Surgical strategy Growth at UM: Last year, organ transplants at the University of Maryland Medical System rose 69 percent. But the increase, in Maryland and throughout the nation, raises some difficult questions.

March 24, 1996|By Patricia Meisol | Patricia Meisol,SUN STAFF

The call comes in the dead of night, often on a weekend. Somewhere in Maryland, a seriously ill person is awakened by a bedside beeper. The messenger brings salvation, in this world at least. A heart has arrived. Your lung is in. We have a kidney for you. Are you ready?

It's the University of Maryland Medical Center calling. In four years, Maryland has built one of the busiest transplant centers in the country. In 1995 alone, transplants at Maryland rose 69 percent. The hospital now does more transplants than Johns Hopkins, the historic local leader. Maryland won't be satisfied until it elbows the world-famous University of Pittsburgh out of the way and dominates the region's lucrative, prestigious transplant business.

University officials have invested tens of millions of dollars to make that happen, hiring a team of young superstars and developing programs for every major organ kidneys, hearts, lungs and livers.

But Maryland's growth, and that of other new transplant programs across the country, is raising complex issues, among them:

Who should receive transplants? Hospitals once avoided patients considered too fat, too old or too sick to benefit from transplants. Now, with medical advances and new drugs on their side, Maryland and others are taking high-risk patients and expanding the boundaries of transplant science to help them.

Which organs to use? Hospitals once rejected organs from some donors because of their age or medical problems. But faced with a severe nationwide organ shortage, Maryland and others are using borderline organs to save lives.

When should patients be placed on the transplant waiting list? Some doctors believe patients should not be listed until they are gravely ill.

But Maryland and others argue that patients should be listed as early in their illness as possible, making them eligible for transplants much sooner.

Maryland's approach to transplants is simple: Offer them to everyone who can benefit, even if that means taking more risks.

"[We] have a philosophy here, which is never say no," says Morton I. Rapoport, president of the University of Maryland Medical System. "If we can do it, we will do it."

The hospital's attitude and above-average results have attracted hundreds of patients and intensified a bitter rivalry with Hopkins. Already, Maryland has won the kidney war and is on the brink of overtaking Hopkins in heart and lung transplants. Maryland also is taking on Hopkins' liver transplant program, one of the most prestigious in the nation.

The competition has had decided benefits, sharpening everyone's performance. Fewer organs are being discarded or exported by the state's three transplant centers Maryland, Hopkins and Hopkins-Bayview and all three continue to grow.

But that hasn't necessarily made it easier for Maryland residents to get a transplant. Maryland and Hopkins now attract more than a quarter of their patients from out of state all vying for organs donated here. This, along with a growing number of Marylanders seeking transplants, has led to a sharp increase in the waiting list.

The average wait for a kidney in Maryland is now about 15 months, more than twice as long as in other parts of the country. The result is that more people die before they can receive a transplant. In 1994, 100 people in Maryland died while waiting for a transplant. The death rate for those on the waiting list was 9.3 percent, compared with 5.5 percent nationally.

Even so, more people than ever are getting transplants in Maryland. The number has more than doubled in five years. "The benefit to patients is tremendous," says Stephen T. Bartlett, Maryland's chief of transplants. "It's the whole issue of access to care, and we've provided that."

A new chief

Maryland was transplanting only a dozen kidneys and a heart every year when a new chief of surgery, Anthony L. Imbembo, arrived in 1988. The hospital was eager to grow and already had a large cardiology program and top lung specialists. Dr. Imbembo argued Maryland could build the best transplant center in the East.

From a financial viewpoint, it made sense. Profit on transplants is 30 percent higher than most medical services. Kidney transplants central to any academic program are government-financed as part of a $7 billion Medicare program for dialysis patients.

Dr. Imbembo hired Dr. Bartlett, a kidney and pancreas specialist from the University of California, Davis, to be Maryland's chief of transplants. The 42-year-old Eastern Shore native pioneered simultaneous kidney-pancreas transplants in California and performed the first successful one here. The operations aim to cure diabetics, people whose pancreases don't work and whose kidneys fail as a result.

Until five years ago, there was no cure for diabetes. Today, the University of Maryland is at the center of it, running the second largest pancreas transplant program in the country and the sixth largest kidney program.

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