Patients anxious about close of transplant program

The pending shutdown of the kidney transplant program at Miami Valley Hospital has left many patients apprehensive about their futures, with some worried they’ll have to move to the back of the line as they get transfered onto wait lists at other programs.

MVH CEO Bobbie Gerhart announced plans to end the program a week ago, mainly because it wasn’t performing enough surgeries to offset losses of up to $3 million a year due, in part, to a lack of live kidney donations.

The announcement left 75-year-old Shirley King of Middletown facing the prospect of waiting even longer for a kidney transplant after spending more than four years on the waiting list at the University of Cincinnati Medical Center Cincinnati Transplant Center before coming to MVH with a live donor.

“I cried all day after I heard the news,” said King as she slumped in a living room chair undergoing one of her thrice-weekly in-home dialysis treatments for kidney failure. “Sometimes I just want to give up.”

Her mood was decidedly more upbeat last Thanksgiving when her granddaughter and donor, Kathrine Cleary, told her that MVH had agreed to perform the surgery. The family turned to MVH after UC surgeons rejected the granddaughter because of a hereditary medical condition, malignant (MH), which can cause fever and severe muscle contractions under general anesthesia.

But Cleary said the medical director of the living donor program at MVH, Dr. Lucile E. Wrenshall, assured her that the program had an anesthesiologist with experience anesthetizing patients with MH.

“The surgery was suppose to be either on the 10th or the 17th of April, and a nurse coordinator was suppose to call us back Monday (March 11) to give us an exact date,” Cleary said. “We never heard from them. And when I called back the next day, the coordinator told me they were no longer scheduling surgeries.

“I was seething,” said Cleary, a phlebotomist who said she turned down a job at Greene Memorial Hospital because her start date would have conflicted with the surgery. “If you’re saying the program is closing because of low patient volume and lost revenue that means somebody with a pen and paper has been keeping track of this. They knew the program was heading nowhere, so why were they still accepting new patients?”

MVH spokeswoman Nancy Thickel noted that Cleary’s surgery hadn’t actually been scheduled and that she or her grandmother may not have met all the criteria to have the surgery performed.

Cleary said she and her grandmother both had been cleared for surgery after undergoing a battery of tests. Gerhart returned a call from Cleary last week, but did not give her a definitive answer on whether they could schedule the surgery, Cleary said.

“She (Gerhart) could have blown me off, so I appreciated the call,” Cleary said. “But all she could tell me was that she was waiting for a call back from CMS. I’m assuming at this point, we’re going to get outsourced.”

The Centers for Medicare & Medicaid Services regulates the hospital’s transplant program and will make the final decision about when the program closes, Thickel said.

“We have not heard back from CMS regarding an official closing date,” she said Tuesday. “It could be April 13 or May 13. We hope to hear from them by the end of the week.”

Surgeries will be performed until the program ends, and any patients still on the waiting list will be referred to other hospitals in the area with transplant centers, including University of Cincinnati Medical Center Cincinnati Transplant Center.

Many patients are concerned they’ll have to wait longer for a transplant because the average wait time at Miami Valley — about 18 months — is remarkably shorter than wait times at other big city hospitals with hundreds of patients on their wait lists.

But Dr. E. Steve Woodle, director of transplantation at UC, which is likely to get a lot of MVH patients because of its proximity to Dayton, said those patients referred to Cincinnati might actually shorten their waits in the long run because they do about four times the number of live donor transplants as MVH.

“When you look at the advantages of patients coming to our program in Cincinnati, the chances of a patient successfully getting a living donor transplant is markedly enhanced,” Woodle said. “If you take 100 patients and refer them into our program, we’re actually probably going to do better in the long run in terms of waiting times because we get so many more patients transplanted with a living donor.’’

Jeanna Williams, 65, of Dayton, who received a kidney transplant at MVH in November 2008, said she still receives follow-up care at the hospital and is concerned that she won’t be able to see her regular doctor.

MVH officials say they will continue to provide care for the hospital’s approximately 1,100 post-operative patients, even after the program ends.

But Williams fears she won’t be meeting with the same doctors that are most familiar with her condition.

“Once you establish a rapport with your doctors and you have confidence in them, you want to retain that relationship,” she said. “I know I can continue to get blood work at the hospital, but I also want to be able to continue to see the kidney doctor that I see. It’s a comfort level.”

Williams, who has diabetes and high blood pressure, is like a lot of transplant patients who have other conditions that may have contributed to their kidney failure.

And she said she feels more comfortable dealing with doctors who are familiar with her complete health profile.

Williams had open heart surgery at Good Samaritan Hospital in Dayton last summer to remove a benign tumor inside her heart.

“The doctors at Good Sam consulted with my kidney doctor to make sure my kidney could take the hit from the trauma and medication I had to take after the surgery,” she said. “If my kidney had taken a hit, the doctors at Miami Valley would know what to do and be able to treat it immediately.”

She said losing the transplant center is not only a loss for her but a loss for the community.

“The transplant center to me is an important part of Montgomery County, especially the City of Dayton,” she said. “There’s an awful lot of testing and other things you have to do before and after a transplant, and if you have to travel to do all this, that’s going to be a hardship on a lot of people.”

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