Joey Shervey’s wife reached out a comforting hand to soothe her husband as he told a state employee about his harrowing journey with kidney failure. Shervey is 28 years old.
This trip, one of hundreds Shervey and his wife have made related to his disease, was different — this time, he came as an advocate.
On Tuesday, Carilion Clinic defended its proposal to establish a kidney transplant program at Carilion Roanoke Memorial Hospital — a proposal that was recommended for denial by staff with the state’s Certificate of Public Need division.
The staff report cited an opposition letter from the University of Virginia, the only health system to oppose the proposal. The report also pointed to previous issues with stained surgical instruments at the hospital, which Carilion addressed. The Virginia Department of Health signed off on the action plan.
Shervey was one of eight witnesses who spoke in favor of Carilion’s proposal during a four-hour hearing before the division.
Shervey was 26 and living in Roanoke when he went to the doctor with a bad cough. He came home with an appointment to see a nephrologist, a kidney specialist, the next day. He was immediately diagnosed with Stage 5 kidney failure.
“My nephrologist said I needed to be on dialysis yesterday,” Shervey said.
Jessica and Joey Shervey have only been married since August, but Jessica made the decision to be a caregiver for her husband since he entered the transplant program at UVa.
Her time commitment was immense. She attended all of his pre- and post-operative appointments and drove Joey to UVa and Wake Forest Baptist Medical Center in North Carolina to increase the odds of finding a kidney.
He lost his job, and now the couple hardly has any income. Just a few months after his kidney transplant, they’re living with Joey’s parents at Smith Mountain Lake.
“I’ve become the person I did not want to be. I am a 30-year-old man living in my parents’ basement. That’s not the goal I want to set for my future family,” Shervey said.
Twice-weekly trips to Charlottesville
UVa operates three outpatient clinics for transplant patients across Southwest Virginia: in Roanoke, Martinsville and Lynchburg.
In its opposition letter, UVa stated that transplant candidates are able to access 90% of pre- and post-operative care at these sites.
Shervey visited UVa’s satellite clinic in Roanoke before he entered the transplant program in 2023, but since then, all his appointments have been at the main campus in Charlottesville.
He drove to Charlottesville twice a week for appointments for a while, he said during his Tuesday testimony.
These appointments required him to have his blood drawn before taking his morning medications, and the timing of those medications was critical. So most of his appointments were early in the morning.
Shervey would have had to pay for a hotel for every visit if it weren’t for friends who lived 45 minutes away from Charlottesville. He and his wife stayed the night with them many times.
He was fortunate to find a kidney from a living donor, which increases life expectancy by about 15 to 20 years, compared to a donation from a deceased donor where the life expectancy is seven to 10 years.
He’s likely to need two more kidney transplants later in his life.
A debate over donor organs
UVa argued in its opposition letter that the primary barrier to organ transplant surgery is not the distance to a transplant center but the limited availability of donor organs.
Dr. Marlon Levy disagrees.
Levy is the chief executive officer at Virginia Commonwealth University Health System and senior vice president for VCU Health Sciences. The transplant center at VCU is one of the largest in the country.
Many kidneys from deceased donors, about 35%, are never used, Levy said.
“Sometimes it’s because of organ quality. Sometimes it’s because of geography that prevents the organ from being transferred to the organ center. Sometimes it’s because the surgical teams are too busy to accept another organ,” Levy said during the hearing.
In recent years, VCU Health has seen a significant increase in the number of solid organ transplants performed. It has expanded its capacity and expertise to meet growing demand, offering advanced care for patients requiring kidney, liver, pancreas and other organ transplants. The center achieved this by committing to cutting-edge surgical techniques and post-transplant care, Levy said.
“We deployed additional surgeons so you never get caught without a surgeon that wasn’t rested and ready to go,” Levy said.
The Richmond-based health system has agreed to partner with Carilion to provide necessary screening and lab work for the program.
Carilion has procured more donated organs from deceased kidney donors than any other system in Virginia over the last three years, said Dr. Arnold Salzburg, who will serve as the director of the kidney transplant program at Carilion. Those organs, however, are sent off to other centers for transplantation.
Questions about qualifications
Carilion has already made significant investments in building a kidney transplant program in Roanoke. The system has brought on transplant surgeons, nephrologist partners, coordinators, social workers and other essential staff, Salzburg said.
However, UVa has questioned the qualifications of Carilion’s team, specifically Salzburg.
For the past decade, Salzburg’s focus has been on bariatric surgery at Roanoke Memorial, where he is the director of metabolic and bariatric surgery.
The Organ Procurement and Transplantation Network offers guidelines for organ transplant programs, suggesting that surgeons have experience with solid organ transplants within the last two years. UVa cited this resource in its opposition letter.
A Carilion lawyer said at the Tuesday hearing that Virginia law does not require health systems to follow recommendations set forth by OPTN.
There are two ways a surgeon qualifies to lead a program, Salzburg said. One is through a formal fellowship program, which he has completed. The other is through clinical experience, which is fulfilled by Dr. David Cronin, who was recently hired by Carilion.
The record is set to close on Feb. 28.
Over the months that follow, the state health commissioner will consider the proposal before issuing a final decision in the spring.
