Carilion Clinic has received state approval to launch its long-awaited kidney transplant program at Carilion Roanoke Memorial Hospital, following months of uncertainty.
The hospital first announced the new service in January 2024 and hoped to begin accepting patients by that October, confident that approval would come quickly. The state’s Certificate of Public Need Division initially recommended a denial, leading Carilion to gather hundreds of testimonials and testify at a hearing.
Carilion’s kidney transplant program will be the first of its kind in Southwest Virginia. Until now, the University of Virginia Medical Center in Charlottesville, located about two hours away from Roanoke, has been the westernmost transplant center in the state.
Now, with the approval from the state, Carilion will start the application process with the United Network for Organ Sharing, or UNOS, a nonprofit that manages the national organ transplant system, said Dr. David Salzberg, the surgeon who will direct the program at Carilion.
The hospital needed permission from the state before it could formally apply to the organ sharing network, he said.
“We’ve already started that process, of course, just like we’ve already started everything else. This took a massive amount of preparation just to get to this point,” Salzberg said.
Carilion expects to start providing kidney transplant surgeries in 2026.
[Disclosure: Carilion is one of our donors, but donors have no say in news decisions; see our policy.]
During a media event about the announcement on Thursday, Salzberg said he didn’t know how many procedures the hospital would complete in its first year. Carilion’s proposal to the state division said that it projects it will perform 10 kidney transplants in the first year of operations and 30 kidney transplants in the second year.
Salzberg has been with Carilion for about a decade, serving as a bariatric surgeon and head of Carilion’s Weight Loss Center. He completed a fellowship in organ transplants in 2007 with Virginia Commonwealth University.
Dr. David Cronin, who will serve as a second transplant surgeon, was recently recruited to Carilion. Previously, he practiced as chief of surgery at Salem Veterans Administration Medical Center.
More than 5,000 patients in Southwest need kidney care
Data from the Centers for Disease Control and Prevention shows that chronic kidney disease cases among Medicare beneficiaries 65 and older in Virginia are highly concentrated in the Southwest and Southside regions. That concentration is expected to grow.
Carilion’s letter of intent cited projections that the region’s over-65 population will grow by 45% between 2020 and 2030 — far outpacing the statewide average of 26%.
Adding to the burden, the region has the highest adult diabetes rate in the state, at 15.4%. Danville, in particular, reports the highest diabetes prevalence in Virginia, according to County Health Rankings. Diabetes is one of the leading causes of kidney failure.
According to Salzberg, 5,000 to 6,000 patients in Southwest Virginia currently have kidney failure or are approaching it.
“That’s a big number. That means a lot. But what means more is the exponential increase over the next coming years. So over the next 10 years, that number will, if not double, triple, possibly even more,” he said.
Closing the distance to transplants
A key point in Carilion’s case was a guideline in Virginia’s State Facility Plan stating that all residents should live within a two-hour drive of a kidney transplant center. Many in far Southwest Virginia must travel at least five hours to reach the University of Virginia Medical Center, the state’s westernmost transplant provider.
Adding transplant services in Roanoke cuts travel times down to around two hours for most people living in Southwest Virginia. While patients in the far western areas, such as Grundy and Wise, still live beyond the two-hour drive, the new center will bring them significantly closer than their current five-hour trip to Charlottesville.
“[The distance] means so much more than what it seems on face value,” Salzberg said. “It’s not just the full tank of gas that it costs and the time off for a day of work. It means a number of things. It means them being able to continue their care without interruption. … But you know what else it means, when they get that call for a kidney, many people here have trouble getting to the clinic in the middle of the day on a regular day when we’re here in Roanoke. Imagine having to go six hours in the middle of the night.”
UVa was an outspoken critic of Carilion’s proposal. In its opposition letter, which played a key role in the initial recommendation for denial from the state division, UVa argued that the Carilion program would not enhance access to transplant surgeries. Instead, the primary barrier to care is the number of available organs, it said.
Once Carilion’s program is running, Salzberg said he hopes more living donors will become interested in donating.
“It’s hard to encourage a living donor from a distance, right? But when you see it happen right in your backyard, absolutely. And living donation is a very safe, very effective way to decrease the transplant pool,” Salzberg said.
UVa argued that placing a transplant center so close to its own would significantly threaten its staffing, disrupt its educational and research missions, and undermine the sustainability of its related transplant services. The university also claimed that Carilion’s program would rely on drawing patients away from UVa.
According to a report from the state division, UVa performed 181 kidney transplants in 2021. Of those, 66 patients were from Southwest Virginia.
Following the state’s decision to approve Carilion’s program, UVa has withdrawn its opposition. In a statement, the university said it looks forward to continuing its collaboration with Carilion.
“We recognize and respect the Virginia Department of Health’s thorough review process and their demonstrated commitment to ensure high-quality healthcare is delivered safely throughout Virginia. VDH’s approval reflects Carilion Clinic’s dedication to expanding care options for patients in Southwest Virginia,” the statement said.
UVa operates four outpatient support clinics for organ transplant across the Southwest region with locations in Lynchburg, Martinsville, Roanoke and Wytheville, which is the most recent addition.