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Northwell Health: Long Island's new organ transplant destination

For heart, kidney, liver and more, Northwell is making it happen through scientific innovation, guided by a new transplant chief with a plan.

A cell phone rings. The man wearing mahogany cowboy boots apologizes profusely but he has to take a call. It's understandable. As Northwell Health's vice chair of surgery and director of solid organ transplantation, one of the certainties of Lewis Teperman's life is this: when a vital organ becomes available, his phone is going to ring.

"This call is important," he says, winking. And it is.

Dr. Teperman is in the middle of procuring something essential. It is one day before Passover and the liver transplant surgeon's family is hosting the Seder. "Could you imagine if there wasn't horseradish?" he says. "The previous person I spoke to said they didn't have any horseradish. At Passover? Nonsense."

He hangs up and smiles. It's the natural byproduct of a successful outcome. The good news for patients is that Dr. Teperman smiles a lot. Back in 2016, he joined Northwell to launch a new liver and transplant program after founding NYU's Organ Transplant Center in Manhattan. He served there for 27 years and now, the born and bred New Yorker is helping make Northwell a destination for transplant services from liver and heart to kidney, bone marrow, islet and more.

But cowboy boots? In New York?

"Been wearing them since my high school days in the Bronx," Dr. Teperman says. "I used to ride horses in Van Cortlandt Park." Manhasset may not be the Wild West but when it comes to transplant services, Long Island does remain largely unchartered territory. So maybe a cowboy mentality and those boots will come in handy.

"I was recruited to make Northwell the best transplant program in the Northeast and there is certainly an opportunity to do that and improve access for Long Islanders," Dr. Teperman said. He notes that the number of Northwell's adult kidney transplants have nearly doubled in one year, going from 34 to 65.

"There are small kidney transplant programs on the Island but we wanted to change that. You're looking at more than seven million people who really didn't have a major transplant program and had to go into the city for care. On Long Island, heart transplantation didn't exist, liver doesn't yet exist, and pediatric transplantation of any kind didn't exist. None of it really existed until we started it. But they will all exist under Northwell. It's a very forward-thinking approach."

Eliminating hardship

Dr. Teperman explains that 40 percent of the patients he was transplanting in Manhattan came from Long Island. "Patients went to the city because they had to," he said. "It's a huge hardship for these patients to come back and forth from Manhattan in terms of time, money and family issues." There are more than 120,000 people waiting for organ transplantation in the US. "More than 10 percent of that list is in New York and the majority of these patients come from Northwell just because of the breath and scope of our facilities and service area. The patient population is enormous.

"We doubled the number of patients in our adult kidney transplant program and we will likely increase another 25 percent this year. We also opened the pediatric transplant program at Cohen Children's Medical Center and we've done seven. The first pediatric transplant patient, Matthew Francis celebrated his one year anniversary by throwing out the first pitch at Citi Field (March 31) to mark the anniversary. "The results have been spectacular."

quotation mark The vision here is that we’ll be at the forefront of transplant medicine. We’re proud of that. If imitation is the sincerest form of flattery, I do believe everyone else will be copying us.
Lewis Teperman, MD

An ocean away

These are all hallmarks of a successful transplant program. But if you ask a veteran surgeon like Dr. Teperman how success is measured, he takes you an ocean away to Dublin, Ireland where a yellowed newspaper article hangs on the bedroom wall of a 17-year-old boy.

"I transplanted a gentleman 15 years ago. He owns an Irish restaurant in New York and his brother came over from Dublin to donate half his liver. A decade and a half later, I was taking a trip to Ireland and the recipient, donor and their 84-year-old mother insisted that I visit the family when I was there. When I did, the donor's son, who was 2 years old at the time his father donated his liver, had an article about that event hanging on his wall. That says everything. Health care transforms families. You never know how far it reaches."

Living donations, a warming trend and a new building

Since its inception, both the art and science of transplantation has been dependent on organ preservation. That continues to be the case but Northwell is already innovating to improve upon currently standards.

"When you take an organ out of the body, it only has a certain amount of time to exist. We apply a preservation solution and cool the organ," Dr. Teperman said. "We have this idea that instead of cooling it maybe we should instead keep it warm. If we pump the organ with blood and give it nutrients maybe we can keep it out of the body longer, assess it and take injured organs and nurse them back to health to use for transplantation."

Currently, there are trials in Europe and the US and Dr. Teperman explains that once the warm preservation devices are licensed in America, Northwell will put them into use. "The organ preservation room in our new building being constructed at North Shore University Hospital will house this device," he said. "Timeframe for approval is next year, about the time the new transplant center is scheduled to open." It's one of the reasons he is so confident Northwell will be the leading program in the Northeast.

"Northwell has come up with an innovative idea to increase deceased donation. We have an eICU (electronic ICU) interface that helps nurses and doctors remotely take care of patients but can also identify early on whether someone may be a candidate to be a donor. Time is of the essence in these cases. It enables us to connect with the procurement agency LiveOnNY. Quicker notifications mean we are able to take people to the OR quicker and secure and transplant donated organs quicker."

Also on the docket, he says, is a greater investment in living transplantation."We need living donation because there are not enough donors in the US," said Dr. Teperman, adding that 35,000 people are transplanted in the US and the rest of those people approximately 85,000 don't. "There's a shortage in New York because heart kidney and liver disease have higher incidences here. We're devising newer techniques to do living donor liver transplant because the liver is a unique organ that can grow back. At the end of nine months, there are two whole livers. It is a very labor intensive operation but it is absolutely something Northwell is committed to doing."

Transplant expertise makes all of the difference

Dr. Teperman says he would stack up the Northwell transplant with any other program. "We've already changed the way living renal transplantation is done here in New York. One of the surgeons we recruited is Ahmed Fahmy, MBBCH. He developed a technique called single port donor nephrectomy, where a small belly-button incision is made to remove a kidney. He's done 25 of them here already. No one else does them on the Island. He's an outstanding surgeon. It has increased the number of live donors that are looking to Northwell."

Part of the key to transplantation services is an expertise in immunosuppression, Dr. Teperman says. "Using these medications so patients can live a lifetime is the goal. We have the expertise to lower them so patients become more tolerant to the organ transplanted and can be weaned off some of the medication. That's the art of transplantation," Dr. Teperman said. "The people in our program understand that. They are the best in the business."

That mix of art, science and innovation is already apparent in Northwell's program. It's why Dr. Teperman is so confident Northwell will be the transplant center others will look to emulate in breath, scope and quality of service.

We will become very large very quickly. There is no question, he explains. "The vision here is that we'll be at the forefront of transplant medicine. We're proud of that. If imitation is the sincerest form of flattery, I do believe everyone else will be copying us." Dr. Teperman smiles. There is such a confident combination of New York swagger and cowboy sensibility in that statement that you can almost picture him adding that famous cowboy-inspired movie quote that begins with "Yippee ki yay …" and ends with the unprintable New York subject for emphasis.

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