Carilion Clinic on Monday announced plans to launch an adult kidney transplant program at its Roanoke Memorial Hospital. It would be the first organ transplant service to be offered at Carilion and the first in Western Virginia.
Pending state approval, a tentative start date has been set for October.
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There are about 5,000 people in Southwest Virginia with advanced kidney disease, more than any other region in the state, said Dr. David Salzberg, general surgeon and director of metabolic and bariatric surgery at Roanoke Memorial.
When kidneys function poorly, the patient is eventually put on dialysis, a procedure that diverts blood to a machine, which then removes waste products and excess fluid from the body. Dialysis is time-consuming — patients must either visit a center or, in some cases, perform a procedure at home three times a week for three- to four-hour sessions — and is one of the most expensive treatments a hospital can support, Salzberg said.
“Think of the prices that are associated with having to go to the doctor, having to go to dialysis three times a week, having to sit around, leading to absenteeism at their actual job,” he said. “We can literally change the life of the hospital, the doctors that are treating these patients, and most importantly the lives of the patients. All in one shot. All in one night.”
Salzberg has been with Carilion for about 10 years, performing minimally invasive bariatric surgery and general surgery. He is trained in abdominal organ transplant surgery and will lead the program as it moves forward.
There are seven transplant centers in Virginia, but none serving the western part of the state. Currently, patients must travel two hours or more for transplant surgery — either to Charlottesville, where the University of Virginia has a kidney transplant program, or to Wake Forest Baptist Medical Center in Winston-Salem, North Carolina.
This, Salzberg said, is unacceptable. In Carilion’s service area, the need for kidney transplants is expected to grow by more than 25% by 2025 and by 32% each year in the next 10 years, according to a press release distributed by the health care system.
“If we stand by our commitment to the community, we need to address the problem. And that is a pillar of Carilion, and the problem is addressed by solid organ replacement. That involves the genesis of a kidney transplant program. That’s why we’re here,” Salzberg said.
Carilion last week submitted an application to the Virginia Department of Health’s Division of Certificate of Public Need, which is a legal requirement for new health care services in the state.
Staff there will now determine if the request is complete. Requests must include a considerable scope of data and documentation that describes and supports why the service is needed, according to an overview of Virginia’s certificate of public need program by Sands Anderson, a law firm that serves government entities and health care organizations.
If the application is deemed complete, a 120-day review cycle by the state will begin. It takes about six months to complete the process from the day that the request is received.
Organ transplant care is multidisciplinary and will touch nearly every specialty at Carilion. At the moment, Salzberg is the only surgeon who will be performing the transplants, but another will be hired if the program progresses. It will also create jobs for more nurses, social workers and pharmacists, Salzberg said.
In preparation for the review process, Carilion applied for membership with UNOS, a national transplant and procurement allocation organization.
“It’s a long process, and it’s completionist to a fault on purpose. … We need to show that we’ve done our due diligence to show that we are responsible as a transplant program,” Salzberg said.
But Salzberg feels confident that the state will approve the program.
“We certainly have a need for it. They should recognize that,” he said.
In 2023, the University of Virginia transplant program performed more than 200 kidney transplants for adults and pediatric patients, according to spokesperson Eric Swensen. UVa’s Charles O. Strickler Transplant Center is the only comprehensive adult and pediatric transplant center in the state and recorded 30,000 clinic visits during the same timeframe.
“A substantial number of our patients come from southwest Virginia, leading us to establish outreach clinics in Roanoke, Martinsville and Lynchburg. This thoughtful approach ensures that our patients receive the necessary care closer to their homes,” Swensen said over email.
Between cultural ideas around health care and limited options for services, people living in rural communities often present with higher acuity diseases, and the same is true in Southwest Virginia.
“Our community is one that is much more independent than most. Our patients know how to take care of themselves and handle their own problems. They’re actually quite savvy at it,” Salzberg said.
But the delay in accessing care can lead to an increase in high blood pressure, diabetes, heart disease and high cholesterol, which are ubiquitous in the U.S., but when untreated can result in chronic issues, such as kidney failure.
Providers in Salzberg’s line of work expect renal failure to go up by 10% nationally in the next 10 years.
“That is a clinically significant number. And seeing how we barely scratch the ice on renal disease and transplantation in 2024, that represents a hill to climb. And we need to get started.” Salzberg said.
Anyone interested in receiving updates about Carilion’s plans for a kidney transplant program can email transplants@carilionclinic.org to stay in touch.