On a recent Thursday in mid-July, a woman in her 50s got a second chance at life.
A man had died from unspecified trauma and was an organ donor. After Todd Merchen completed a two-hour transplant surgery, the woman was recovering at Greenville Memorial Hospital.
“As a surgeon, we probably get disproportionate amounts of credit, but there’s not much better than waking up in the morning and going to work and getting to watch a miracle happen,” Merchen said.
Merchen serves as director of the Prisma Health Transplant Center, the first in the Upstate that is within a 100-mile radius of another transplant center, Prisma Health said. Aided by a 10-month-old bipartisan bill and a relatively recent organ-allocation system, transplant procedures in Greenville have increased by more than 83%, according to Merchen and Prisma Health.
The facility opened in 2022 with 17 kidney transplants the first year — two on the first day alone — and 78 in the second year. Now, Merchen said it is on pace to perform nearly 100 this year. In just two years, Prisma’s center accomplished 209 procedures through June 24, according to federal data.
The Medical University of South Carolina’s MUSC Health Transplant Center, the state’s oldest center which opened in Charleston in 1968, has performed more than 10,000 kidney transplants as of late June. The system also operates the MUSC Health Transplant Clinic — Grove Road in Greenville, where Zachary Sutton, a certified physician assistant, works in transplant outreach and telehealth.
South Carolina’s first “altruistic living donor” — someone who gives a kidney to a nonfamily member — Sutton has seen transplantations in South Carolina and the Upstate skyrocket, with record-breaking numbers year over year.
Transplant reform
Last September, President Joe Biden signed into law the Securing the U.S. Organ Procurement and Transplantation Network Act, which modernized the nation’s 40-year-old transplant system.
In a nutshell, the law essentially dismantled a monopoly in which the U.S. Health Resources and Services Administration exclusively awarded the Organ Procurement and Transplantation Network the federal contract to manage the United Network for Organ Sharing, or UNOS, which allocated organs. Now, the HRSA can award contracts, grants and cooperative agreements with approved organ procurement organizations throughout the country, not only through UNOS.
Having more than one vendor means more competition. Among other reforms, the law also codified an OPTN proposal to address geographic disparities in patient access to transplant centers, according to the National Institutes of Health.
In 2021, the OPTN shifted away from arbitrarily defined service areas for patients to get a deceased donor’s kidney. It created “proximity circles” that prioritized wait-listed patients within a 250-nautical-mile radius of a donor hospital, according to the NIH.
That benefitted the Upstate.
“You can imagine that Charleston gets half the ocean, right?” Sutton said. “Allocation changes made it advantageous for Upstate transplant programs.”
Merchen said there were previously “many people who never even thought of transplant because it was just beyond their ability to get to a center.”
Dave Stefano is president and CEO of We Are Sharing Hope, a Charleston-based, federally designated organ-procurement organization working in Greenville, Columbia and Myrtle Beach.
“I think having a transplant program in the area gives more people easier access to the gift of life, to the second chance,” DeStefano said.
“Transplant centers do a good job at having a long reach, but I think once you have a hospital that’s dedicated to doing these transplants, you’re going to expect to see more transplants.”
As for the Modernization Act, Sutton and Merchen are still taking a wait-and-see approach.
“One of the concerns about all modernization is that you may not have a perfect system, but it’s the devil you know,” Merchen said. “And what we get a little worried about is when the federal government might get involved in something and make changes that you’re not quite sure what the results are going to be. The most important principle here is the outcome for the patient. At the end of the day, if we do that, that’s the true north.”
By the numbers: Prisma Health Transplant Center
Prisma Health Transplant Center joins 257 other transplant hospitals across the country and three others in South Carolina, according to Centers for Medicare & Medicaid Services.
In 2019, transplants in South Carolina numbered 277, an 18% increase from the year before, according to Prisma Health in March 2022, and federal figures. As of last June, Prisma Health’s new transplant center had performed 209 procedures, federal data shows.
Kidney disease is the ninth leading cause of death in the U.S.
More than 1,000 South Carolinians are waiting for transplants, with more than 120,000 people on the national waitlist, according to the Medical University of South Carolina.
Slightly more than 200 people are on the Prisma Health Greenville Memorial Hospital’s waiting list for a kidney. Nearly 6,400 patients are on MUSC’s list, according to federal data.
The average wait time for a deceased donor kidney transplant is five years, while more than half of listed candidates die or are removed from the list before transplant, according to 2021 figures from the National Institutes of Health.
Each day, 22 South Carolinians die waiting for organ transplants, MUSC reports.
Nationally, some 6,000 patients awaiting transplants die each year, “a figure policymakers have said highlights the urgency for reform,” Politico Pulse reported on May 24, citing figures from the U.S. Health Resources and Services Administration.
Nearly 92,000 patients in the U.S. are waiting for a kidney or kidney-pancreas transplant, the NIH says.
As of 2021, the U.S. had 256 transplant centers.
As of December 2018, nearly 220,000 patients in the United States were living with a functioning kidney transplant.
In 2019, a record 24,273 kidney transplants were performed in the U.S. with nearly three-quarters of them from deceased donors.
In 2020, the average transplant cost more than $440,000. Most recipients — 60% — have Medicare, which covers 80% of the cost, the NIH says.
While Medicare is typically available only to those 65 and older, patients with end-stage renal disease qualify for the program for three years, the NIH says. Then-President Richard Nixon signed that provision into law in 1972.
Major players and their acronyms
HRSA: The Health Resources and Services Administration is a division of the U.S. Department of Health and Human Services. The HRSA oversees the following organizations:
OPTN: The Organ Procurement and Transplantation Network, part of the HRSA and created in 1984, is “the national system that allocates and distributes donor organs to individuals waiting for an organ transplant. The OPTN system includes transplant centers, donor hospitals, organ procurement organizations and other transplant stakeholders.”
UNOS: The public-private United Network for Organ Sharing had been the government’s only contractor — until the 2023 modernization act allowed organ procurement organizations, or OPOs, to submit requests for proposal to the OPTN.
Timeline
2019: OPTN changes kidney-allocation system, from designated service areas to radii of 250 nautical miles within a transplant hospital.
2021: Prisma Health starts transplant program.
2022: Prisma Health Transplant Center performs its first transplants, two on the inaugural day.
2021: MUSC starts a kidney program in Lancaster, with its first transplant in 2022. The program has moved to MUSC Indian Land Hospital, roughly 25 miles from downtown Charlotte, to be closer to available organs.
2022: Increased media coverage helps boost transplants at Prisma Health and MUSC.
2023: UNOS proposes OPTN Modernization Act; Congress orders administration to revamp the system; UNOS updates Modernization Act with congressional recommendations.
2024: Medical professionals from all three programs start the South Carolina Transplant Foundation, a charity to raise funds to assist transplant patients from South Carolina.
To become an organ donor: Donate Life South Carolina, donatelifesc.org.
