Developments in Transplantation: Q&A with ASTS President Charles M. Miller, MD

In this Q&A with Consult QD, President of the American Society of Transplant Surgeons (ASTS), Charles M. Miller, MD, Director of Liver Transplantation in Cleveland Clinic’s Transplantation Center, weighs in on key developments in transplantation and reflects on his presidency.

Consult QD: Your ASTS presidency comes to a close soon. What are the most important accomplishments during your tenure?

Dr. Miller: It is truly a healthcare crisis when you have 70,000 to 100,000 people on waiting lists for organs. So many people die waiting. I’ve focused my presidency on improving organ donation. It’s my BHAG — big hairy audacious goal. We are striving to make organ donation the rule rather than the exception. Improvements are being made, but we need to do better.

Organ donation is supposed to be a gift, and not require a living donor’s money or resources. There are many hidden costs — housing, transportation, lost wages, etc. We have done a lot of work to improve donors’ lives and keep them whole financially, including getting private insurance companies involved. But again, there is more to be done.

A new Transplant Therapeutics Consortium, including ASTS, pharmaceutical companies and the FDA, is working to improve the pipeline of new transplantation drugs.

Since transplant program results are getting better and better, we are working with regulatory agencies to create realistic quality metrics and regulations to encourage surgeons to accept more organs.

We have also helped fund a study at the Institute of Medicine to examine how to improve research in deceased donors, specifically the value of creating a federal organization, something like a centralized IRB.

In June, our executive director, President-elect and I will be going to the White House for the Summit on Organ Donation. President Obama’s National Donate Life Month proclamation was quite detailed about the need to increase organ donation and reduce the size of the waiting list.

CQD: What are some of the emerging trends in transplant, topics likely to be on the agenda at the upcoming American Transplant Conference (ATC)?

Dr. Miller: Organ donation and doing the right thing for living donors will certainly be topics of discussion.

Normothermic machine preservation of donor livers, a new technology to improve preservation between harvesting and transplant, will be on the agenda. A pump circulates oxygenated warm blood and fluids through the organ, and the organ’s viability can be tested. This is a paradigm shift; it will allow us to use organs now deemed marginal and unusable, particularly in the case of donation after cardiac death (DCD). Cleveland Clinic has FDA approval for use in liver and lung preservation.

New and emerging immunological technologies, xenotransplant, transplant of other organs (uterus and penis) and use of organs from HIV-positive donors (the Hope Act) are also on the agenda.

CQD: Finally, can you tell us about how Cleveland Clinic’s liver transplant program has evolved over the past 30 years?

Dr. Miller: We perform 130 to 140 liver transplants in adults and children in Cleveland and in adults at Cleveland Clinic Weston (Florida), making us one of the nation’s largest programs. We are known for our living-donor program and for emphasizing donor safety, especially by using the left lobe. We try to promote living donation for children because it’s better for them too. We perform every type of liver transplant and pioneered split-lobar liver transplantation to be applied n two adults. In addition to working on the pump I mentioned, we are exploring presurgical planning using 3-D printing of organ replicas, and new diagnostic technology. I’m very proud of our talented team, thought leaders respected around the world.