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Today we're discussing a new transplant partnership between MedStar Georgetown University
Hospital and the Washington DC Veterans Affairs
Medical Center that benefits military veterans across
The country. We're talking today with dr.
Rohit Satoskar, director medical services for the MedStar Georgetown
transplant Institute and a special guest
Dr. Atoosa Rabiee
Chief of Transplant Service transplant service at the DC.
VA Medical Center,
Dr. Rabiee
Dr. Satoskar
Welcome to doc talk.
Thank you for having me.
Thank you so much for having us. So we're here to
talk about the Veterans Health Administration
Adding MedStar Georgetown University Hospital to its National solid organ
transplant Network.
So first start doctor Rabiee
Can you give us some background on exactly what that
means for the VA Medical Center and your patients.
Yeah, absolutley. So there are VA transplant centers Across the Nation
that are open to Veterans,
to get evaluated and transplanted for solid organs
to give you a little bit of background.
We would be the fifth in the nation that are
approved for both liver and kidney transplantation.
The importance of,
this is a previously through using our community care services
over the last 5 years or so,
we have developed a relationship with MedStar transplant Institute and
we have been sending our patients through that route to
Georgetown.
However,
adding us as a VA
transplant center means that not only patients in the
DMV area,
but any other patient Across the Nation as long as
you're a veteran,
and they have VA benefits,
can,
potentially,
get evaluated and listed and transplanted at Georgetown.
So this would definitely increase access to veterans in the
DMV area,
but far beyond that. so we're gonna dive into, in just a second, exactly
what this means for these patients.
Specifically.
But first,
Dr. Satoskar
what is this change?
And how does this benefit us at the transplant Institute
of MedStar Georgetown?
So as Dr. Rabiee mentioned,
this was sort of a natural expansion of a partnership
that began many years ago.
So,
when I had the pleasure of working with dr.
Rabiee I think,
since she arrived at the DC VA and we have
collaborated on Patient Care on liver transplantation,
bringing liver transplant to Veterans,
who are in need.
Of the life-saving procedure in that sort of continued partnership
is now going to a different level.
And so,
you know,
rather than sort of answering the question of what it means.
Really,
for us in
the transplant Institute,
I think the bigger question is what it means for
patients.
So quickly,
answer,
the first question for us.
We know,
we have the capacity to do this.
We,
of course,
have a very strong interest in doing this.
We are on the verge of moving into a new
hospital Pavilion which will bring state-of-the-art technology in the
OR, as well as private patient care rooms on the
veterans would enjoy when they're here.
But with this partnership,
really is going to expand the reach for for veterans
in terms of access to this life-saving procedure.
So I think that's really the great benefit of this
partnership.
Dr. Rabiee
you said,
there's a couple different organizations.
Now that you've worked with
and this is something that's a priority,
at the VA
Medical Center.
So what is the benefit now,
to the patient's you're seeing that are in need of
these transplants moving forward.
They have more access. Correct so I think even before we
had this partnership approved by national surgery office as a
VA transplant center,
our closest transplant center was Richmond or Pittsburgh,
which obviously made it very difficult in case of patients,
who are very,
very sick,
were admitted in the hospital and were in urgent need
of transplant.
So we basically developed this very close relationship,
which according to my own patients,
they never felt like they were being treated in two
different institutions.
So while we
sort of,
ironed out all the details of our partnership,
we then approached National Surgery
Office to give us this opportunity to be basically placed
on the map as an approved
VA transplant center.
And I think, as Dr. Satoskar
mentioned, the part that we were able to demonstrate that
there is a very close partnership.
We have the details of this partnership already sorted out
and,
and be can basically rely on our partner Whenever there is
a lack of specific services at the VA.
But also we have this sort of trust between us
that we are able to improve our services at the
VA.
We got this approval in again other
than providing services to the patient who are in the
DMV area.
We have now already over the past couple of months,
we have been able to evaluate patients from Virginia from
Connecticut and we just hope that this will continue to
grow.
So we know the idea here is linear more inclusive
care in his partnership.
So let's dive into exactly what this might look like.
For a patient,
who's coming into this
so this is going to help veterans specifically who are suffering
end-stage liver disease,
kidney failure,
resulting from conditions for which transplant is the only
available option
We talked about long-term survival.
So Dr. Satoskar
let's start with you,
what is it
going to look like for patient.
Moving forward who are in need of these transplants now that
this door has been opened.
So for patients who are in need of some of
these transplant procedures.
They may come to Dr. Rabiee's
team from the VA's across the country.
So they may be within sort of our VA region
or what's called a VISN, or beyond that.
so they may come from VA's that are
more local to their Community,
for example,
in Baltimore or in Winchester,
or they might come from farther out.
So they would be identified initially
By their local Physicians as needing a liver or
kidney transplant.
And then the VA has an internal system by which
that referral would be placed and then Dr.
Rabiee's team would sort of take it from there and maybe
I'll turn it over to her to talk a little
bit about what happens after that but their team would
would pick up that referral and then begin the process
and then bring us in. Correct, so
Any physician within the VA system can make this referral
usually for end-stage liver disease patients,
they come from a gastroenterologist or a hepatologist who has
been taken care of them . For kidney patients
sometimes these are patients who have been on dialysis so
kind of can self-identify and ask their Physicians to place
this referral.
As Dr. Satoskar mentioned,
there is an internal referral process of these patients.
Basically are placed in a system that then the VA
transplant center that they're assigned to gets an alert,
depending on how urgent it is.
They're usually
seen at least by a video visit,
which is a very common platform that is being used
at the VA within two weeks to determine for some
formulas.
If medically,
they're eligible. From that point,
If they are medically eligible, they are then brought to the
VA. One of the important things about this
partnership is that we are able at the VA to
help veterans and their support person with their travel 201 00:07:57,700 --> 00:07:57,690 expenses,
with their lodging,
which there is a lodging accommodations.
At the VA,
called Fisher house, that they can stay at with their support
person and then this would provide them with an in-person
visit so they can meet the whole team.
We are able now to do almost all of their
evaluation at the VA,
including Social Work,
mental,
mental health provider,
and some of these tests are actually done at the
local VA.
Once this sort of evaluation is completed then we have
a joint committee that we discuss medically socially and sort
of all aspects that are involved in the
transport process and then patients are listed.
Again, when they go back to their local VA,
there is an arrangement by their local VA that we
walk them through it that they would be able to
use travel and lodging when they are called for an
organ,
So that they can travel to DC.
So, we know
that there's a lot involved in a transplant
it's not
just a transplant
Procedure itself. It's, Dr. Rabiee,
like you talked about, expenses for travel the list
to get a donation, preoperative, post-operative care recovery and
follow-up. Dr. Satoskar, how might we,
as a transplant Institute work with the VA Medical Center
on all these steps.
Not just getting a patient but working with them on
follow up on the care of the patient on all
these things.
How does that benefit doctors at the transport Institute?
Now,
you know,
one of the things we've been fortunate with, is that
again,
this long-standing relationship has allowed us to iron out some
of those details even prior to going live.
So we really aim to have a seamless process
for patients and part of that is based
on having seamless communication between our teams.
So,
you know, Dr. Rabiee
has really assembled
I think a world-class team at the VA.
To be honest with you.
Which includes,
you know,
not only the The Physician expertise that's there but in
addition the the other staff that goes into supporting patients,
who go through the liver transplant process,
as you alluded to in your question and I shouldn't
just say liver transplant,
because it's both liver and kidney,
but patients who undergo organ
Transplantation,
get support by their centers in various
ways.
and it's not
only medical support but there is support
from nurse coordinators.
From dietitians from social workers
and from many other parts of the staff to make sure
that the patient really has a successful experience that
exists,
both at the VA and at the MedStar Georgetown Transplant
Institute and we really work collaboratively to make sure that
that happens for the patient.
So that begins at the VA but then throughout that
process,
there is back and forth communication up until the time.
The patient is discussed for listing at our
listing meeting and then once they're placed on the list
that communication really continues until they are transplanted,
transplant procedures will occur at MedStar Georgetown University
Hospital in the immediate post-operative care will also occur at
the hospital here.
Once patients are discharged from the hospital,
they will have some initial visits with the team at
the MedStar Georgetown transplant Institute.
But once stable we'll return their care to the VA
where they will go back seamlessly again to dr.
Rabiee's team,
but we are always available even after that point,
if need be. As a liver transplant physician,
I'm going to focus a little bit on the liver.
You know,
we have seen increases in terms of the incidence of
liver disease in general.
Over the past several years and there's multiple things that
are driving that we've seen a continued increase in what
is called,
non-alcohol alcoholic fatty liver disease.
This is fat deposition in the liver.
That is a result of factors that do not involve
alcohol.
So many patients have risk factors such as diabetes,
or obesity or metabolic syndrome
a recent estimates suggest that up to 30%
of the US population may have this disorder.
Now,
of course,
not all of those patients will develop Advanced liver disease
or need a transplant.
But when you're talking about 30% of the US population,
that's a,
that's a lot of people.
So that's one driver.
So we're seeing now a rise in Need for liver
transplant
for this indication,
and it's one of the top indications.
now for a liver transplant.
another indication for liver transplant is alcohol related,
liver disease.
And we have seen an increase in incidence of alcohol-related
liver disease during the pandemic for various reasons as you
can imagine.
So that is another driver of Need for transplant,
but then beyond that,
there are many other causes of end-stage,
liver disease.
There are,
you know,
genetic causes, viral causes, drug-induced
liver injury.
Sometimes we see and there are other conditions that affect
you know,
children,
which we're not here,
to talk specifically about that today.
But those are some of the things,
some of the reasons why someone may need a liver
transplant,
and some of the things that are kind of driving
the increase in that needed.
So MedStar Georgetown,
University hospital,
and the DC.
VA Medical Center are both based in centered in the
DC area.
However,
this new partnership is not just going to benefit veterans
needing transplants in the DC area.
DR. Rabiee,
Can you talk a bit about how this might benefit
patients in other parts of the country, what that
might look like for somebody who's going to come here
for their care,
even though they don't live here.
Right, so, although there might be a situations where there
would be a transplant center.
A VA transplant center,
that is closer to a veteran.
But there are some unique features here that we can
point out.
One is a fact that we are able to offer
both liver and kidney simultaneous transplant,
which is more and more becomes a problem as dr.
Satoskar mentioned with the increase in the number of
those patients who have a lot of risk
factors with metabolic syndrome,
get transplanted.
The other important thing to mention is that Georgetown is
able to offer living donation,
for a liver transplant,
as well as including the kidney transplant candidates in
NKR, which is the National Kidney Registry.
So,
both of these options are available to Veterans as well,
if a Veteran identifies someone as a donor who is
not a Veteran, they can still register at the
VA and their costs can be covered by the VA.
And those are very unique features for which somebody might
decide to actually travel. That is aside from, obviously,
looking at outcomes
that was one of the main reason that we actually
chose and demonstrated that to National surgery,
office to pick this partnership,
which is excellent with the MedStar Georgetown.
So moving forward, what stands out to you most
about this new partnership? So for us,
this is really a an incredible opportunity.
It's a unique opportunity and it's truly an honor for
us to be able to care for the nation's veterans
in the nation's capital.
I think that there's something very nice and symbolic about
that,
but being able to partner with the VA and bring
these life-saving procedures to Veterans is very important to
us and I'm just very honored to be included.
We are extremely excited about this.
I think this is one of those important stops
that National Surgery Office
has made to increase access but specifically, as Dr. Satoskar mentioned,
in the capitol. And we look
forward to expanding the access,
not only liver and kidney,
but to other organs and continue our partnership.
Thank you so much for taking the time to be with us today.
Dr. Satoskar
and Dr. Rabiee
we hope you've enjoyed learning about this new partnership between
MedStar Georgetown University Hospital,
and the Washington DC Veterans Affairs
Medical Center, which benefits military veterans,
across the country who are in need of liver or
kidney transplant.
We've been talking with Dr. Atoosa Rabiee of the
DC VA Medical Center and
Dr. Rohit Satoskar with MedStar Georgetown,
University Hospital in Washington DC.
For more information on this new partnership and what it
means for veterans visit
medstarhealth.org/services/MedStar-Georgetown-Transplant-Institute
or call 202-444-3700.