The Pandemic Rages, But Oregonians With Heart Failure Still Get New Hearts
Despite the pandemic, Portland heart transplant surgeons and heart failure specialists have been busy.
Providence St. Vincent Medical Center in Southwest Portland announced Wednesday it had performed five heart transplants since July. Those operations mark its first heart transplants since it launched its heart transplant program in May.
“It’s going great,” Dr. Dan Oseran, executive medical director of Providence Heart Institute, said in an interview released by Providence. “The patients are doing well. We’re very pleased with the team we’ve assembled, so it’s all systems go.”
Providence decided to build a heart transplant team in March 2019 following the collapse of the program at Oregon Health & Science University in 2018 and the transfer of 400 heart failure and post-transplant patients from OHSU to Providence St. Vincent.
Providence’s program got a boost in 2019 with a donation of $75 million from Phil and Penny Knight. The health care system said Wednesday it will rename its West Pavilion at Providence St. Vincent after the couple in gratitude.
“We are incredibly grateful to the Knights,” Oseran said. “Not just for the gift but for what it represents. Because It represents an endorsement of Providence St. Vincent. It represents their confidence in our ability to execute successfully on this initiative.”
In 2012, the Knights gave OHSU $125 million to build its cardiology institute, which underwent a shakeup after the heart transplant program imploded in 2018.
Last April, OHSU performed its first heart transplant in nearly two years.
In June it hired a new director, Dr. Deborah Meyers, and the same month performed another heart transplant. Last week, Meyers added a fifth heart failure cardiologist, Dr. Conrad Macon, who was chief resident at the University of Miami.
“We’re doing very well here,” Meyers told The Lund Report. “I’m just thrilled (that) everybody who has this awful disease can get better.”
OHSU has performed four heart transplants since April, and a fifth operation is taking place on Thursday.
Meyers said she’s not worried that OHSU, which used to have the only heart transplant program in Oregon, now has to compete with Providence St. Vincent.
“To me this is not a numbers game,” Meyers said. “We are increasing our volumes but we have to do this in a safe and sustainable way. The thing that I’m proudest of right now is the fact that all of our patients are out of the hospital. They’re out leading their lives. They’re having a good time. They’re getting better and stronger and fitter. To me, ultimately, that’s the most important outcome.”
OHSU has not set a goal for the number of heart transplants it wants to perform this year. Unlike Providence, it is not under pressure from federal authorities to obtain certification from the Centers for Medicare and Medicaid Services. Its certification was continued because it did not suspend its program for more than a year.
But Providence St Vincent, which discontinued a previous heart transplant program in 2012, needs to perform 10 heart transplants to be certified by CMS. Certification enables providers to be reimbursed for the operation and accompanying expenses. That funding is crucial. A heart transplant can cost more than $1 million.
The health care system is committed to footing expenses that are not paid by insurers to earn CMS approval, Oseran said.
Providence has ample resources, With 51 hospitals in six states, it reported nearly $12 billion in unrestricted cash and investments as of June. Nearly $10 billion was in investments and $1.9 billion was in cash.
Providence expects to become certified by CMS next year.
“We’ve been relatively conservative and careful in the patients we’ve chosen,” Oseran said. “As we get more experienced, we will be doing more complex cases.”
Providence currently has four people who’ve been approved for a heart transplant and are on its waiting list, according to a spokeswoman for the United Network for Organ Sharing, a nonprofit that manages the U.S. transplant system. Three people are on OHSU’s waiting list, she said.
Need For Safety During The Pandemic
The pandemic has added an extra layer of complexity to heart transplants and recovery.
Oseran said that Providence was prepared to transplant the first patient after winning federal approval in May but decided to wait.
“We decided we would pause the opening of our program until we could be absolutely certain we had the capacity in the hospital and the safety in the hospital to go forward,” Oseran said.
The pandemic has been challenging for the heart transplant team. They can’t all get together in the same room.
“COVID has put strains on the team building efforts,” Oseran said.
And safety precautions have been added throughout the transplant process.
Donors, whose bodies are kept alive after the person is brain dead to preserve their organs, have to be COVID negative, and the hospital tests the recipient as well.
“We have to make sure the recipient doesn’t have latent or blatant disease,” Meyers said.
The hospital has to have an intensive care bed available in a unit where there are no COVID patients. OHSU keeps severely ill COVID patients in their own ICU to avoid spreading infection.
When patients waiting for a heart transplant arrive at OHSU, they’re whisked to a sanitary room. The hospital is not allowing guests in the clinic either, unless it’s someone in that person’s household or on their caregiver team.
After the transplant, heart failure staff spend a lot of time educating the patient and their caregivers about how to avoid getting COVID.
They encourage families to get takeout food and celebrate Thanksgiving over Zoom instead of getting together in person. And they instruct the families about what to do if someone in the household gets the virus.
“We have not yet had a post transplant become positive,” Meyers said. “But we are doing heaps of education.”
Providence’s first heart transplant patient is 63-year-old Thomas Hatch. He was diagnosed with heart failure in 2006 and retired as an Oregon State Police detective in 2015.
In an interview that Providence distributed, Hatch said he was close to dying before he had the operation.
“I was getting ready to check out,” Hatch said. “When I was admitted, it was my birthday. It’s almost like being a new reborn.”
He’s now doing well. He can lift weight, walk up stairs, empty the dishwasher and carry groceries.
“I feel like I’m a success story,” Hatch said. “I continue moving forward and it’s exciting for me.”
Oseran said the hospital’s heart transplant patients have been a bright spot during the pandemic.
“It’s been a really tough year with everything that’s happened with health care and society at large, but this has been a real joyous initiative,” Oseran said.
Nov 18 2020