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1M organ transplants - what comes next?

The director of the Hume-Lee Transplant Center reflects on the milestone of 1 million transplanted organs in the U.S. and what’s next for the world of transplantation.

Dr. Marlon Levy

In September 2022, the United States reached 1 million organ transplants. Far outpacing other countries with this accomplishment, the demand for transplants still drastically outweighs the supply. Currently, the national organ waitlist is over 100,000 people and many die on the waitlist.

To learn more about how VCU Health’s Hume-Lee Transplant Center is working to meet this demand and what’s next for the future of transplants, we sat down with Dr. Marlon Levy, chief medical officer at VCU Medical Center and director of the transplant center.

How has transplant care evolved over the last 20-30 years?

For over 30 years, I’ve witnessed the growth of the transplant field firsthand. One of the biggest changes is how mainstream transplants are compared to 30 years ago. When someone has organ failure, the most desired approach is transplant because people know and trust the transplant technology, though this wasn’t always the case.

There’s also a significant increase in the awareness that not everybody is being treated equally or given the same access when it comes to organ transplants. Minority patients, rural populations or those who are socioeconomically disadvantaged do not always have the access that others have. This continues to be a very important conversation in the transplantation and organ failure world.

Thinking about the 1 million milestone, can you tell us about the reach of Hume-Lee’s transplant program?

At Hume-Lee, we have roughly 20,000 to 22,000 clinic visits a year, and we transplant about 500 organs each year. Out of 120 liver transplant programs in the country, we are ranked No. 6 by volume. Out of 256 kidney transplant programs in the country, we are ranked in the top 10% by volume.

Patients come to us from all over the United States, and Hume-Lee has become a national destination for exceptional transplant care.

How is the Hume-Lee transplant center working to bridge the gap between the need for transplants and the demand?

We are doing this in a few ways. One way is through our living donor program. Living donation is the transferring of an organ from a living person to someone in need of a transplant. We have two living donor programs — our living kidney program and our living liver donor program — that work to increase access to our patients.

We also participate in kidney exchange, known as “swaps.” A paired kidney exchange occurs when a living kidney donor is incompatible with their recipient, but does match with another person on the waitlist. For example, if there were two donor/recipient pairs, Donor and Recipient A and Donor and Recipient B. Donor A would give a kidney to Recipient B. Donor B would then give a kidney to Recipient A. This paired kidney donation transplant enables two incompatible recipients to receive healthy, more compatible kidneys and provides increased transplant opportunities for patients on the kidney waitlist.

Finally, we consider organs that may not be considered by other transplant programs. For example, we have helped pioneer the use organs from people who've had Hepatitis C. In the past, those organs were not used because there was concern that the infection would spread. However, recent studies have shown that organs infected with Hepatitis C can be safely transplanted with medicine that removes Hepatitis C. We're really trying to push the boundaries of knowledge to do things safely and to get more people transplanted.

What’s in store for the field of transplant in the next 10 years?

I think we’ll have a better understanding of organ preservation and how to make organs work. A great example are the Hepatitis C organs I mentioned earlier. I think we’ll be able to make more organs viable for transplant in the coming years.

There’s also a lot of emerging technology that I am excited about. One example is normothermic organ preservation. This is when organs that will be transplanted are pumped with warm and reoxygenated blood in an effort to re-create the same type of environment that the organ will be transplanted into. This procedure enables prolonged preservation of the organ — allowing more flexibility on the timing of transplant operations and many other positive outcomes.

Looking down the road even further, I’m excited about the advancement of xenotransplantation — being able to use an organ from an animal that's been genetically modified so that it could be used in humans. With new gene editing techniques and a better understanding of the immunology of the animals compared to the immune system of human beings, we’ll continue to see advancements in this area.

Is there anything else that you’d like to add?

Whenever I talk about transplantation, I never miss an opportunity to highlight the incredible generosity of the organ donor — whether it's somebody who has died and the family donated their organs or it's a person who wants to become a living donor in order to save a life. It's simply amazing, and we never, ever take it lightly.

The need is still there and it’s real. Even with the success of the one millionth transplant, the gap between supply and demand continues to grow. And that's why we have to be relentless about understanding how to make things better and continue to improve our work each and every day.

For more information about the Hume-Lee Transplant Center, visit /hume-lee-transplant-center.