Organ transplant programs are so prestigious, they're sparking crosstown rivalry in Chicago

Here's a new twist on crosstown rivalry among Chicago-area hospitals: They're aggressively bulking up their organ transplant programs and poaching prominent specialists from local and national competitors to pull it off. Demand is up, but there's another reason for Illinois' surge: more available organs. It's an unintended consequence of the opioid epidemic—people who die of overdoses have become a new source of organs.

It takes only a quick glimpse at the numbers to understand the demand. Nationwide, in 2016, transplants hit a record high of nearly 34,000. That year, nine Illinois hospitals performed a collective 1,208 transplants, a 23 percent jump from 2015 and the most since 2009.

"Even though there's a record number of transplants this year, it doesn't come close to meeting the need," says Dr. David Klassen, chief medical officer of United Network for Organ Sharing, or UNOS, a Richmond, Va., nonprofit that manages the national organ transplant system. While the number of people waiting for kidneys, livers and lungs, for example, dipped for the second year in a row, the national waitlist still totals nearly 120,000. In Illinois, about 4,700 people are waiting for transplants.

Besides long waitlists, there are also fewer organs leaving the state, unlike in previous years when hospitals here shunned some available parts fearing subpar patient outcomes. While the industry is still heavily regulated, the federal government has applied less scrutiny recently to patient and organ survival rates. That has prompted hospitals to consider organs they might have otherwise rejected.

"Programs are less concerned," says Kevin Cmunt, CEO of Gift of Hope Organ & Tissue Donor Network, an Itasca nonprofit organ donation advocacy group. "They can be a little bit more aggressive."

Transplants are one of the most resource-intensive services hospitals provide, and the procedures are not necessarily a big moneymaker, says Pamela Damsky, a New York-based director at health care consultancy Chartis Group. Milliman, a Seattle-based actuarial firm, estimates that the average total cost for a heart transplant in 2017 will reach $1.38 million. That's not just for the surgery. It includes lengthy doctor visits before and after surgery and anti-rejection drugs that patients must take for life.

Still, having a transplant program brings cachet and prestige to a health system. Maywood-based Loyola University Medical Center, which performed 246 transplants last year, spends up to $40 million annually to maintain its program, which grew 64 percent from 2015 to 2016. The academic medical center nearly tripled its kidney transplants during that period, totaling 106. Kidneys are, by far, the most in-demand organ and are among the hardest to get. About 40 percent of people on the kidney waitlist in Illinois have been there for at least three years.

Among those waiting for a kidney is Chicago Police Superintendent Eddie Johnson, who has put a public face to the plight. He is expected to underscore the importance of organ donation at a summit Feb. 21 organized by Gift of Hope and government agencies, including Mayor Rahm Emanuel's office.

In 2014, Dr. Edwin McGee Jr. was recruited away from Northwestern Memorial Hospital, the powerhouse academic medical center downtown, to rekindle Loyola's heart transplant program. Lured in part by the idea of growing a program, he's done so steadily with a team he says takes on patients other hospitals won't, fearing they aren't good candidates and will hurt success rates, capturing the eye of federal regulators. "It's not any of our first rodeos here," McGee says.

Loyola is ramping up in other ways. This spring, the hospital plans to launch a pancreatic transplant program, a niche, low-volume piece of the transplant business but one that already exists at competitors, including Northwestern and Rush University Medical Center. Dr. Raquel Garcia-Roca, who will lead Loyola's pancreatic transplant program, acknowledges stiff competition. But the hospital has turned away potential patients in the past because Loyola lacked the program.

Other local medical centers are aggressively seeking talent, too. On the South Side, University of Chicago Medicine staged a coup last fall when it snapped up Dr. John Fung from the renowned Cleveland Clinic. Hired to launch the University of Chicago Medicine Transplantation Institute, Fung has built transplant programs around the world and has bold ideas for expansion here.

"When you look at the number of transplants done in the city for the population that we serve in Illinois, there are patients that aren't getting access," Fung says.

His plans include adding an intestinal transplant program and using technology that helps repair organs that otherwise might be discarded. Such science involves keeping an organ warm and functioning—making sure a heart is beating, for example—rather than packing it in ice to bring to a waiting patient.

On the Near West Side, University of Illinois Hospital & Health Sciences System is doubling down on transplants, too, after scaling back on surgeries and spending about $2 million to improve survival rates. (Northwestern and Loyola also have resolved similar issues with federal regulators in recent years.) Dr. Enrico Benedetti, chief of transplantation surgery, says efforts to bolster the transplant program include focusing on UI Health's niche: treating obese patients other hospitals turn away. Obese patients are often told to lose weight before getting new organs.

Still, he's acutely aware of the competition. The state-funded hospital treats many poor and uninsured patients. Those with private insurance, which reimburses hospitals at higher rates, typically head to his rivals, Benedetti says.

But he's optimistic. The hospital has added more than 10 employees, from social workers to coordinators, to help patients navigate the transplant process. His message to the community: UI Health is open for transplants.

"Organ transplant programs are so prestigious, they're sparking crosstown rivalry" originally appeared in Crain's Chicago Business.