Chicago-based Northwestern Medicine has built one of the country’s most ambitious transplant programs. Whether performing the first double lung-liver transplant in the U.S., eliminating all traces of colorectal cancer for a terminal patient through a liver transplant, providing an anesthesia-free kidney transplant or developing a lung transplantation method specifically for COVID-19 patients, innovation is infused into every aspect of care.
“If history looks back on Northwestern Medicine during this era of transplantation and says, ‘Wow, they did a lot of transplants,’ of course we’ll be happy. We saved a lot of lives,” Satish Nadig, MD, PhD, chief of organ transplantation, told Becker’s. “What would make us happier is if history looked back and said, ‘Northwestern changed the paradigm of transplant.'”
He and Ankit Bharat, MD, chief of thoracic surgery, spoke to Becker’s about their mission for the transplant program and how they plan to maintain a steady push against one of their biggest rivals: time.
‘Solution-based innovation’
Besides providing quality care at scale, Northwestern’s transplant program operates under a thesis of innovation. That thesis has become mission-centric, from the C-suite, to nursing, to administrative support teams, Dr. Nadig said.
Dr. Bharat told Becker’s the program’s focus on innovation moves beyond novel treatments and technology.
“We take the most pride in trying to formulate solutions for problems that don’t have a solution right now,” he said, calling the system’s strategy a “solution-based innovation approach.”
An example of this approach comes from the COVID-19 pandemic. While Dr. Bharat and his team implemented the conventional treatment at the time, they continued to search for a more effective solution. The team discovered that, in the early days of the pandemic, the COVID-19 virus was destroying the fundamental structure and framework of the lung. The damage was occurring in such a way that the lung could never recover or be repaired.
“That gave us the idea that we should be doing lung transplants,” he said. “Patients were coming from all over the world to us because we were the only center doing lung transplant.” Their findings were published in Science Translational Medicine.
That experience helped push the boundary on another transplant innovation. In the last three years, Northwestern Medicine has performed 80 transplants on patients with lung metastases of cancer with 100% survival.
“If you can clear the disease outside the lungs and then replace the lungs, you can potentially cure a stage 4 patient,” Dr. Bharat said. “It goes back to our solution-based innovation approach.”
‘Where the real race is’
Programs of all sizes contend with time. But for Northwestern specifically, “time” does not necessarily mean the period between donation and transplantation.
Northwestern’s transplant program has developed perfusion and refrigeration technologies, as well as assembled transplant-focused teams who are available 24/7, which together have widened the donor pool, improved scheduling capacities and extended organ storage windows. Being centrally located has its benefits too, allowing the program to offer organ procurement services to programs across the U.S.
For Northwestern, the clock begins ticking after transplantation.
“What we’re racing against is this idea of tolerance: the ability for patients to withstand the organ without the need for systemic anti-rejection medications,” Dr. Nadig said. “That’s where the real race is. It’s not time, minute by minute, but how do we get these organs to last as long as possible, if not forever?”
While the program has made great gains toward having fewer patients on anti-rejection medications — which often cause more problems than the transplant itself — Dr. Nadig said he believes organ rehabilitation will be the next transplant “mountain” to climb. He envisions a future in which marginal organs are “pre-treated” and made transplantable.
A field built on hope and trust
Other headwinds facing transplant programs in the U.S. are public perception and regulatory policy.
Dr. Nadig said misinformation surrounding transplant procedures in the media is a threat to a field built on trust and dependent on compassion.
“Some press talks about donors going to the operating room while awake, which is normal for a particular type of donation called donation after cardiac death,” he said.
Donation after cardiac death, also called donation after circulatory death, occurs only when a family has withdrawn care for a patient who wanted to be an organ donor and may not meet full brain death criteria, but whose quality of life would not have been sustainable or in line with the patient’s wishes on how they wanted to live.
“It is a very difficult process to explain, but it is a reality for us,” Dr. Nadig said. “[This] type of donor has allowed for over 10,000 donations to be realized and that many lives saved in the last year — more than any other time in the history of transplantation.”
Dr. Bharat similarly highlighted the challenge transplant programs experience when trying to pursue innovation without taking appropriate risks.
“We have a regulatory environment that’s extremely risk averse, and for good reason, but it’s so stringent that if a program has even one or two adverse outcomes, it could get shut down,” Dr. Bharat said. “Some institutions will not accept a patient deemed too high risk because if the patient dies, it counts toward their mortality
When programs feel unable to take risks, patients do not benefit and the field does not move forward, he added.
“If I could advocate for one thing at the policy level, it would be a safe, structured pathway for clinical innovation in transplantation that doesn’t penalize programs for doing what might help advance care,” Dr. Bharat said.
Both leaders emphasized how Northwestern’s biggest goal is to be a destination of hope.
“If someone is not able to have a second chance at life somewhere else in the country, they should be thinking, ‘I wonder if we can go to Northwestern and get it done,'” Dr. Nadig said. “That’s already happening, and we’re feeling it.”
