Tonya Yvette Moss-Oneal shares a full house with her husband, daughter and two granddaughters, ages 11 and 8, in Northwest Roanoke. She lovingly describes the chaos. Four times a week, some of that energy gives way as Moss-Oneal settles into her chair. For two hours and 38 minutes each session, she sits while the dialysis machine filters and cleans her blood.
Patients usually start dialysis once end-stage kidney failure sets in. The machine filters the blood, removing waste from the system the same way kidneys would when functioning properly.
Some patients survive on dialysis for only a few months, while others do well with the treatment for years. Moss-Oneal, 56, has spent thousands of hours with the machine over the last four years.
“Sometimes I read my book or I’ll find a movie that’ll last at least two hours, or I’ll fuss from the chair at the kids,” she said laughing.
She hasn’t visited her family outside of Roanoke since she was diagnosed with end-stage renal failure in the early days of the COVID-19 pandemic. The thought of hauling her dialysis machine wherever she goes feels overwhelming.
For a while, she held out hope for a kidney transplant through the University of Virginia’s transplant program. But last month, a letter arrived from the health system informing her that her application for its program had been put on hold. Satisfying these additional concerns will put her further back on an already long waitlist.
The UVa letter cited two reasons for the decision. She has a couple of lingering health issues — she needs to quit smoking and lose weight. The second reason is that she lacks reliable transportation.
Her primary care doctor at Carilion Clinic, Dr. Stephen Morgan, told Cardinal News that he has already started helping her with the health challenges. The issues with transportation are the biggest barrier to her getting back into the program.
When she started treatment at UVa, she would take the train from Roanoke to Charlottesville and back. Transportation challenges forced her to cancel some appointments, Morgan said.
What would have made a difference? A transplant program closer to home, Moss-Oneal said.
Carilion’s patients are driving more than 2 hours for transplant care
In early 2024, Carilion proposed launching its own kidney transplant program to serve patients in Southwest and Southside Virginia. Under Virginia’s Certificate of Public Need law, Carilion must demonstrate the need for a service before opening or expanding services.
(Disclosure: Carilion is one of our donors, but donors have no say in news decisions; see our policy.)
Currently, the majority of Southwest and Southside residents travel far beyond the two-hour guidelines set by the state’s administrative code for kidney transplant services. Carilion’s program would put more of the state’s residents within the two-hour proximity to care.
The state’s staff report recommended denying Carilion’s proposal. The decision cited opposition from UVa, as well as a recent state report that detailed issues with contaminated surgical instruments at Carilion Roanoke Memorial Hospital.
Carilion representatives are scheduled to meet Tuesday with staff for the Certificate of Public Need division, where they will argue in favor of reversing the recommendation. Both sides will present their arguments before an adjudication officer, who will issue a renewed recommendation to the state health commissioner in the next few months.
The commissioner will issue a final decision after reviewing the second recommendation.
Half a million more Virginians would be within 2 hours of a transplant center
Fury consumed Moss-Oneal as she read the letter from UVa. She shared the news with her family, then cut the letter up into tiny pieces and threw it in the trash.
Moss-Oneal’s family relies on a car that’s only dependable for local trips — it’s not fit for highway driving. Her husband supports the five-person household with the income he makes as a mover with Allied Van Lines. Buying a new car is out of reach.
The train fare, $13 each way, from Roanoke to Charlottesville eventually strained their budget, Moss-Oneal said. Still, they stretched every dollar to pay for it because her life depends on getting a kidney transplant.
“[Our budget] is really tight. Keeping the children fed, their clothes clean for school, just keeping my house clean, you know? Keeping my body clean. It’s a lot, it really is,” Moss-Oneal said. Her voice changed and she took a deep breath during a recent interview at a coffee shop in Roanoke.
She’s not alone. Southwest and Southside Virginians suffer from chronic kidney disease and diabetes, a leading cause of kidney failure, more than any other region of the state, according to data from the Virginia Department of Health.
Some of the highest rates of kidney disease among Medicare beneficiaries 65 years old and older can be found in these regions: Dickenson County at nearly 34%, Prince Edward County at 33%, and Pulaski County at 32%.
These regions also face significantly higher levels of poverty compared to the rest of the state, according to recent census data. No trains or bus routes touch large parts of the region, especially in Southwest. Transportation challenges cause significant barriers to essential health care in these regions, according to findings from the House Select Committee on Advancing Rural and Small Town Health, which visited three rural communities across Southwest and Southside Virginia in 2024.
A transplant program at Carilion would expand access to these services in Southwest and Southside Virginia. Currently, 92% of the population in Virginia is within two hours’ drive time to an in-state transplant center. Carilion’s program would increase that figure to 97%.
Nearly half a million Virginians, which represents a quarter of Southwest and Southside residents, would gain access to care within a two-hour drive if the expansion moved forward. These residents are currently more than two hours away from a kidney transplant program.
Some counties farther west would still see drive times that exceed the two-hour guideline. Driving from Wise County to Roanoke takes about two hours and 40 minutes. The trip from Lee County takes about three hours and 20 minutes, an improvement compared to the nearly five-hour drive to get to Charlottesville.
‘It just weighs on you’
Morgan, Moss-Oneal’s primary care provider, knows the kidney transplant system all too well. His own wife struggled with kidney disease for more than a decade before dying from the illness. He remembers the grueling drives between transplant centers while his wife sat in the passenger seat, too sick to drive herself. As her caregiver, Morgan relied on a compassionate employer who allowed him the flexibility to ensure he could take her to appointments.
Even with more resources than Moss-Oneal, Morgan and his wife struggled with the constant travel.
“I was blessed that my employer was very understanding of the commitment that this took. I had to rearrange my schedule a lot of times. And then having [my wife] feeling ill, it just weighs on you.”
He regularly added an hour to his drive time just to find parking and navigate the sprawling hospital campuses.
In addition to going to UVa, Morgan and his wife frequently traveled to Wake Forest Baptist Medical Center in North Carolina. Transplant patients are encouraged to seek evaluations at multiple centers, according to the Organ Procurement Network. It can increase their chances of receiving a kidney sooner, but for people like Moss-Oneal, traveling to multiple centers isn’t an option.
Reliable transportation is a universal expectation at every transplant center, Morgan said, and Carilion will have one, too, if the proposal is accepted.
“It’s just that Carilion has a lot of patients that have end-stage renal disease that have to drive a long way, and we have no way of knowing how many of them don’t even have the opportunity to get care,” Morgan said. “We have patients that have difficulty even getting to dialysis centers because of transportation.”
Moss-Oneal didn’t cry when she opened the letter from UVa, even though she describes herself as a sensitive person. She only felt rage when the letter offered no guidance on solving her transportation issue, despite UVa having a program to support transplant patients with financial, lodging and transportation needs. Her primary care physician in Roanoke is working to identify transportation options for her as he also manages her ongoing health challenges.
UVa doesn’t have specific criteria for transportation, but it does include the expectation that patients can reliably attend follow-up appointments, which are critical for transplant success, Eric Swensen, a public information officer with UVa, said by email Friday.
“Due to the lengthy waitlist for organ transplants, the UVA Health Transplant Center works carefully to give every transplant recipient the best chance for long-term survival and a full life with their donated organ. This includes evaluating a patient’s ability to manage their health and follow their care team’s instructions both before and after their transplant. This is critical because a patient’s immune system is suppressed following a transplant, making them more susceptible to a range of diseases,” Swensen said.
Dozens of cities, counties and organizations support Carilion’s request. One health system doesn’t.
Patients who have already traveled time and time again are speaking up on Tuesday, this time to tell their stories to support Carilion’s proposal.
Carilion received at least 1,500 responses from the community in support of the program since launching an online campaign in August 2024. Many letters described personal experiences about living with kidney disease in rural Virginia, said Hannah Curtis, a media relations representative for Carilion.
More than 20 community organizations have submitted letters endorsing the proposal. Sixteen cities and counties have voiced their support for the program.
Virginia Commonwealth University in Richmond, which operates its own kidney transplant program, has agreed to partner with Carilion to provide necessary screening and lab work for the program.
“An additional transplant center in the state would not make more kidneys available for transplants for the people of Southwest Virginia. Instead, those transplants would be divided between what would become two smaller transplant programs. As those national studies have shown, smaller transplant programs have worse patient outcomes,” Swensen said.
UVa performed 76 kidney transplants in 2022 on patients from Carilion’s coverage area — patients who might have received care at Carilion if the health system had a transplant program.
Carilion expects to perform only 10 kidney transplants in its first year. It would increase to 30 transplants in its second year, according to its proposal to the state.
Many of the resources tied to organ transplants, such as in-person support groups, are concentrated near the health systems that provide organ transplant services — meaning more drives of three or four or five hours would be necessary for the people of Southwest Virginia to continue to get the full benefits of a transplant.
Tonya Yvette Moss-Oneal feels the weight of that travel, even while sitting still in her chair while her blood runs through the machine that helps keep her alive. While she’s come across some online support groups, it’s not the same as the connection felt from meeting in person. The past year has been particularly painful for her, as she endured the loss of her mother, who died during dialysis treatment of her own.
“I try to keep from crying all the time. I’m real sensitive,” Moss-Oneal said. This time, she does cry. For herself, and others in her situation. “I love God’s people.”
The only time she can grieve for her mother and her own health is when the kids are at school and her husband is at work. She sits alone in her chair while the dialysis machine filters her blood, and she grieves in solitude.
