Satish Nadig, MD, PhD, was recruited to lead Chicago-based Northwestern Medicine’s Comprehensive Transplant Center in 2021.
At the same time, Dr. Nadig, who serves as transplant center director and chief of the division of transplant surgery at Northwestern, told Becker’s he felt as though transplant medicine had “lost its way.”
“I didn’t want to go somewhere to do the same thing over and over again,” he said. “I wanted to be somewhere where we could actually change the paradigm of the field.”
More than three years and numerous record-setting procedures later, Dr. Nadig reflected on his paradigm-changing mission with Becker’s.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: Here are just a few examples of Northwestern’s recent transplant milestones: a liver transplant for a terminal cancer patient, an awake kidney transplant, the nation’s first double lung-liver transplant and ‘lungs in a fridge.‘ What is driving this type of innovation?
Dr. Satish Nadig: Transplant is a very young field, the first transplant ever done was in 1954. That transplant worked because it was on identical twins and there was no need for anti-rejection medication. But, in order to make the field grow, we had to find a way to transplant in people that don’t have identical twins. So between the 1950s and 1980s there was a race to suppress the immune system and make it so that anybody could get a transplant.
Then we had an era of preservation in the ’80s and an era of advancing techniques in the ’90s — and then everything just stopped. Transplant medicine is largely still using all those same anti-rejection, preservation solutions and techniques.
Now, with things like machine perfusion, nanotherapy, robotics and gene therapies, we’re very much in the beginning of what I like to call an era of technology. I personally did not want to be a spectator of this era of technology. I wanted to be able to be in a situation where we, as a group at Northwestern, could be at the forefront of innovation and have a part in changing the paradigm of transplant. That’s the motivating factor.
Q: How does your team ensure quality and safety when navigating these delicate types of transplant situations and unique patient circumstances?
SN: Our program is rooted in two pillars: innovation and quality. We are very much — we have a large, long way to go in transplant.
Much of the standard of care has not been questioned because people were still figuring out how to do the transplant. Parameters were put in place during the time when transplantation was relatively experimental. Now, it is incumbent upon us to make it safer, provide better quality care while also adopting the technologies that exist in our time now.
Two of the ways we are pursuing that are in anti-rejection medication and post-operative care.
While some patients may tolerate a new organ well, they may experience life-threatening complications from side effects of the anti-rejection medication. We are studying situations where patients can come off of anti-rejection medication while maintaining an organ and quality of life. We are also moving toward more outpatient or same-day procedures, so patients do not incur the risks of being in the hospital. Both of those efforts are built in innovation and quality.
Q: What advice can you share with other hospital and health system leaders who are building transplant programs?
SN: Transplantation programs in the country have become siloed and competitive and we need to flip the script. It’s very important that we look beyond the walls of our own institution to expand our own technological opportunities, to look at other high-volume or innovative programs in the country and learn from them. I have no problems sharing what we do with folks, and I have no problems reaching out to folks and learning from them as well.
My biggest advice is to get out of the competitive mindset, which is actually artificially built in. When we focus on transplanting more organs than the center across the street, it becomes like a business and you lose your way a little bit. But if you’re working together and learning from each other, it improves the global aspects of the field.
Q: Can you briefly share your perspective on the rising costs associated with transplant medicine?
SN: I think the onus is on us to reach out to our own community to help them realize that we’re transplanting livers for colorectal cancer, for example. It starts with education, and then leads to a sort of coalescence of our experiences to have a larger voice at the federal level because transplant, in and of itself, is federally regulated. If we want something changed, we have the ear of the government; we just have to band together and make the voice louder.
