by George Taniwaki

There are over 6,000 hospitals in the U.S. but only 268 of them offer kidney transplant therapy. Further, these transplant centers tend to be clustered in big cities. For instance, in the Northwestern U.S. which includes Alaska, Washington, Idaho, and Montana, there are only five transplant centers to cover an area of 965,000 square miles (2.5 million sq. km). But they are not broadly distributed. Four of the five are in a single city, Seattle, within a few blocks of each other.

This is very inconvenient for patients and donors who don’t live in or near a big city. However, the answer is not to open more transplant centers in medium or small cities. That’s because organ transplantation is a complex process that involves a lot of specialized skills and coordination with external organizations.

Transplant therapy involves a lot of medical and psychological testing for both the patient and the donor (in the case of live donation). It also involves a lot of record keeping, coordination with an organ procurement organization (in the case of deceased donation), working with dialysis centers, working with the United Network for Organ Sharing (UNOS), and with a variety of other government agencies, medical organizations,  and insurance providers.

Not every hospital can qualify to become a transplant center. And not many hospital administrators would want to commit the time and resources needed to become a transplant center. Further, research shows that better medical outcomes are associated with hospitals that perform a large number of procedures. Thus, patients have a better chance of success at a hospital that performs 100 or more transplant surgeries per year than at one that only performs 20 per year.

A clever solution

Texas is a large state, both in size and population with 33 transplant centers. But as mentioned above, they are not evenly distributed. The city of Laredo, located along the Rio Grande River in south Texas, is the tenth largest city in the state with a population of about 236,000 according to the 2010 U.S. census. Despite the city’s size, it does not have a transplant center.

The nearest cities with transplant centers are San Antonio which has four, Corpus Christi which has one, and McAllen with one. See the map below for the location of all these cities.

Texas

Map of Texas. Image from Microsoft

The Laredo Sun Jun 2011 reports that Providence Medical System is partnering with the South Texas Transplant Center in McAllen to open an evaluation center for kidney patients and donors at Providence’s Doctors Hospital in Laredo.

This evaluation center will not perform transplants, but will provide all the necessary patient and donor testing and monitoring services pre- and post-transplant. This will save transplant participants living in or near Laredo from having to travel to McAllen to get evaluated. This can shorten a round-trip driving distance of 250 miles (400 km) for each visit. An evaluation may require several visits for various blood tests, CT scan angiograms, 24 hour urine tests, psychological exams, and post-surgical follow-up examinations. Thus, being able to get the evaluation done closer to home can save many days spent traveling. Even more important, it can help ill patients who find it difficult to travel and people who cannot miss time from work from dropping out of the transplant option entirely. This will increase the number of patients who will pursue transplant therapy, extending their lives and improve their quality of life.

This new hospital partnership helps kidney patients in Laredo get transplants even though that city doesn’t have a transplant center. I hope more transplant centers partner with hospitals in medium-size cities to create evaluation centers to assist these underserved patients and donors. Improved access to health care requires innovative programs like this.

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