The achievement is not an anomaly but the result of a yearslong coordinated effort led by David DeNofrio, MD, director of heart failure network development at Tufts Medical Center.
Dr. DeNofrio spoke to Becker’s about why and how Tufts heart transplant team keeps setting records.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What factors have contributed most to this continued success?
Dr. David DeNofrio: Our team has put many years of hard work into developing our program.
We set out many years ago to develop a shared care model through partnerships with cardiologists and primary care physicians in the region. First, keeping as much of our patients’ care local and letting our patients continue to be cared for by their local physicians and hospitals is a real win for patients. Second, supporting local cardiology teams and hospitals, to continue to take care of their patients. Even though they’re not able to do transplants or more advanced heart failure surgeries, they’re able to provide a lot of the initial pre- and postoperative care.
Patients just don’t fall out of the sky. To continue to have a flow of patients into the system, you need to develop a great referral base and network throughout your region.
Q: How does Tufts strengthen relationships with referring providers?
DD: You need to have good communication with your referring providers and keep them involved with the care of patients that they send to you all along the way. We’ve been able to do that over the last 20 years that I’ve been here at Tufts. We’ve been a little bit more successful each year, until we finally hit a threshold where most people now see us as a center of excellence for providing advanced heart failure care.
Q: What are the biggest challenges facing heart transplant programs today, and how is Tufts working to overcome them?
DD: Clearly for us, growing so much over the last few years, doing up to 70 transplants last year — which put us 13th in the country in volume for heart transplantation with great outcomes — that puts a big strain on resources and capacity in terms of being able to provide for that large increase in patients.
When we talk about volume and capacity, we’re talking about both the inpatient and outpatient side. If we’re doing 60 to 70 transplants a year, we’re doing about 200 transplant evaluations. That’s a lot of patients that need to get into the system.
We’ve been able to manage those challenges pretty well so far by hiring new heart failure physicians to support the growth of the program.
We also rely on nurse coordinators, who do what’s called referral and network management. Besides coordinating patient referrals, these nurses also stay in communication with the referring provider every step of the way, updating them on their patients’ progress.
Q: How does the program leverage advancements in organ procurement, preservation and transport logistics to expand access to donor hearts?
DD: There have been a lot of changes in transplant that have contributed to an increase in the number of transplants being done nationwide and we’ve clearly benefited from that.
One is that we’ve developed a routine process now of accepting hepatitis C donors, which years ago, we would have never done. There has been an expansion of taking good donor organs, even if they’re hepatitis C positive, putting the organs into hepatitis C-negative recipients and treating those recipients with these new antiviral medications.
The other big thing has been the expansion of donors through donation after cardiovascular death. A heart is procured after the donor dies. The heart is then resuscitated, and using machine perfusion technologies, the heart can stay viable for many hours for up to 12 hours outside the body. This allows transplant teams a wider geographic area to travel for donor hearts. This has increased the number of available hearts by about 30%, though some estimate it has increased the donor supply by about 50%.
Q: What trends are emerging in heart transplant care that hospital and health system leaders should be paying attention to?
DD: With the new priority allocation system, where sicker patients are getting hearts before less sick patients, most of our patients now are on support and waiting in the ICU up to several weeks for a donor. Additionally, most of our donors are now coming from out of the region.
The increase in length of stay and the greater distance we go for organs now has increased the number of transplants we do, but it’s also increased the cost. The cost of doing transplants will continue to be a challenge for at least high-volume transplant hospitals.
