Jewish Hospital announced last week that it was suspending its heart transplant program. Besides affecting about 32 patients on the heart transplant waiting list who will have to drive longer distances for care, the hiatus has implications for the University of Louisville’s cardiology program that is based at Jewish Hospital.
The 462-bed Jewish Hospital has been struggling financially over the past few years as its parent company has tried to sell it and other affiliated health facilities. U of L Health and Jewish Hospital have a long-standing business relationship; the hospital is home to U of L’s cardiology and transplant program, and some U of L medical students do their residencies there. Because of that relationship, the University of Louisville was trying to find a partner to buy the hospital, but recently announced it hadn’t been successful.
The hospital’s heart transplant program is the only one in Louisville, and it’s relatively small. Last year, it performed 10 heart transplants. As a comparison, the University of Kentucky Hospital performed the procedure for 29 patients in 2018.
In a statement, Jewish Hospital said it is shutting the program down temporarily for two main reasons; one is a change to how hearts are distributed across the country.
Some say this new policy makes the heart transplant process a little more fair. Previously, transplant patients were divided into three categories, depending on how sick they were and likely to die on a waiting list.
That changed in October 2018: the three categories were broadened to six, meaning that there are now fewer patients in the highest-need categories. Hearts now go to those very sick people first, even if they’re further distances away.
“The sickest people who are going to die, they should have the first crack at any heart that’s available,” said Michelle Kittleson, the director of heart failure research at Cedars-Sinai Smidt Heart Institute in Los Angeles. “Everyone had some trepidation about how this would impact patients on the wait list, but ultimately, I think it’s only been a good thing.”
At the end of 2018, Jewish Hospital had 18 people on its heart transplant waiting list. Almost 70 percent of them were listed in the second tier. Alanna Morris, an assistant professor of cardiology at Emory University, said under the new system those patients are likely listed as level four, and are thus at a lower priority for available hearts.
“If most of their patients were listed at a lower priority status, they may not be as competitive for hearts as other big centers around them that had more patients in the status one [through] status three,” Morris said.
At the end of 2018, the University of Kentucky had 38 people on its heart waiting list, and about eight percent of those were in the highest level. They’re likely still in those higher categories under the new system.
Another factor in the temporary closure of Jewish’s heart program is the loss of cardiology doctors, according to Jewish Hospital. Kittleson said a large staff is needed to run a heart transplant program, so losing doctors is a critical problem.
“If they’re losing cardiologists, they may simply not have what they need to even have a program,” Kittleson said.
What Will This Mean For Patient Care?
The patients on Jewish’s heart waiting list will have to transfer to nearby centers, which might include UK, Vanderbilt University Medical Center in Nashville or the University of Cincinnati. And getting a heart transplant isn’t just a matter of going to a hospital the day-of a transplant; there are numerous appointments both before and after, which will complicate matters for Louisville patients.
“Patients have to pay the gas money, sometimes hotel stays — there’s a lot of financial investment on the part of patients to be able to engage in this very intensive care,” said Alanna Morris of Emory University. “Even having to drive an hour or two further away certainly can put even greater hardship on patients and families who are already on a difficult journey.”
And many heart transplant programs require patients live a certain distance from the hospital for a number of months prior and after surgery. At Cedars-Sinai — a leading heart transplant program by volume — Michelle Kittleson said doctors require patients live within a 70-mile radius for two to three months after a transplant.. A University of Louisville spokesperson said their heart transplant patients needed to live within two to four hours of Jewish Hospital.
“What that can turn into is patients having to fund raise on their own for the finances to relocate,” Kittleson said. “Within Kentucky, there will be implications for the patients in how they’re going to manage the logistics.”
Morris said that additionally, patients who chose to transfer to waiting lists at out-of-state hospitals often have to go through a new evaluation of their medical standing. Patients should also check with their insurance company to find out if the cost — both of visits and of the transplant procedure — will be any different.
“If for some reason that transplant center is out-of-network, their co-pays may change, benefits may change,” Morris said.
Implications For The University of Louisville
Since University of Louisville cardiologists staffed the heart transplant program, the hiatus doesn’t bode well for the university. Michael Imburgia is a cardiologist and medical director of the downtown Louisville nonprofit Have A Heart Clinic. He said U of L might have a harder time recruiting surgeons, fellows and medical residents because of the change.
“They’re going to be interested in doing things other than just bypass surgery or valve surgery – a lot of them may want to do transplants, and that won’t be here,” Imburgia said. “And if you’re doing a cardiology fellowship, you’re typically exposed to at least caring for patients that are post-transplant, but they won’t get that training anymore.”
Imburgia added that having a successful heart transplant is good for everyone: the city, patients, medical students and fellows. In 2018, Jewish Hospital completed its 500th heart transplant.
A spokesperson for the University of Louisville declined to comment, beyond providing answers to basic questions about the program.
What To Know
Jewish Hospital said it will help people on the waiting list transfer to another transplant center. If the patient chooses to initiate transfer to UK, they can contact the UK Heart Transplant Program at 800-456-5287.
For information on wait lists and patient outcomes at programs across the country, visit SRTR.org.