How an Arizona hospital added heart transplant services amid a pandemic: Q&A with Dr. Francisco Arabia

Early this year, Banner-University Medical Center Phoenix added heart transplants to its program for treating advanced heart failure. As the COVID-19 outbreak grew into a pandemic and cases began to surge in the U.S., the program has continued to provide these lifesaving treatments for its patients.

Francisco Arabia, MD, physician executive of advanced heart failure and mechanical circulatory support at Banner-University Medicine Heart Institute in Phoenix, spoke with Becker's Hospital Review about how the hospital added heart transplantation to its suite of services, the ways in which the pandemic changed its protocols and what the hospital told nervous patients.

Editor's note: The following responses were edited for length and clarity.

Q: What was the process behind adding heart transplantation services?

Dr. Francisco Arabia: Conversations regarding the need for a transplant program at Banner- University Medical Center Phoenix started in 2015. An analysis of the need for an advanced heart program in Arizona revealed a need for a program that encompasses prevention, advanced medical management, ventricular-assist devices, artificial heart and heart transplantation. Banner's approval for the heart transplant program was secured in early 2019. A consultant came on board to help write all the policies and necessary protocols for heart transplantation. The left ventricular-assist device and artificial heart program was rapidly expanded.

Organizational meetings took place regularly for six to eight months with different hospital departments that would be involved. These included: pharmacy, blood bank, cardiac rehab, nursing, operating room, admissions, anesthesia, surgery, nutrition and many more. Several didactic sessions were prepared for all those involved.

The heart transplant program received approval from United Network for Organ Sharing in late December 2019. Patients with advanced heart failure started to be evaluated for transplantation in January. The first transplant took place in February.

Q: When the first transplant was performed, the pandemic was in its very initial stages. How did the initial plans for the implementation of heart transplantation services change when COVID-19 cases started spiking across the country?

FA: The pandemic did not delay or mitigate the start of the program. We encountered patients in heart failure whose advanced therapies could not be delayed. The first transplant was performed as the pandemic was starting. For all the subsequent patients, tests were performed to rule out COVID-19 on the recipients and donors before transplantation. After the procedure, the patients were placed in isolation for the duration of the hospitalization. Visitors are still not allowed.

Q: What did Banner-University Medical Center Phoenix tell patients who required heart transplants but were nervous about COVID-19?

FA: The advanced heart failure team communicated to patients all recommendations made by Banner Health following CDC and Arizona Department of Health recommendations regarding face masks, social distancing and how outpatient visits would be done. Donor Network of Arizona (the local organ procurement organization or OPO) and out-of-state OPOs started testing all donors for COVID-19.

Only COVID-19 negative donors have been utilized. We communicated this information to the recipients prior to transplantation. Patients understood the need to move forward with transplantation because of how sick they were.

Q: How is the hospital handling its burgeoning heart transplantation program now that Arizona is seeing a surge in coronavirus cases?

JA: We continue to follow all precautions and testing. We implemented recommendations from CDC, International Society for Heart and Lung Transplantation, Arizona Department of Health and Banner Health. This practice will continue indefinitely.





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