This story is breaking and will be updated.
Providence Health & Services is re-entering the heart transplant business on its own, funded in part by a $75 million donation from Phil and Penny Knight.
Oregon has been without a heart transplant program since August, when Oregon Health & Science University shut down its transplant operation. Providence says it is already the highest-volume heart care program between San Francisco and Seattle, with 900 to 1,000 surgeries performed each year. It has gotten larger since OHSU’s difficulties, taking on about 350 former OHSU patients.
Yet at the same hour of Providence’s announcement on Thursday, OHSU issued a press release saying it would restart its heart transplant program, but gave few details about how they would pull it off. The news indicates that OHSU might have been able to hire at least one heart transplant cardiologist. But to actually perform surgeries, the hospital would likely need more. Heart transplant patients require intense after-surgery care that is so specialized that essentially no nurses or residents can do it.
OHSU has performed more than 700 heart transplants since the program started in 1985. In a typical year, they could do up to 30.
When OHSU discontinued its transplant program last summer, it threw about 20 patients in desperate need of new hearts into limbo. OHSU halted its program after four cardiologists who specialized in working with post-transplant patients quit.
Providence had moved cautiously and deliberately to fill the gap left by OHSU, staffing up its own heart failure program. But it wasn’t ready to jump into the transplant business. As recently as three weeks ago, Providence doctors said they would prefer to collaborate with OHSU on a transplant program rather than go it alone.
But negotiations between the two sides failed to produce a plan.
A “transformational gift”
Providence then got word of the hefty gift from the Knights, which convinced them to go ahead with its own heart transplant program, the Providence Heart Institute. Dr. Dan Oseran, executive medical director of the institute, called the Knights’ donation a “transformational gift.” Providence aims to have the program up and running within six months to a year.
“We believe our state needs a stable heart transplant program,” Oseran said. “These patients who felt orphaned, we want them to feel they have a home.”
Providence also has the largest advanced heart failure team in Oregon and has quietly hired two transplant doctors. The cardiology department has also hired a nurse from OHSU’s advanced heart failure program and several support staff to deal with the influx of patients.
One of the departed OHSU cardiologists, Jill Gelow, joined the Providence program.
When asked about the parallel announcement on Thursday, Oseran said he did not think OHSU’s restart would have much impact on Providence.
Oseran added that there is no partnership between the two. “Not right now,” he said. “Today is about Providence.”
This is not the first time the Knights have invested in heart transplants. They gave $125 million to start OHSU’s Knight Cardiovascular Institute in 2012. It was the largest donation OHSU ever received at that point. The institute was co-founded and led by Dr. Sanjiv Kaul, who gave up his leadership role at the institute last year after the heart transplant program was put on hold and all the heart transplant cardiologists working under him left. Kaul now focuses on research at the university.
The Knights declined to continue to fund OHSU’s institute after the first infusion of cash.
Oregon patient overjoyed
Karanjeet Samra learned he would need a heart transplant within days of OHSU suspending its program last summer. Providence had referred him to OHSU, only to call and be told the hospital was no longer accepting patients.
Samra was nervous about what would happen. He had been sick awhile and had just been told he could die without a new heart. His family forced him to stay home and rest instead of keeping himself busy at the restaurant they run in Southeast Portland so he had plenty of time to worry.
“It was scary and very disappointing,” Samra said.
Last year, he ended back up at Providence as the hospital stepped up to offer advanced heart failure services to the orphans of OHSU’s program. He received a device in May that will keep his heart running temporarily. After six months, Samra got on the waitlist for a heart at the University of Washington and started to make the three-hour train ride to Seattle every few weeks for check-ups.
Now he is overjoyed that there might be a chance he could get a heart – or even just the intensive after-care in Oregon, rather than staying in Seattle for at least three months with relatives, far from his wife and children.
“They are good," he said, "but it’s so far away from home.”
He might get the call for a heart before either OHSU or Providence are back up and running, which he would be fine with. But he is anxious about the procedure and the travel makes it worse.
“If it’s done here in Oregon, it would be a great relief to me and people like me who are getting after-transplant care here,” Samra said.
Volume is key
When OHSU’s heart transplant program started the first time, it competed against Providence’s at the time. Providence eventually bowed out after company officials found that there wasn’t enough of a patient population in Oregon to justify both programs. It appears the state’s only academic university will again face competition – but this time, Providence could have the edge with a larger staff and the fact it’s currently caring for the former OHSU patients.
Providence officials insist that Oregon needs a resident heart transplant operation. The University of Washington, which has had to absorb Oregon transplant patients, strongly agrees, said Dr. Jacob Abraham, executive director of advanced heart failure in a recent press conference
Volume is key to any transplant program’s success. Abraham said there’s no doubt Oregon generates a sufficient number of transplant candidates -- 30 to 50 a year -- to support a program.
Providence would need approval from both the federal Centers for Medicaid and Medicare and the United Network for Organ Sharing before launching a program. About 2,500 to 3,000 heart transplants are conducted annually in the U.S., far less than the approximately 250,000 people a year who need a new heart. The imbalance is created by the shortage of donor hearts.
Providence must perform 10 heart transplants successfully to earn accreditation from the federal Centers for Medicare and Medicaid. That means that the hospital will likely have to eat the costs of those surgeries and after-care.
OHSU would have to do the same if it went a year without performing a heart transplant. Its announcement on Thursday means that it could squeak in a surgery before that deadline comes up in August.