The gift of life: HCA Healthcare leads nation in live donor kidney transplants

HCA Healthcare is honored to celebrate the gift of life. Thanks to our incredible multi-hospital collaboration, altruistic donors, and forward-thinking transplant physicians, HCA Healthcare led the nation in 2018, performing more live donor kidney transplants than any other hospital system in the country.

Led by industry leader Dr. Adam Bingaman, the organization’s medical director of solid organ transplants, HCA Healthcare transplant centers outperformed systems such as Mayo Clinic and the University of California Health System in live donor kidney transplants, according to the latest data put forth by the Organ Procurement and Transplantation Network (OPTN).

Alone, affiliate Methodist Specialty and Transplant Hospital accounted for 53.2 percent of HCA Healthcare’s total living kidney donor transplants.

“Living donation is a fantastic option for patients with kidney failure, because they can receive a kidney from a living donor, without even having to be on the transplant waiting list at all,” said Dr. Bingaman, who also serves as the director of abdominal transplant at Methodist Specialty and Transplant Hospital. “With living donation, patients get kidneys in record time and have exceptional outcomes and survival rates.”

Adam Bingaman, M.D.; Medical Director of Solid Organ Transplants, HCA Healthcare; Director, Abdominal Transplant Program, Methodist Specialty and Transplant Hospital; Transplant Surgeon, Director Live Donor and Incompatible Kidney Transplant Programs, Methodist Specialty and Transplant Hospital

“Kidneys from living donors work better and last longer with the average deceased kidney lasting from seven to 10 years, said Dr. Bingaman. “Whereas, an average kidney from a living donor is expected to last 15 to 20 years.”

Kidney disease: a public health crisis

Chronic kidney disease (CKD) is an under-recognized public health crisis, affecting more than 30 million people in the U.S.

“Diabetes is the most common cause of kidney failure in the United States with links to the country’s obesity epidemic,” said Dr. Bingaman. “The second leading cause is high blood pressure with other contributory factors being auto-immune diseases, like Lupus, and genetic contributors, such as polycystic kidney disease. Patients either need a transplant or dialysis to stay alive.”

In the United States, more than 113,000 people wait for life-saving organ transplants. Topping the list, kidney organs are the highest in-demand with nearly 95,000 patients waiting for a kidney.

“We have an extreme kidney shortage, and to make matters critical, just last year about 40,000 patients were added to the waiting list. There simply aren’t enough kidneys to go around. This is a tragedy.”

One of the most critical challenges for patients in need of a new kidney is finding a donor. The national waitlist for a deceased donor can be several years. Even altruistic friends and family members aren’t always a good match. Patients are forced to wait on transplant lists.

And, on average, just more than 10 people die each day while waiting for a transplant.

HCA Healthcare affiliate Medical City Fort Worth ranks among the nation’s most efficient centers, moving patients from the waiting list to transplant the fastest in the country.

“We’re proud to have hospitals in the HCA Healthcare system that are being recognized as one of the nation’s quickest transplant centers,” said Dr. Bingaman. “The goal is to be excellent at everything our transplant centers do. It’s an added achievement to be able to address this crisis quickly.”

Enter Artificial Intelligence (AI)

In 2008, Dr. Bingaman teamed up with a software architect from Massachusetts Institute of Technology (MIT) to develop new artificial intelligence (AI) algorithm methodology that has increased the odds of matching hopeless patients with potential donors. Through this technology, computers are able to delve into patient and donor charts, like never before, to locate complicated blood and antibody matches. The data system helps match patients in need of a kidney to those willing to donate one.

Before, kidney donors who were not used due to incompatibility, but were willing to donate, would get lost in the system. The patient would go back on the list to wait for a deceased donor organ. Now, through intricate algorithms, patients are identified to “swap” their incompatible donors with compatible ones from other incompatible donor-patient pairs. This can be done in a single swap or through multiple swaps in chains of unrelated donors.

Patients interested in a paired exchange must procure a donor, even one who isn’t a match, to volunteer to donate a kidney to another patient.

Paired Exchange is an innovative donor-recipient matching tool

“Paired exchange has provided remarkable opportunities for the kidney transplant community,” says Dr. Bingaman. “During the first year in 2008, we did a total of 10 paired donations. Now, fast forward to 2019, we are closing in on our five hundredth paired exchange transplant at Methodist Specialty and Transplant Hospital.”

Excellent systems, excellent relationships, excellent people 

When not advocating for living donor kidney transplantation, Dr. Bingaman can be found in the operating room at Methodist Specialty and Transplant Hospital in San Antonio, Texas.

“Contributing to the live donor kidney transplant volumes, is the innovation in paired exchange for incompatible donors that we have pioneered,” said Dr. Bingaman. “Also, great systems, like online donor screening, make it easier for physicians to transplant more patients, faster than we ever have before.”

But, the standout reason behind the margin is “the people behind it. HCA Healthcare builds a team of great people and great people are the foundation of every great organization,” said Dr. Bingaman.

Transplant hematologist, Dr. Abhijeet Goyal and vice president of transplant services, Amanda Weichold

Confronting a community need

Methodist Transplant and Specialty Hospital also was a standout amongst hospitals nation-wide for their ability to transplant the most total Hispanic patients and living donor Hispanic patients.

A skilled surgeon, Dr. Bingaman chooses to transplant patients in South Texas because of the transplant needs of the community. The average person is on the waiting list in South Texas for more than six years.

“Kidney disease discriminates. African Americans have a three times rate of end-staged kidney disease as compared to Caucasians and Hispanics have a one and half times increased rate,” said Dr. Bingaman.

Texas, a state with a large Hispanic population, has been a huge focal point for Dr. Bingaman and his team to revolutionize. The transplant team is part of the South Texas community and understands the needs of the community members.

Patient, George DeLeon, received a life-saving kidney transplant as part of a three-way paired exchange. His daughter, Vanessa DeLeon, was not a match for her father but donated her kidney to a compatible recipient so that her father could receive one through a paired exchange.

“It’s vital that our transplant teams have great relationships with the community, immunology labs and amongst each other,” Dr. Bingaman said. “In order to save lives, our social workers, dieticians, nurses, administration, nephrologists and surgeons all need to be on the same page.”

Fostering those relationships in Texas border towns such as Laredo and Eagle Pass, the team at Methodist Transplant and Specialty Hospital are able to bring world-class care to those who need it. “We can’t be successful if we are not a part of the community,” said Dr. Bingaman.

Early referral to transplant

HCA Healthcare forges into 2019 with campaigns to give referring nephrologists and chronic kidney failure patients more tools to assist in identifying living donors. Often, many patients do not get referred to transplant until it’s too late or they are already adhering to the grueling process of dialysis. Patients with kidney disease have better long-term transplant success when they avoid dialysis and receive a kidney from a living donor.

“Family and Friends Before Fistulas” – is a new movement that HCA Healthcare transplant centers have pioneered to increase awareness of living donation. AV fistulas are the preferred access point for hemodialysis. Through a surgical procedure, blood vessels made wider and stronger to handle the needles that allow blood to flow in and out of a dialysis machine. The surgery is typically performed in advance of needing dialysis. The point of the campaign is for patients with chronic kidney disease to identify a friend or a family member as a possible living donor and avoid dialysis altogether.

“GFR 20 One Time” – is a new initiative intended to fast-track transplant referrals from referring nephrologists. Glomerular Filtration Rate (GFR) is a test that measures a patient’s level of kidney function. “If a patient’s kidney function is 20 One Time, then nephrologists need to refer to transplant so patients can be added to the waiting list and discuss options for transplant prior to initiating dialysis. HCA Healthcare has been getting into nephrology offices everywhere and really advocating for early referrals to transplant,” said Dr. Bingaman.

The educational initiatives are working as more patients are pursuing live kidney donor transplants. At Methodist Specialty and Transplant Hospital, 33 percent of living donor transplant recipients never see a dialysis unit.

Consider becoming a living kidney donor

It is extraordinary that in the U.S., 6,000 people make the decision to be a living kidney donor every year. Because we have two kidneys, we can donate one and still remain healthy with the kidney we keep. Donating a kidney is not without risks but for many, the risks seem minute compared to the lifesaving benefit the recipient receives. Of all of the decisions we make over a lifetime, the lifesaving ones like these are exceedingly rare.

“It’s remarkable that donors allow part of their body to be taken out and given to someone else who really needs it so that a patient can live a longer and healthier life. The donors are the real heroes in the transplant community,” said Dr. Bingaman.

If you are interested in finding out more information about becoming a living donor, visit United Network for Organ Sharing (UNOS).

HCA Healthcare uses the most advanced technology and medical innovations to provide individualized ongoing care for kidney transplant patients. Learn more about the live kidney donor process below:

What to expect from live kidney donation

Kidney failure and how live kidney donations help

The evaluation process to be a live kidney donor

HCA Healthcare specializes in kidney transplants, living kidney donation and paired exchange kidney transplants at:

1. Texas Transplant Institute at Methodist Specialty and Transplant Hospital
2. Medical City Dallas Kidney and Pancreas Transplant Programs
3. Medical City Fort Worth Kidney Transplant Institute
4. The Kidney Transplant Center at St. David’s North Austin Medical Center
5. TriStar Centennial Transplant Center
6. Kidney & Liver Transplant Center at Presbyterian/St. Luke’s Medical Center
7. The Transplant Institute at Largo Medical Center
8. Transplant Institute at Research Medical Center
9. Virginia Transplant Center at Henrico Doctors’ Hospital
10. The Kidney Transplant Center at Las Palmas Medical Center
11. Tulane Transplant Institute
12. Riverside Community Hospital Transplant Center