeed. Dr. Halff and Dr. Cigarroa attribute much of their success to their dedicated transplant teams and support staff, and they are grateful for their strong partnerships with institutions such as University Health and the Texas Organ Sharing Alliance.
The transplant center’s success is also due to the work of numerous former staff, said Dr. Halff, who provided as an example his strong partnership with former UT Health San Antonio transplant surgeon Ken Washburn, MD, now the executive director of the Comprehensive Transplant Center at The Ohio State University. Dr. Washburn believes part of his success at Ohio State was a result of his almost two decades working with Dr. Halff and Dr. Cigarroa.
“We all valued each other as equal partners,” Dr. Washburn said. “I learned a lot from both Dr. Halff and Dr. Cigarroa about leadership issues that I took when I left for Ohio State that certainly helped me when I took on a much larger role here.”
Dr. Cigarroa’s impact on the transplant center has been profound. Dr. Halff credits the cohesiveness of the program directly to the influence of Dr. Cigarroa. “Dr. Cigarroa is a wonderful surgeon, incredible physician. He really touches patients emotionally in a way that you don’t see very frequently,” said Dr. Halff. “His character, optimism and enthusiasm have really permeated everything we’ve done.”
A Meritocracy of Ideas
As chief administration officer, Milton considers herself lucky to work at a transplant center that fosters innovation at all levels.
“If you have an idea to improve patient care, it doesn’t matter who you are,” she said. Key to innovation is recognizing the value of the suggestion no matter where it originates.
Milton operates in a reality in which demand for donor organs outpaces supply, and too many people die as a result. In an effort to address this persistent reality, Milton led the creation of the Center for Life, a dedicated area of University Hospital that is staffed by critical care intensivists who manage the needs of organ donors and honor their life-giving wishes. In addition to managing the complete physiology of the donor, the team is dedicated to compassionate care and support of donor families.
“The Center for Life is a very special place. It is described as sacred ground,” Dr. Cigarroa said. “It’s really been beautiful to watch. Jennifer Milton is another champion—she’s inspiring.”
The Center for Life is just one example of a novel approach to increase the supply of viable organs. Here’s another: UT Health San Antonio Transplant Center recently performed the first living donor liver exchange in the United States. These ideas put into practice save lives and are part of a longstanding dedication to providing hope.
Areas of UT Health innovation that are rapidly improving outcomes range from dynamic imaging techniques to measure organ function to new methods of organ preservation. Crucial answers and previously unseen patterns are emerging with the analysis of the vast amount of data collected over many years of organ transplants, Milton said. And the structure built by the founding team is proving fertile ground to help solve the organ supply crisis while improving patient care.
“It’s been an intellectually stimulating, fulfilling, creative field to work in,” Dr. Halff said. “It is tremendously fulfilling from the point of view of helping patients but it’s also just as fascinating from the science and research point of view. Appreciating what people have done before in terms of development and teaching is something I’m immensely grateful for—it’s something I value every day.”