Latest / Becker’s Healthcare Podcast / Expanding Access to Heart Transplantation Through Innovation and Collaboration with Sharon Klarman

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Expanding Access to Heart Transplantation Through Innovation and Collaboration with Sharon Klarman · Becker’s Healthcare Podcast

• 0:02
  - The strategic agenda facing hospital and health system
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  - leaders right now is not a short list.
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  - a tech investment cycle that demands both urgency
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  - and a workforce story that is still being
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  - Eker's fourteenth annual CEO CFO roundtable brings together
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  - 400 speakers across four days of sessions that
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  - are designed to help c suite leaders benchmark,
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  - Not in the abstract, but against the real
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  - decisions they'll face heading into the next year.
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  - It's the kind of event you leave with
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  - a clear sense of where you stand and
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  - what comes next.
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  - So join us November second through the fifth
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  - at the Hyatt Regency in Chicago, and come
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  - ready to do the hard thinking.
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  - Register on our events page at beckershospitalreview.com
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  - by clicking on the events tab in the
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  - upper right.
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  - Welcome to the Becker's Cardiology and Heart Surgery
• 1:01
  - podcast. I'm Mariah Taylor, assistant editor, and I'm
• 1:04
  - thrilled to be speaking with Sharon Klarman,
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  - assistant vice president of solid organ transplantation and
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  - VAD at Tufts Medical Center. Thank you so
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  - much for joining me today. I'm really excited
• 1:15
  - to learn more about how you're reaching heart
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  - transplant excellence and increasing access. But before we
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  - dive into my questions, I would love for
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  - you to introduce yourself and tell us a
• 1:23
  - little bit about your background.
• 1:25
  - Sure. And and thanks for having me, Mariah.
• 1:28
  - Yeah. I'm Sharon Klarman. I'm the assistant associate
• 1:30
  - vice president for solid organ transplantation at Tufts
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  - Medicine.
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  - I've worked in solid organ transplant now for
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  - over twenty years,
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  - and I'm actually a nurse, by background.
• 1:41
  - But today, I oversee the strategy and operations
• 1:44
  - of our liver,
• 1:45
  - heart, kidney, and bad programs.
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  - And really at the heart of my work
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  - is
• 1:50
  - expanding access to transplantation
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  - for the patients that we care for,
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  - and making sure that our teams have the
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  - resources,
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  - and support needed to turn those opportunities into
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  - life saving care.
• 2:01
  - Amazing. Now the transplantation
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  - environment is always shifting and changing. So I'm
• 2:07
  - curious, what are some of the greatest barriers
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  - to heart procurement and access that you see
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  - right now?
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  - Sure. So I think when we talk about
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  - access, I see it as two really dis...
• 2:18
  - Distinct challenges. So the first is
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  - getting a patient to a transplant center, completing
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  - an evaluation,
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  - making sure that the patient has the support
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  - needed to move forward. And the second is
• 2:31
  - once the patient is on the national waiting
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  - list, it's receiving a suitable organ offer for
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  - that patient.
• 2:37
  - So getting to a transplant center can be
• 2:39
  - difficult for someone who lives several hours away.
• 2:42
  - We care for patients all across,
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  - New England.
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  - So certainly focusing on helping with transportation and
• 2:49
  - access to our program, ensuring that their caregivers,
• 2:53
  - can be present at the bedside.
• 2:55
  - Those barriers can affect whether a patient ever
• 2:58
  - has the opportunity to actually be evaluated.
• 3:01
  - And then once that patient's listed,
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  - access is really shaped by the availability,
• 3:07
  - of suitable donor hearts and how broadly a
• 3:10
  - transplant center,
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  - can safely consider donor offers. So there's still
• 3:14
  - a significant gap between the number of patients
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  - who need a transplant
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  - and the number of suitable donated hearts that
• 3:21
  - are available.
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  - At Tuftside, say, we take a very proactive
• 3:25
  - approach through careful donor assessment and leveraging advanced
• 3:30
  - preservation techniques,
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  - allows us the willingness to
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  - travel upwards of 3,000 nautical miles to recover
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  - an appropriate heart.
• 3:39
  - And, really, I think our our guiding question
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  - is, what does it take to make this
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  - opportunity possible for our patients?
• 3:46
  - That's amazing. And I love what you just
• 3:47
  - said. What does it take to make this
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  - possible?
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  - I'd kinda love to dive into that a
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  - little bit more. What kind of innovations have
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  - you implemented in HEART procurement, and what have
• 3:56
  - the results been?
• 3:58
  - Yeah. So, you know, I think acting on
• 4:00
  - opportunities to expand access
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  - requires a tremendous amount of coordination, and that's
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  - that's really where our advancements start. So depending
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  - upon
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  - the recovery approach that we're taking for a
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  - particular heart, we may be deploying specialized surgical
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  - teams,
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  - perfusion staff, preservation equipment,
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  - and all of this needs to be seamlessly,
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  - coordinated.
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  - So in heart transplant, what we've seen is
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  - a significant growth in the volume of donation
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  - after cardiac death donors,
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  - also known as DCD donors, and that has
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  - really allowed us to consider hearts that historically
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  - wouldn't have been available for transplantation.
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  - But in order to leverage those hearts, we
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  - need
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  - to use,
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  - different perfusion and preservation
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  - techniques.
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  - This includes regional perfusion to assess heart function
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  - before recovery,
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  - warm machine perfusion outside the body,
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  - colds,
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  - controlled temperature, cold preservation.
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  - And our team considers the donor, the patient,
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  - and the anticipated
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  - transportation times when we're choosing the approach for
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  - for recovery.
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  - Amazing.
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  - Now as you kind of talked about earlier,
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  - access, of course, is a huge barrier for
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  - a lot of people looking for a new
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  - heart, and so are the wait times with
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  - so many people that die on the wait
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  - list.
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  - What innovations have you been implementing in this
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  - area, and do you have any results to
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  - share around that?
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  - Sure. You know, I think one of the
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  - approaches that we've taken as a transplant center
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  - located in Boston, recognizing that many of our
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  - neighboring states
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  - actually don't offer heart transplant or liver transplant
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  - services,
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  - has been to create
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  - this
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  - shared care model,
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  - with other hospitals where we can jointly share
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  - the care
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  - of patients during their pretransplant
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  - phase.
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  - So we have many partners that extend through
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  - Vermont and New Hampshire, Maine and Rhode Island,
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  - where patients
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  - also have access to care locally.
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  - But then when they need to be transferred
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  - to us for higher level of care, we
• 6:04
  - make that transition seamless.
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  - We've also expanded our ECMO services, our management
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  - of cardiogenic shock patients,
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  - and, again, access to our center to be
• 6:15
  - able to receive that higher level of care,
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  - has been critical
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  - in,
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  - growing our pretransplant
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  - patient population.
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  - Amazing.
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  - Now looking ahead, I know there's been a
• 6:26
  - lot of new devices coming out and new
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  - ways of procuring organs.
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  - Are any of those catching your eye as
• 6:33
  - maybe the next innovation you'll implement?
• 6:36
  - Yeah. Definitely. I think on the procurement side,
• 6:39
  - we are looking at, different recovery,
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  - approaches, including,
• 6:45
  - rehab. We're already using,
• 6:48
  - TA NRP.
• 6:50
  - And in combination with the recovery techniques that
• 6:53
  - we're using, we're also looking at,
• 6:56
  - different types of preservation
• 6:57
  - and perfusion devices.
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  - Those devices allow us to keep the heart
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  - outside of the body for a longer period
• 7:05
  - of time,
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  - and we're certainly always looking at, new devices
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  - that are,
• 7:10
  - becoming available and are FDA approved.
• 7:13
  - Excellent.
• 7:14
  - And then with the last question I have,
• 7:18
  - here at Becker's, I've talked to a lot
• 7:20
  - of different cardiology leaders, and many across the
• 7:22
  - nation are standing up for the first time,
• 7:25
  - new heart transplant
• 7:26
  - programs. So they're trying to figure out how
• 7:28
  - this works, how to make it grow. And
• 7:30
  - then there's several others that are very small,
• 7:32
  - but they're looking to grow. Right? And then
• 7:34
  - you there at Tufts. You've performed 70 adult
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  - heart transplants in 2024
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  - on pace to beat that this year. Clearly,
• 7:41
  - have a lot of growth. You have a
• 7:42
  - lot of great structures and things like that
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  - to make this a really successful program.
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  - So what has changed over the past few
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  - years that allows your program to scale to
• 7:52
  - that level?
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  - Yeah. I think several things have really come
• 7:56
  - together,
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  - and most of it has really been building
• 7:59
  - on the foundation,
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  - that was established at Tufts, you know, several
• 8:02
  - years ago.
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  - A big part is the trust that we've
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  - built with cardiologists in our shared care centers
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  - throughout New England.
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  - They know our team. They can access us.
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  - They know how to reach us, and they
• 8:14
  - remain really involved in the care of their
• 8:16
  - patients.
• 8:18
  - But then we also have advances in donor
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  - utilization. So the preservation,
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  - transportation
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  - have expanded
• 8:25
  - the opportunities available to those patients.
• 8:27
  - And, simultaneously, we're growing our clinical teams and
• 8:30
  - our hospital capacity to support that work. So
• 8:33
  - our advanced heart failure program, cardiogenic shock management,
• 8:37
  - ECMO expertise,
• 8:39
  - really allows us to care for very complex
• 8:41
  - patients,
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  - while,
• 8:44
  - getting them set up for for a heart
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  - transplant.
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  - Amazing. And do you have any advice for
• 8:50
  - other heart transplant leaders? They're at beginning of
• 8:53
  - their journey, but they're trying to have the
• 8:54
  - same expertise that you do.
• 8:57
  - Yeah. I think it's, you know, evaluating, looking
• 8:59
  - at the process holistically,
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  - both from the team's perspective, but also from
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  - the patient's perspective,
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  - and looking at the process from the point
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  - of the patient's,
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  - first encounter with our team all the way
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  - through their post transplant care,
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  - and designing a system that your team can
• 9:16
  - support,
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  - but also a system that is is very
• 9:19
  - patient centric.
• 9:21
  - Perfect. Well, this has been such a great
• 9:23
  - discussion. I really appreciate you joining me on
• 9:25
  - the podcast today.
• 9:27
  - Thanks so much for having me, Mariah.