Providence Plans Heart Transplant Program To Fill Vacuum Left By OHSU

Providence Health & Services said Thursday it will start a heart transplant program thanks in part to a $75 million gift from Phil and Penny Knight.

The announcement comes seven months after the state’s only heart transplant program imploded at Oregon Health & Science University. The university was forced to close the program after its four heart failure physicians resigned, leaving about 20 patients awaiting a heart transplant in the lurch. Another 400 patients in various stages of post-transplant recovery or in need of a heart assist device were transferred to Providence, which hired an OHSU heart failure physician and other transplant staff. 

“Oregon needs a high quality, stable and sustainable heart transplant program,” Dr. Dan Oseran, executive medical director of the Providence Heart Institute told The Lund Report on Thursday. “At this moment in time, we are in the best position to deliver that.”

OHSU also plans a program of its own. It, too, put out a news release on Thursday, saying it will reactivate its heart transplant program.

“Through the years, OHSU built a multidisciplinary team and the extensive infrastructure required for complex transplant patients, encompassing specialists in advanced circulatory support, cardiac critical care, nutrition, social work and more,” the release said. “Today, OHSU is the only heart hospital in Oregon with advanced experience treating adults born with heart disease and those with inherited disease affecting the heart muscle (such as hypertrophic cardiomyopathy) -- all conditions that can complicate care for these highly vulnerable patients.”

In 2012, Phil and Penny Knight gave OHSU $125 million to bolster its heart program. The Knight Cardiovascular Institute, under the leadership of Dr. Sanjiv Kaul, grew to 555 professionals, including 125 physicians, nurse practitioners and physician assistants. The university expected the Knights to follow-up with a second donation, sources told The Lund Report. Instead, the couple gave $25 million to Providence in 2014. The hospital system found donors to match that amount, enabling it to expand its cardiology services. Today, physicians at Providence St. Vincent Medical Center implant more heart assist devices than any other medical system in Oregon, company officials said.

Oseran said Providence is honored by the gift from the Knights and other donors.

“We are deeply grateful for our patients who choose Providence to service them,” Oseran said. “Providence Heart Institute is considered one of the best cardiac programs on the West Coast, and we have been able to consistently recruit outstanding physicians from the top programs in the country to join us."

Oseran said Providence expects to have its heart transplant program running within six months to a year.

Providence needs to recruit a lead surgeon to run the program, which will be based at Providence St. Vincent Medical Center in Southwest Portland. Providence currently has five heart failure specialists. A sixth advanced heart failure specialist will start in August. The team includes physicians with experience in heart transplantations. To open for business, however, the health system needs a surgeon who’s performed a transplant within the last 24 months, Oseran said.

Its team includes Dr. Jill Gelow, a heart failure physician who left OHSU’s heart transplant program last July. Her departure was followed by that of the three other specialists on the university’s heart transplant team. Dr. Jonathan Davis went to San Francisco where he attended medical school and did his residency. Dr. Divya Soman left, and Dr. James Mudd, formerly the head of the program, found a position in Spokane.

None of those physicians has spoken publicly about their reasons for leaving. But several faculty members at the university told The Lund Report the implosion stemmed from a managerial problem. A year earlier, Dr. Joaquin Cigarroa had been put in charge of the program. Mudd, the lead heart failure cardiologist, was removed from his leadership role. OHSU managers refused to give the heart transplant team more resources, the sources said. The cardiologists felt that they were overworked, and they were angry about Mudd's demotion. 

“They didn’t understand nor were they informed that this was going to happen to Jim,” one source told The Lund Report. “The people who allowed this to happen still have their jobs. The irresponsibility of that entire thing is unconscionable.”

OHSU has not commented about the problems. It hired four outside specialists to do a peer review but it’s declined to release those results. It would not say whether the peer review team interviewed one or all of the cardiologists who left.

The collapse of the program gave the university a black eye. 

Since OHSU launched its program in 1985 it's performed more than 700 heart transplants, averaging about 30 a year. Providence ran a heart transplant program between 1999 and 2002 but closed it because of a lack of demand. Heart transplant centers need to perform a certain volume of surgeries to remain sustainable.

When OHSU's program closed, the university shifted its patients to Providence, the University of Washington and elsewhere. It started talks with Providence about the potential for collaboration. Those talks are still ongoing Oseran said.

"I met with their senior leadership earlier this week," Oseran said. "Those conversations continue."

But the two hospital systems appear to be going their own way.

OHSU has hired two heart failure transplant cardiologists, spokeswoman Tamara Hargins-Bradley said in an email.

"We are actively interviewing additional heart failure transplant cardiologists," she said. "We are being deliberate and analytical in our reactivation process to ensure our heart transplant program best serves the needs of all Oregonians."

Kaul has not been in charge since Jan. 1. University officials did not give any details about his departure, saying he wanted to focus on research. 

Oseran said there's room in Portland for two heart transplant programs. He said other cities like Salt Lake City and Indianapolis have two programs.

The decision to open a heart transplant program was a logical step after taking on those 400 patients from OHSU, Oseran said.

“In order to be able to take care of all those patients, we had to build some infrastructure," Oseran said. "We thought it's not going to take a lot more for us infrastructure-wise to begin a heart transplant program."

He said that caring for transplant patients requires a lot of expertise from the pre-evaluation phase to post-operation.

"These are very vulnerable patients who require a lot of attention," Oseran said.

Besides Gelow, Providence hired three transplant coordinators and two nurse practitioners from OHSU.

To open a program, the hospital will need the approval of the United Network for Organ Sharing. 

"To apply for a transplant program, you have to have staff that meet certain criteria," said Anne Paschke, spokeswoman for the organ sharing nonprofit. They include a primary surgeon and physician. Providence also will have to reach agreements with other organizations, including a donor organization and lab specialized in transplantation testing.

OHSU did not comment on Providence's announcement, and Oseran deflected a question about potential competition between the two hospital systems.

“I just know what we can do," Oseran said, "and I have great confidence in our physicians I think we can deliver a really high-quality product for our patients.”

Have a tip about the region's cardiology programs? Contact Lynne Terry at [email protected].

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