Kidney and liver transplants to resume at Penn State Health after shutdown due to problems

When Dr. Johnny Hong was growing up in the Philippines, his father’s life depended on a kidney transplant.

Kidney transplants were rare in the late 1960s, and Hong’s father had to travel to Taiwan. He survived the transplant, but soon died of infection related to anti-rejection drugs, which were far less effective than today.

The experience inspired Hong to become a transplant surgeon and devote his career to advancing the field.

In November, he came to Penn State Health Milton S. Hershey Medical Center to lead the kidney and liver transplant program that shut down voluntarily last April after state and federal health agencies found assorted problems.

Penn State Health said it has rebuilt the program and announced the restart on Wednesday. Transplants could resume in a week, said Hong, who is chief of the division of transplantation and director of liver transplant surgery.

“I think we have taken a very deep, in-depth analysis of the past and really worked on new processes,” he said.

Asked about the root of the problems, Hong cited “communication, teamwork, culture.”

He said the solution has included efforts to “ensure that every single member of the team has a voice in how to improve patient care” and focusing on every step of the transplant process from the viewpoint of patients.

Penn State Health has two hired new transplant surgeons in addition to Hong, and has recruited a fourth who will start in August.

It also has hired a new administrator to oversee kidney and liver transplants as well as heart transplants, which is a separate program that wasn’t affected by the problems that shut down kidney and liver transplants.

The problems, found during inspections by the state health department and Medicare and first reported by PennLive/The Patriot-News, included: failing to inform national transplant authorities including Medicare of personnel changes that could impact quality of transplants; failing to analyze five instances of newly-transplanted patients having to go back to the operating room or be readmitted to the hospital; and not informing two patients they were receiving high-risk organs.

Investigators also found problems with the credentials of a surgeon hired as program chief early last year, concluding it was unclear if the surgeon had done enough recent liver transplants to be considered “current.”

In September, the Organ Procurement and Transplantation Network, which oversees transplants in the United States, declared Penn State Health “a member not in good standing,” the most severe action it had taken against a hospital in 15 years. OPTN cited concerns including “reports of surgical complications and questions about the currency of surgical expertise, as well as a culture of retaliation for reporting potential problems.”

In an interview Tuesday, Hong noted he’s only been at Penn State Health for four months, and declined to elaborate on matters such as personnel changes or actions taken before he arrived. However, he said the recent investments in the program have enabled it to attract highly-skilled surgeons.

Asked for his main message to prospective transplant patients, he said: “Transplant is a second chance for life. My message is that Penn State Health will be their team for life.” That includes not only high-quality medical care during and after transplants, but during the time patients are waiting, when their failing organ can lead to cascading medical problems, Hong stressed.

Penn State Health had about 200 patients on its waiting lists for kidney or liver transplants when it shut down the program. Many of them switched to different programs, with some getting transplants through UPMC’s Harrisburg-based transplant program. About 100 chose to remain listed at Penn State Health — patients commonly register with multiple programs — and Penn State Health has been contacting them and scheduling their pre-transplant appointments, according to Hong.

The kidney and liver transplant team, which includes about 40 people, has been conducting “mock” transplants in preparation for resuming transplants, he said.

The OPTN said it has approved Penn State Health’s request to resume kidney and liver transplants. However, it said the program remains “a member not in good standing,” for reasons including the fact the declaration was made last fall, and programs can’t regain full standing until at least nine months later. An OPTN committee “will continue to monitor their progress and implementation of their corrective action plans and plans for quality improvement until they are satisfied that the hospital has made the necessary changes,” a spokeswoman said.

Penn State Health says Hong “has demonstrated a lifelong commitment to teaching and advancing the field of transplantation and surgery, training transplant surgeons throughout the world.”

He previously worked at the Medical College of Wisconsin, Froedtert Health and Children’s Wisconsin and is a former medical director of liver, pancreas and intestinal transplantation at the University of California, Los Angeles. His accomplishments include some “firsts,” such as “an innovative liver surgery procedure on a two-month-old infant,” according to Penn State Health. Hong also patented a method of resuscitating marginal-quality livers, thereby extending the supply of the scarce organ that many people die while awaiting.

The other two new transplant surgeons are Dr. Thomas E. Butler, who previously worked at Montefiore Medical Center in New York City, and Dr. Raymond Lynch, who previously was director of public policy and community relations at Emory Transplant Center and associate director of the Emory Health Services Research Center.

Michelle Lorenz, the new administrator for the kidney and liver transplant program and the heart transplant program, previously worked at the University of Virginia Medical Center.

Lynch specializes in overcoming inequities including race-based barriers to getting an organ transplant. For example, research shows African Americans, while having the highest rates of end-stage kidney disease, are less likely to be referred and listed for transplants. One of Lynch’s roles will involve understanding barriers in central Pennsylvania, and “outreach” aimed at informing patients how to get referred, and informing doctors how to overcome the barriers, Hong said.