In June 1967, the UVA Transplant Center transplanted its first solid organ, a kidney. Since then, we have completed over 1,500 kidney transplants, 1,200 liver transplants, and our lung and liver programs have achieved the highest survival rates in the country.
As the only Comprehensive Transplant Center in Virginia, UVA has more than 45 years of experience.
We provide comprehensive treatment for patients needing heart, lung, pancreas, kidney, liver and islet cell transplants.
Hear from Dr. Alden Doyle, the medical director of UVA’s kidney transplant program, about the evolution of transplantation, and UVA’s commitment to patient centered care.
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Celebrating 50 Years of Organ Transplantation at UVA
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Learn more about UVA Health System
Alden Doyle, MD
Dr. Alden Doyle is a transplant nephrologist and the medical director of the kidney transplant program at UVA’s Charles O. Strickler Transplant Center.Learn more about UVA Health System
Transcription:
Celebrating 50 Years of Organ Transplantation at UVA
Melanie Cole (Host): In June 1967, the UVA Transplant Center transplanted its first solid organ, a kidney. My guest today is Dr. Alden Doyle. He’s a transplant nephrologist and the Medical Director of the kidney transplant program at UVA’s Charles O. Strickler Transplant Center. Welcome to the show, Dr. Doyle. Tell us a little bit about the transplant center at UVA and the 50th anniversary coming up in 2017. Give us a little background on the evolution of kidney transplantation over the years.
Dr. Alden Doyle (Guest): Sure. So, the program is a well-established one that does most of all the solid organs. So, they have a robust program in heart transplant, kidney transplant, pancreas transplant and lung transplant, and a separate one in bone marrow. So, almost all of the normal organs that are transplanted. They have been innovators in the field for years with tissue typing and different organ transplant techniques, and there’s a lot of nice overlap. So, they’ve been in the business for a long time, and recently, with a new dean who is a lung transplant specialist himself, have really put a lot of resources to make all the transplant programs go under one transplant institute, and continue to grow and be innovators in the field. In terms of history of transplant, we’ve come a long way. As you know, in the mid-50’s, the original transplant was basically reserved for very healthy folks who had living donors, and so the immunosuppression was very modest and the understanding of how the immune works to keep one healthy and to reject organs was only very rudimentary. So, it was really only available for a few folks under special circumstances. And now, with lots of medicines and a lot of greater understanding, it’s available to, not all but many, people with different kinds of organ disease and different backgrounds.
Melanie: So, there’s are many organs that you transplant now, and UVA is the only comprehensive transplant center in Virginia with more than 45 years of experience. Dr. Doyle, speak about some of the other organs that are transplanted, what people should look for when looking for a transplant center?
Dr. Doyle: So, I think there are a couple of things you can look at. There’s publicly available data. So, there’s an organization that the government funds and supervises which is called “United Network for Organ Sharing” or “UNOS”. So, they have the responsibility of maintaining oversight for transplant programs across the country and publish on the website the outcomes. So, I think one question a potential transplant recipient would ask is, “How do they do? And if I get a transplanted at the center, would I expect to survive, and how would the function of the organ work?” So, they publish one- and three-year patient and graft survival as a first test. On top of that, I think you’d want a comprehensive center that can offer the broad range of services, including overlap of disease. So often we see that patients have not just kidney disease but also liver disease, and so it’s nice to have one center that can manage the thing from soup to nuts, and even up to the unusual circumstance of requiring two organs at once.
Melanie: What do you anticipate the future holds for kidney transplantation?
Dr. Doyle: Well, our hope is a couple of things. One is, one of the biggest problems we have and we’re victims of our own success in a way. We have the one-year graft survival and patient survival that has gone steadily up and, as I mentioned before, there are a lot more folks who are potential candidates. And so, with organ donation rates being reasonably flat—they’ve grown a little bit--then there’s a bigger disparity between need for organs and availability of suitable organs. So, we hope that there’s going to be continued public advocacy for donation, different ways to do this, but to increase the supply because there’s a growing number of people who die waiting for organs even though they know that if they got transplanted, they’d be successful, but there just isn’t enough to go around. So, that’s a piece of it. Part of it is public policy so there are some things we hope Congress will do to make living donation and organ transportation even easier. They’ve been supportive but there are some important steps to make right now. There’s also a lot of science in immunology and related fields like genomics and proteomics that we hope will translate into better outcomes for transplants so we have more of an individualized medicine. We know that different people respond to medications and have different risks of rejection, but why that is in all circumstances is less clear. So, going forward, if we can make an individual plan so that this combination of medications and these organs will be the best for an individual patient, that would be a real step forward in keeping with the way--the direction--of modern medicine.
Melanie: So, can you tell us about any breakthroughs in post-transplant care?
Dr. Doyle: There’s been some. It’s been incremental. I wouldn’t call it absolute breakthrough. There have been some new medications that change the paradigm of immunosuppression. For example, there are some medications that people can get once a month by IV, that’s never been possible before. There’s been some work to try to promote tolerance where, under certain circumstances, patients would not require immunosuppression--although it’s the exception. But, it’s exciting stuff.
Melanie: Dr. Doyle, what factors are considered in organ matching and allocation? How does that matching process work?
Dr. Doyle: A number of things. It’s complicated and simple. In kidneys, unlike other organs, the primary driver for allocation of a kidneys, in other words, who gets which kidney, is based on time on the waitlist. So, recently that’s undergone a big change. So, now time counts back to when either you get listed or when you started dialysis, whichever is first, because some people used to wait years before they came in to get evaluated. So, the time is the number one thing. There are some immunologic factors and a degree of matching for the human leukocyte system, the HLA system. So, you get points for certain types of matching where, if the kidney’s a better match, you would get the equivalent of more time. And then, there are some special circumstances where your body may have immune barriers to block kidney transplants. So, it makes it harder, and so you’re given a special dispensation. So, that’s the normal thing. And then, kids get transplanted earlier because they know that kidney failure doesn’t allow them to grow normally. So, there’s couple of special circumstances, but mostly it’s driven by time.
Melanie: How does somebody get on the waiting list?
Dr. Doyle: You come into a center and you have to either be on dialysis or it should be importantly noted that you can have 20% kidney function or less. So, the best circumstance is, as soon as you hit 20% function, before you go on dialysis, which usually occurs at around 10% function, you get into a transplant center and get listed quickly because that pushes the time clock going earlier. The evaluation process always involves a multidisciplinary approach: that’s a dietician; that’s a social worker; that’s a transplant coordinator, which is a nurse or a nurse practitioner; the nephrologist like me; and a surgeon. So, we all work together in concert to try to make a decision about who’s a candidate or, more importantly, what things we need to do to get people ready so they’re the best candidate they can be.
Melanie: That is exciting. Tell us about the transplant center. Tell us about your approach to patient-centered care. What can a patient expect, because that’s a very scary thought but yet very hopeful and exciting?
Dr. Doyle: Yes. So, we try to take the broad view and that is, once upon time transplant centers were largely happy to have their success of transplant. So, the focus was always on the numbers and getting people through the operation and getting them up to a year or three years. I think as they got better, we still want--those are really obviously very important metrics but there’s more to that. So, I’m trying to push for a patient-centered approach which means yes, we want the numbers to look good but we also really want to take a person through a journey from a point of end-stage organ disease--kidney in this case--all the way through to health because kidney transplant and other organs, too, is a special case where people can really know what it’s like to be sick, sometimes deathly ill, on dialysis, and they see some people--some make it and some don’t, and you can give them the second chance. And, unlike things where people have a revelation at the end of their lives or their final days of their life and that may or may not be true for a short time, people can have--we’ve had kidney transplant patients who’ve lasted 40 years. So, you can have somebody who gets very close to being very, very sick and have the knowledge that that brings, the wisdom that that brings sometimes, and then get a second chance and be able to live that second chance for potentially decades. So, as we go forward, I’d like to continue to manage the nuts and bolts of transplant but also to increasingly focus on the human aspect which is this is really a wonderful celebration of life and a second chance.
Melanie: Wow. Such great information. Thank you for all the great work that you’re doing, Dr. Doyle. You’re listening to UVA Health Systems Radio. And for more information, you can go to www.uvahealth.com. That’s www.uvahealth.com. This is Melanie Cole. Thanks so much for listening.
Celebrating 50 Years of Organ Transplantation at UVA
Melanie Cole (Host): In June 1967, the UVA Transplant Center transplanted its first solid organ, a kidney. My guest today is Dr. Alden Doyle. He’s a transplant nephrologist and the Medical Director of the kidney transplant program at UVA’s Charles O. Strickler Transplant Center. Welcome to the show, Dr. Doyle. Tell us a little bit about the transplant center at UVA and the 50th anniversary coming up in 2017. Give us a little background on the evolution of kidney transplantation over the years.
Dr. Alden Doyle (Guest): Sure. So, the program is a well-established one that does most of all the solid organs. So, they have a robust program in heart transplant, kidney transplant, pancreas transplant and lung transplant, and a separate one in bone marrow. So, almost all of the normal organs that are transplanted. They have been innovators in the field for years with tissue typing and different organ transplant techniques, and there’s a lot of nice overlap. So, they’ve been in the business for a long time, and recently, with a new dean who is a lung transplant specialist himself, have really put a lot of resources to make all the transplant programs go under one transplant institute, and continue to grow and be innovators in the field. In terms of history of transplant, we’ve come a long way. As you know, in the mid-50’s, the original transplant was basically reserved for very healthy folks who had living donors, and so the immunosuppression was very modest and the understanding of how the immune works to keep one healthy and to reject organs was only very rudimentary. So, it was really only available for a few folks under special circumstances. And now, with lots of medicines and a lot of greater understanding, it’s available to, not all but many, people with different kinds of organ disease and different backgrounds.
Melanie: So, there’s are many organs that you transplant now, and UVA is the only comprehensive transplant center in Virginia with more than 45 years of experience. Dr. Doyle, speak about some of the other organs that are transplanted, what people should look for when looking for a transplant center?
Dr. Doyle: So, I think there are a couple of things you can look at. There’s publicly available data. So, there’s an organization that the government funds and supervises which is called “United Network for Organ Sharing” or “UNOS”. So, they have the responsibility of maintaining oversight for transplant programs across the country and publish on the website the outcomes. So, I think one question a potential transplant recipient would ask is, “How do they do? And if I get a transplanted at the center, would I expect to survive, and how would the function of the organ work?” So, they publish one- and three-year patient and graft survival as a first test. On top of that, I think you’d want a comprehensive center that can offer the broad range of services, including overlap of disease. So often we see that patients have not just kidney disease but also liver disease, and so it’s nice to have one center that can manage the thing from soup to nuts, and even up to the unusual circumstance of requiring two organs at once.
Melanie: What do you anticipate the future holds for kidney transplantation?
Dr. Doyle: Well, our hope is a couple of things. One is, one of the biggest problems we have and we’re victims of our own success in a way. We have the one-year graft survival and patient survival that has gone steadily up and, as I mentioned before, there are a lot more folks who are potential candidates. And so, with organ donation rates being reasonably flat—they’ve grown a little bit--then there’s a bigger disparity between need for organs and availability of suitable organs. So, we hope that there’s going to be continued public advocacy for donation, different ways to do this, but to increase the supply because there’s a growing number of people who die waiting for organs even though they know that if they got transplanted, they’d be successful, but there just isn’t enough to go around. So, that’s a piece of it. Part of it is public policy so there are some things we hope Congress will do to make living donation and organ transportation even easier. They’ve been supportive but there are some important steps to make right now. There’s also a lot of science in immunology and related fields like genomics and proteomics that we hope will translate into better outcomes for transplants so we have more of an individualized medicine. We know that different people respond to medications and have different risks of rejection, but why that is in all circumstances is less clear. So, going forward, if we can make an individual plan so that this combination of medications and these organs will be the best for an individual patient, that would be a real step forward in keeping with the way--the direction--of modern medicine.
Melanie: So, can you tell us about any breakthroughs in post-transplant care?
Dr. Doyle: There’s been some. It’s been incremental. I wouldn’t call it absolute breakthrough. There have been some new medications that change the paradigm of immunosuppression. For example, there are some medications that people can get once a month by IV, that’s never been possible before. There’s been some work to try to promote tolerance where, under certain circumstances, patients would not require immunosuppression--although it’s the exception. But, it’s exciting stuff.
Melanie: Dr. Doyle, what factors are considered in organ matching and allocation? How does that matching process work?
Dr. Doyle: A number of things. It’s complicated and simple. In kidneys, unlike other organs, the primary driver for allocation of a kidneys, in other words, who gets which kidney, is based on time on the waitlist. So, recently that’s undergone a big change. So, now time counts back to when either you get listed or when you started dialysis, whichever is first, because some people used to wait years before they came in to get evaluated. So, the time is the number one thing. There are some immunologic factors and a degree of matching for the human leukocyte system, the HLA system. So, you get points for certain types of matching where, if the kidney’s a better match, you would get the equivalent of more time. And then, there are some special circumstances where your body may have immune barriers to block kidney transplants. So, it makes it harder, and so you’re given a special dispensation. So, that’s the normal thing. And then, kids get transplanted earlier because they know that kidney failure doesn’t allow them to grow normally. So, there’s couple of special circumstances, but mostly it’s driven by time.
Melanie: How does somebody get on the waiting list?
Dr. Doyle: You come into a center and you have to either be on dialysis or it should be importantly noted that you can have 20% kidney function or less. So, the best circumstance is, as soon as you hit 20% function, before you go on dialysis, which usually occurs at around 10% function, you get into a transplant center and get listed quickly because that pushes the time clock going earlier. The evaluation process always involves a multidisciplinary approach: that’s a dietician; that’s a social worker; that’s a transplant coordinator, which is a nurse or a nurse practitioner; the nephrologist like me; and a surgeon. So, we all work together in concert to try to make a decision about who’s a candidate or, more importantly, what things we need to do to get people ready so they’re the best candidate they can be.
Melanie: That is exciting. Tell us about the transplant center. Tell us about your approach to patient-centered care. What can a patient expect, because that’s a very scary thought but yet very hopeful and exciting?
Dr. Doyle: Yes. So, we try to take the broad view and that is, once upon time transplant centers were largely happy to have their success of transplant. So, the focus was always on the numbers and getting people through the operation and getting them up to a year or three years. I think as they got better, we still want--those are really obviously very important metrics but there’s more to that. So, I’m trying to push for a patient-centered approach which means yes, we want the numbers to look good but we also really want to take a person through a journey from a point of end-stage organ disease--kidney in this case--all the way through to health because kidney transplant and other organs, too, is a special case where people can really know what it’s like to be sick, sometimes deathly ill, on dialysis, and they see some people--some make it and some don’t, and you can give them the second chance. And, unlike things where people have a revelation at the end of their lives or their final days of their life and that may or may not be true for a short time, people can have--we’ve had kidney transplant patients who’ve lasted 40 years. So, you can have somebody who gets very close to being very, very sick and have the knowledge that that brings, the wisdom that that brings sometimes, and then get a second chance and be able to live that second chance for potentially decades. So, as we go forward, I’d like to continue to manage the nuts and bolts of transplant but also to increasingly focus on the human aspect which is this is really a wonderful celebration of life and a second chance.
Melanie: Wow. Such great information. Thank you for all the great work that you’re doing, Dr. Doyle. You’re listening to UVA Health Systems Radio. And for more information, you can go to www.uvahealth.com. That’s www.uvahealth.com. This is Melanie Cole. Thanks so much for listening.