
                         Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: WEDNESDAY, April 21, 1993                   TAG: 9304210325
SECTION: VIRGINIA                    PAGE: C1   EDITION: METRO 
SOURCE: CAROLYN CLICK STAFF WRITER
DATELINE:                                 LENGTH: Long

HOSPITAL LAUNCHING TRANSPLANT PROGRAM

When transplant surgeon Joseph Hayes was a resident at a Boston hospital in the late 1970s, the drug credited with increasing the survival of transplant patients still was in the experimental stages.

Although kidney transplants were common, doctors were frustrated by the body's willingness to reject the foreign organ. Yet, they were tantalized by the prospect of freeing patients from the time-consuming routine of dialysis and also by the potential for transplanting other organs like the liver and pancreas, which had been virtually inconceivable.

The discovery of Cyclosporine, known for its ability to suppress the body's immune system and allow the body to adjust to the new organ, coupled with amazing advances in transplant technology, intrigued Hayes. He went on to specialize in urology, transplantation and renovascular surgery; completed research in transplant immunology; and underwent training in pancreas transplantation.

Now, Hayes, 39, is preparing to launch the first kidney transplant program in Southwest Virginia at Roanoke Memorial Hospital.

The hospital's new Carilion Transplant Center is expected to attract dozens of patients who now travel long distances to medical centers outside the region, as well as enhance the reputation of the Carilion Health System.

At a Tuesday news conference, Hayes said he and his transplant team - which includes transplant nephrologist Mathew Mathew and two transplant coordinators, Vivian Wilson and Kathy Cavanaugh - already have begun to evaluate patients. He expects to complete the first kidney transplant at RMH within the next month or so.

Initially, the hospital expects to carry out 30 to 40 operations a year.

"I think there is potential to do more, based on the number of patients that are being referred," Hayes said. "The great limiting factor is the limitation on organs."

Americans still are reluctant to become organ donors, despite phenomenal advances in transplant technology in the last decade and improving survival rates for patients. But recent polls suggest that families who have discussed the possibility of organ donation in advance may be more willing to donate a loved one's organs in the event of an accident.

Patients waiting for kidneys make up more than two-thirds of the 31,000 registrations on the national waiting list compiled by the United Network for Organ Sharing, which administers the program and registry under contract from the federal government.

Newell Falkinburg, a Roanoke nephrologist who led the panel that studied establishing a transplant program at Roanoke Memorial, believes a local transplant program will improve the prospects for organ donation.

"The population will be a lot more responsive to that sort of thing if they realize that the organs they donate will be used locally," said Falkinburg. "I realy do feel that having a local transplant program will have an impact on the number of kidneys donated."

For years, patients at Valley Nephrology, the city's only practice devoted to kidney problems, have lobbied for a transplant program closer to home, Falkinburg said. Traditionally, Southwest Virginia patients traveled across the state line to North Carolina's Bowman Gray Medical School at Wake Forest University or the Duke University Medical Center, while Roanoke Valley patients traveled to the University of Virginia.

"We just didn't do enough of them to justify the expense and the hassle of doing them, plus the number that would justify safety for the patients," Falkinburg said. But over the past five years, the number of patients who could benefit from the program increased enough to justify a transplant program.

There also was some initial reluctance on UVa's part to embrace a sister program in such close proximity, fearing a drain of patients and available organs.

"The issue of the resource of organs - it will impact us, there is just no doubt about it," said Betty Jolly, UVa's transplant administrator.

But she said the two hospitals have developed a cooperative relationship during Roanoke's extended effort to win state and federal approval for the program.

"I don't think there is any doubt about the collaborative effort between the University of Virginia and Roanoke Memorial," she said.

Bill Cunningham, senior coordinator for the nonprofit Virginia Organ Procurement Agency, also believes the relationship will be collegial, not competitive.

The agency, which does the actual organ procurement, will maintain one list, and it will be the tissue-typing - matching the donor to the patient - that will determine which center within the region gets the organ. If there is no match, then the agency alerts the national network, which places the organ on its registry.

While UVa likely will lose patients in the short run, Hayes believes those numbers will rise again over time in tandem with a growing awareness of the need for organ donations.

Steering the program through the complex regulatory approval maze has been "a long, drawn-out agonizing process," said Falkinburg.

It has been a year since Hayes arrived in Roanoke from the hectic pace of the Cleveland Clinic in Ohio; a year since he has entered the operating room specifically to transplant a kidney.

But Hayes - who estimates he has carried out several hundred kidney transplants - has kept his surgical skills polished by scrubbing with his associates at Jefferson Surgical Clinic Inc.

Now, he said, he is a little impatient to get the program off the ground.

"The challenge of doing that made me come here," said Hayes.

\ KIDNEY TRANSPLANTS

In 1992, there were 16,475 transplants nationwide, including 10,108 kidney transplants. More than 14,000 remained on the waiting list for transplants at the end of the year.

Of the 10,108 kidney transplants last year, 2,410 came from living donors, while the other organs were procured from organ donor cadavers.

Transplant centers nationwide: 268.

Kidney transplant programs: 240. In Virginia, they are the University of Virginia, Fairfax Hospital, the Medical College of Virginia, Norfolk General Hospital, Henrico Doctors' Hospital and Roanoke Memorial Hospital.

Average cost of a kidney transplant: $20,000 to $30,000; most costs covered by Medicare.

United Network for Organ Sharing

by CNB