Kidney doctor wants more patients to benefit from transplant

South Carolina has one of the lowest kidney transplant listing rates in the nation – in other words, fewer people who could benefit from kidney transplants are even getting in the line for one. The barriers are multiple – geographic, financial and the ability to navigate complex health care systems.

But that has started to change in the past couple of years as MUSC Health has worked to bring its transplant expertise to every corner of the state, including satellite clinics in Myrtle Beach, Florence and Columbia. Earlier this year, despite the pandemic, it opened a transplant clinic in Greenville, and this month, members of the transplant team began to see patients in the new clinic in Bluffton.

A key hire has also made a big difference for the transplant team's work. Transplant nephrologist Carlos F. Zayas, M.D., joined MUSC Health in January. Based in Greenville, he travels the state to see patients at each satellite location. Though he is new to MUSC Health, he is not new to South Carolina. His deep ties with community nephrologists and his passion for this work have made a big difference in MUSC Health’s ability to connect with patients, said Prabhakar Baliga, M.D., chairman of the Department of Surgery at the Medical University of South Carolina.

“Carlos has a very strong zeal for patient care, more than many physicians,” Baliga said.

That zeal goes back to his days as a medical student and resident. Initially, he was drawn to nephrology because he enjoyed the science of it and was impressed by watching the kidney doctors apply concepts from cardiology, pulmonology, internal medicine, infectious disease and rheumatology. But he also saw how much time the doctors spent dialyzing patients.

“These patients are slaves to these machines that keep them alive. Kidney disease, just treated with dialysis alone, takes so much out of the patient,” he said.

People on dialysis are dependent upon a machine for hours each week to remove waste products and extra fluid from their blood – their kidneys’ normal function. The process not only steals much of patients’ physical freedom but their mental well-being, Zayas said. Nephrology began to look less attractive as a specialty.

Then he did his first rotation in transplant. Suddenly he saw people who had been completely dependent upon a dialysis machine return to work, have children, play sports and plan weekends away with their families.

“I discovered the beauty of transplant and said, ‘This is what I want to do the rest of my life,’” he said.

 

Now, he evangelizes the power of transplant wherever he can. “Transplant is by far the best option for people with terminal diseases,” he said. And as a doctor of Puerto Rican heritage, he feels an especially strong pull to advocate for underserved communities.

“I feel like I'm called to help those underserved patients – minorities, either underserved minorities from the origin standpoint or financial standpoint or resources standpoint,” he said. “I feel like I'm called to be an engine of change, for facilitation for these people.”

Zayas has another connection with patients.

“I'm a transplant patient myself. I received two bone marrow transplants. So, I've gone through this as a physician but also as a patient,” he said.

Zayas said the Southeast has a higher concentration of people with kidney disease. High blood pressure and Type 2 diabetes are the leading causes of kidney disease in the U.S. Further, poverty, the distance to specialists and lack of health insurance mean people don’t get care until they are very sick and qualify for Medicare coverage of dialysis or transplant.

Even once someone has reached the stage of needing a transplant, there are numerous hurdles that must be cleared, including cardiac and cancer testing, funds for medication, social support post-transplant and transportation for follow-up visits, Baliga said. MUSC Health has a robust kidney transplant program with excellent outcomes, he said, but in the past, the program has been difficult to access for people farther from Charleston.

“The challenge for MUSC is to provide this level of care across the state, as we hold a special responsibility by being the only transplant program in the state,” Baliga said.

Thus, the importance of having Zayas there to connect with patients – and their local doctors, who may worry about getting information once they send their patients into a large health system.

“I’m the kind of guy that gives all the referring doctors my cell phone. I will answer day and night, weekends, on call or not on call, in town or out of town. I will always be there,” Zayas said.

Telemedicine has also made a difference in MUSC Health’s reach. Prior to the pandemic, the transplant program had started building its telemedicine presence, but the pandemic pushed both providers and patients to become more comfortable with virtual visits, said Daniel Stanton, administrator for the Transplant Service Integrated Center of Clinical Excellence.

“Our patients understand the benefits because almost all of our patients have had some type of virtual visit now,” he noted.

Telemedicine is somewhat different than a pure virtual visit because telemedicine involves having a trained person, such as a nurse, in the room with the patient to perform a physical exam while the doctor speaks with the patient through a monitor.

In January, the transplant program will begin a rotation of weekly telemedicine clinics in each of the five regions of the state, with advanced practice providers physically in place in each of the regions, Stanton said.

“I think 2021 is going to be a big year for transplant and telemedicine,” Stanton said.

Stanton also said Zayas has made a big difference.

“Having a provider out in the community has been the next step for our program. He's been everything we hoped he’d be,” Stanton said.

Already, MUSC Health’s kidney transplant listing rate has increased substantially this year, adding more people to the list than any of its neighboring centers, Baliga said. The next step is encouraging more people to become living donors, as the number of deceased donors has remained relatively level for years. Again, getting patients into the system earlier helps their chances because they have more time to reach out through their social networks to find donors, he said.

Zayas will be there to help patients through the process to get listed.

“I see this truly as my calling, not as just a career,” he said. “I love being a physician. I love being a transplant doctor.”