Following a record 328 organ transplants last year, the Methodist Transplant Institute isn’t resting.

The institute is expanding its donor service area and focusing on harder-to-place organs. 

“The biggest impact has been to the kidney transplant program,” said Gayatri Jaishankar, the institute’s senior director. “Previously, there was a defined geographic area from which the donor pool was consistent within that geography area. So, any center could only access the organs procured within that specific geographic area.”

New director officially takes the helm at Methodist Transplant Institute

Organ procurement organizations are nonprofits responsible for recovering organs from deceased donors for transplantation.

“The organ procurement organization identifies the donors, who are the source of organs,” said Dr. Jason Vanatta, medical director of the institute. “The more donors you have, the bigger your supply.”

There are 56 organ procurement organizations nationwide, each mandated by federal law to recover organs in their assigned donation service area.

But Vanatta said the boundaries of the donation service areas were arbitrarily drawn many years ago, which resulted in organs leaving the state.

“We were able to grow by utilizing the resource that was already here that the state was exporting,” he said.

The United Network for Organ Sharing, the nonprofit that manages the U.S. organ transplant system, said a patient’s hospital location is strongly associated with disparities in timely access to deceased donor kidney transplants.

And it’s largely the result of inconsistently drawn local and regional boundaries historically used in organ allocation. 

Since logistical considerations differ in some parts of the country, and some organs travel by ground while others are transported by air, UNOS changed the policy in 2021 to a model that includes nautical miles. 

“It went from the small area which varied by size, did not have anything to do with the number of viable donors, and was completely inequitable in distribution, to a model that depended on where the transplant program is and how close they are to a donor hospital,” Jaishankar said.

“So now we have 250 nautical miles in and around the transplant program, and if you have a recipient who matches with a donor that becomes available within that area, then that organ becomes available to you.”

In liver patients, the sickest are those with the highest Model for End-Stage Liver Disease score, or MELD Score, a number used as a predictor of survival in patients in need of liver transplants. 

“But if you are sick enough for a transplant, but not as sick as to be on the top of the waitlist, then you have to wait your turn to deteriorate and get an organ,” Jaishankar said. 

Those patients could be candidates to receive hard-to-place organs. 

“These organs could be hard to place for a number of reasons, but many times they are organs that could be of an advantage to a particular patient, so it really depends on each patient,” Jaishankar said. “You have to really evaluate the organ and why it is considered hard to place.”

Vanatta, who’s the endowed chair for Excellence in Liver Transplantation at the University of Tennessee Health Sciences Center, said reasons a liver could be deemed harder to place include fat in the liver, an injury to the liver from a trauma or blood vessels that are smaller or contain calcium deposits.

And 15-20% of livers will have abnormal anatomy because of the way they developed, he said. 

But specialized surgical techniques, such as reconstructing arteries, can resolve some of the issues associated with hard-to-place organs. 

“That’s taking advantage of these organs other people don’t want to use,” Vanatta said. “It’s what’s called a transplant rate. The patients will be put on the list and transplanted at a much quicker rate here than at other places.” 

Methodist said its transplant institute is one of the highest- performing centers in the country in terms of low waitlist mortality and speed to transplant of livers. 

“There’s more technology supporting the success of these organs, and surgical skills being developed for successful transplants for these organs,” Jaishankar said. “Transplant is a major surgery, and there’s always risk. But at our center, we have been very successful with the transplant of hard-to-place organs.”

View Gallery

Donation after circulatory death is another reason an organ can be harder to place. According to the National Kidney Foundation, this means that organs and tissues are recovered and offered for transplant after circulatory and respiratory functions have stopped and a physician pronounces the donor dead. 

This can happen when a patient is removed from life support because they’re not expected to recover. 

“When you have patients who are younger or who are sick but not extremely sick or patients that have a blood type that’s going to make them wait for a prolonged period of time, these patients can go on to get a transplant faster and have a healthy, more productive life faster,” Jaishankar said. “Because you have to keep in mind that if you delay the transplant, they are getting sicker.” 

In the past five years, the institute has accepted and transplanted 104 hard-to-place organs. Of those, 96 patients have livers that are still fully functioning today, which represents a 92% success rate.

“Whether it’s our transplant center or some other transplant center, trust your transplant physician,” Jaishankar said, “because we would only recommend a treatment option to a patient when we know that they will have the most success with it.”