Expanding Transplant Resources Throughout Michigan and Beyond
Nearly 750,000 people in the United States are living with end-stage kidney disease that will require dialysis or a kidney transplant. But with the disease disproportionately affecting minority and low-income patients, many will not receive these life-saving treatments.
The University of Michigan Health Transplant Center team is working to change that by establishing outreach transplant clinics in areas most in need throughout the state. These areas are identified based on distance from Ann Arbor, disease prevalence and high levels of poverty.
According to U-M Health transplant specialist Silas Norman, M.D., M.P.H., “We started our first transplant outreach clinic in Kalamazoo in 2009, with the recognition there were a number of individuals on the west side of Michigan who were medically appropriate for transplant but did not have access to resources based on their geography and financial needs.”
Recognizing the Transplant Center in Ann Arbor was difficult for many patients to reach, the team went about identifying underserved areas throughout Michigan that could benefit from a local clinic for pre- and post-transplant care, while undergoing transplant surgery in Ann Arbor.
A paradigm shift
“We thought it made sense to change the paradigm that expects patients to make their way to Ann Arbor, in particular those in far-away locations. We realized we should be going out into communities to improve access for patients. We want to be imbedded in these communities to make things easy for our patients and those who support them.”
Since the opening of the first outreach transplant clinic in Kalamazoo, others have been established in locations around the state, including Midland, Rochester Hills, Grand Rapids, Lansing and, most recently, Detroit. Locations are selected according to populations most in need.
“In the majority of locations, we’re partnering with local nephrology groups,” said Norman. “The clinics offer pre- and post-transplant care, eliminating extensive travel to Ann Arbor.”
Like all clinic locations, Detroit was selected because of the city’s high prevalence of kidney disease and low economic resources, says Norman.
“Our referring physicians in the area have told us they would send more patients to University of Michigan Health, but the patients find it difficult to get to Ann Arbor. Our outreach clinic is a great example of how we operationalize our Transplant Center mission and vision, which aligns with the entire U-M Health mission and vision to be more inclusive and improve access for patients.”
The model
The outreach transplant clinic model is based on providing local pre-testing services, with transplants performed at University of Michigan Health in Ann Arbor, along with early follow-up appointments there.
“Kidney transplant patients require 10 visits in the first year. Eight of those visits are in the first three months where patients are seen in Ann Arbor,” said Norman. “After the first three months, patients begin to have some of their follow-up locally.”
Specifically in Detroit, the team is looking at a model that will offer pre-transplant care along with early post-transplant care locally to help patients avoid travel. “This is another aspect of our commitment to deliver more and more of the care locally,” said Norman.
Harnessing our expertise
While these outreach transplant clinics are focused on kidney transplantation, the Grand Rapids location is also seeing patients with advanced liver disease.
“The idea is to harness the experience we have in outreach kidney transplant services to address other organ systems and see what might be appropriate for certain populations,” said Norman.
As a nationally recognized leader in transplantation, U-M Health cares for some of the more medically challenging patients in the state, says Norman. “We treat patients with complex conditions — medically, surgically and socially. We address issues of inadequate finance, insurance difficulties, transportation and other caregiver challenges. Our teams of social workers and financial coordinators work to ensure every medically appropriate patient has access to transplant opportunities.”
Looking ahead, the Transplant Center team is evaluating other areas that might benefit from an outreach transplant center, including locations in northern Ohio and northern Michigan.
“This aligns with U-M Health’s hospital-wide goal of delivering equitable care wherever it is needed,” said Norman.