New Heart Transplant Director Takes Reins At OHSU; 2nd Operation Performed

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Oregon Health & Science University performed a heart transplant earlier this month, its second this year after a yearlong suspension of the program.

The first operation was on a 68-year-old man the last week of March and the second involved a 63-year-old man, who was operated on shortly after Dr. Deborah Meyers, a heart failure cardiologist, started work as OHSU’s new director of its heart transplant and heart failure program. 

She started in April not long after OHSU closed research labs and sent many employees home to focus on the pandemic.

In an interview, Meyers told The Lund Report that she’s pleased to be working at OHSU, enjoys Portland and is eager to take on the challenge of rebuilding the transplant program. The program, which is about 30 years old, had a devastating year in 2017. Among the 18 patients who received new hearts that year, six died, giving OHSU a death rate four times above the national average. The following year, the program performed 10 heart transplants. Nine patients are still alive today. OHSU did not release details of when that one patient died. Previous news releases indicated that they lived more than one year, which is a key benchmark in the evaluation of a program's quality by the Scientific Registry of Transplant Recipients.

In August 2018, however, the program imploded when the last of its four heart failure cardiologists left. Sources cited personality issues and loyalties as the reason behind the implosion.

Meyers is no stranger to turmoil at work. During her career, which includes leading the heart failure program at Salinas Valley Medical Center in Salinas, California, she was the medical director of the heart failure program at the Texas Heart Institute at Baylor University in Houston, Texas. In 2017, Baylor’s heart transplant program was forced to temporarily close following a spate of patient deaths highlighted in an investigative report by ProPublica and the Houston Chronicle. Meyers was aware of the program’s problems and spoke out internally at the time, according to the investigation. Worried about the quality of Baylor's heart transplant program, she referred transplant candidates to other hospitals. She later blasted the program as “one of greed, careerism, corporate takeovers, appalling administrative oversight, failure of leadership, poor hiring practices, completely avoidable lawsuits, and the inevitable public distortions of their underlying mission, all of which have occurred as medicine has become perverted into ‘big business,’” according to a ProPublica report.

That kind of sharp criticism is rare among physicians, who typically decline to speak out publicly against an employer, even after they’ve left. The health care world is relatively small, and alliances stretch across the country. 

Meyers is a unusual in other ways, too. She earned a bachelor's degree in fine art and taught photography at the University of California, Los Angeles. After becoming a cardiologist, she worked abroad, directing the Queensland Heart Failure and Transplant Program in Australia.

At OHSU, with an annual salary of $135,470 excluding clinical pay, she supervises two nurse practitioners and three other newly hired heart failure cardiologists: Dr. Johannes Steiner from Massachusetts General Hospital in Boston; Dr. Nalini Colaco of the University of California, San Francisco; and Dr. Luke Masha, of Brigham and Women’s Hospital in Boston. 

Last week, she talked to The Lund Report about her vision. The interview has been edited for clarity and brevity.

You said you are eager to rebuild the program. What are your plans?

When they first reactivated the program, they were very focused on just the very, very sickest patients. My interest is in expanding the broader heart failure services that we offer. There's so much that we can do now to make people feel better and to improve their situation and make them safer, even if we don't consider them for transplant or mechanical circulatory support. 

What are the challenges of performing heart transplants during a pandemic?

We're very worried about the fact that all of these patients require immunosuppression, which makes them more vulnerable to infection -- all kinds of infection -- but with COVID-19, we’re certainly worried about that. So our multidisciplinary transplant group has been meeting, and we've developed protocols for testing donors and testing patients and making sure that when they do come back to the clinic that we're able to isolate the patients, provide sanitized rooms, minimize their exposure to other people. We've developed pretty good processes to try and ensure that safety. 

The first year post-heart transplant is critical for patients. Once they leave the hospital, what are your concerns with this pandemic swirling around us?

I worry about everybody who's a vulnerable person, especially now with the increasing numbers (of cases). We really stress to these patients (the importance of), quarantining as much as humanly possible, wearing a mask, sanitizing and social distancing. These are all critically important for our patients. We spend a lot of time making sure that they understand that. 

The way immunosuppression works is that the highest level is right around the period of the transplant. And usually by four to six months, that immunosuppression is ratcheted down pretty significantly. But patients who've had a transplant have to be on lifelong immunosuppression, and it always makes them more vulnerable to bacterial infections, viral infections and also cancers. So these patients really require lifelong vigilant care.

When you were in Houston, you spoke out about the problems at St. Luke. How has that experience shaped your approach to your work?

Coming from that experience, when I looked at another transplant leadership position, that was one of the things that I really wanted to know: Was the administration aligned with the clinical practice? That was (on the) very top of my agenda because I didn't want to be caught in a situation where an administration was trying to direct clinical care to the detriment of the patient. I was very sensitive to that after having been in it. And that was one of the things that really impressed me when I came here. I was so impressed with (the Executive Vice President of OHSU and CEO of the OHSU Health) John Hunter when I met with him, and the dean and all the leadership. Everyone was aligned in wanting to have a high-quality program. There wasn't one person who said, if you come here, my door isn't open if you run into any roadblocks. That's why I came here because I thought that we could really do something special.

OHSU had a fairly successful heart transplant program for about 30 years and then it had a bad year with a series of deaths. The following year, the heart failure physicians left when they were rebuilding the program. What  do you plan to do to ensure that the program is a success?

I think that the problems that they had that resulted in the program being deactivated -- and that's just the transplant program, the heart failure program continued on -- I think it got everyone's attention in a huge way. There was complete realignment. And I think they also realized how completely important this was to the university mission. My sense is that there was a soul searching from top to bottom. When I came here to interview, I got the message loud and clear from absolutely everybody that I talked to -- and I came a few times to look at the program before I actually negotiated a contract -- (of the high) level of commitment to making this work. 

Providence used to have a heart transplant program but it closed because of lack of volume. It just launched a new program. Are there enough patients in the area for two programs?

I don't know that it's a numbers game so much. One of my favorite mentors used to say that as a transplant doctor, I try not to transplant. That seems odd but transplant is complicated; taking care of patients post-transplant is complicated. On the other hand, advanced heart failure therapies for the patients that need them are a complete gift. It's amazing to see someone so sick and to be able to do a transplant or (implant a heart assist device) and get someone who was basically a cardiac cripple back to a really exciting life. That's what we're going for. My plan is to really focus on heart failure and therapies in a broad way. And I think then we'll be able to see the patients that really are going to be the ones that get the most benefit from a transplant or from mechanical support.

OHSU transplanted its first heart into a patient in almost two years in March. How is he doing?

We've done a second transplant on June 2nd. That patient is a 63-year-old, a very nice man who’s had a long heart failure journey. He has now left the hospital. He’s from Eugene. But both of our patients are doing beautifully.

How long is your waiting list?

That changes from day to day. Because we're just reactivating, the waiting is still very short. We have the shortest waiting time.

How short?

The wait depends on your size, your blood group, your antibody status. But we have one of the shortest waiting lists in the country so we anticipate that anybody that we list actively, or that has a high listing status, will get transplanted reasonably quickly. God willing, right? People sometimes ask me, what day will the transplant be scheduled? And I say, it doesn't work like that. It depends on the donor availability and the people who are gracious enough and their families are generous enough to donate organs. 

So how many transplants are you aiming for per year?

I don't have a number in mind. I want (to treat) patients who are going to have a maximum benefit and get great quality of life and have a good longevity as much as we can predict that. I'm interested in transplanting people that will really benefit from this therapy. I'm not ever going to just transplant someone to get our numbers up. I would never do that. It's not ethical. I have too much respect for the process and for the donors and the donor families.

You can reach Lynne Terry at [email protected].

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Comments

As the husband of a woman who spent weeks at Cedars Sinai and Bakersfield Heart's heart failure programs for weeks and as former longtime Oregonians hoping to return to Oregon when I retire, I am hoping that both the OHSU program and Providence program are successful.  The lack of strong programs in Oregon is a major concern that needs to be addressed before we will return.  My wife is not a transplant candidate for certain unique risk factors but she has recovered exceptionally well with a defib device and has been able to resume a good quality of life with certain limitations. But she needs a strong heart failure program reasonably nearby for the rest of her life. 

I have come to believe that we are fortunate that she did not have a transplant given its high risk. So the new director at OHSU made some nice comments regarding the desire to only do transplants only when it is likely to be beneficial.  We are hoping she and the team at OHSU and the team at Providence are wildly successful in terms of delivering high quality of care to all of the heart failure patients they serve and will serve - to give us the confidence to return to Oregon in the near future.

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