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Interviewer: For patients with lung disease, deciding what medical center you'll partner with for a lung transplant is a big decision and there are a lot of factors to take into consideration. But today, we're going to help answer some of those questions you might have.

Dr. Matthew Morrell, he's dedicated his career to ensuring patients who need lung transplants get them and also have the best outcomes possible. He's been at some of the biggest lung transplant centers in the United States, and now he's the medical director of The Lung Transplant Program at University of Utah Health.

Dr. Morrell, thank you for sharing your expertise. And the first question is I learned that sometimes a patient diagnosed with lung failure isn't even told that a lung transplant is an option. That really surprises me. Explain that for me.

Dr. Morrell: Honestly, it's interesting. Not a lot of people or lung doctors in the community even think this is an option. There's a lot of misinformation, miscommunication between providers and patients that are out there. So our goal has really been to reach out to providers, to reach out to doctors, to really educate them about lung transplant as a potential option.

Interviewer: So if a patient has been . . . if that's never been mentioned, or they've been told, "Maybe that's not an option," it might be a good idea to seek out a second opinion.

Dr. Morrell: That's exactly right. So we here at the University of Utah, we're always willing to talk to any patient that has any questions, even those that don't necessarily even have a referral from a lung doctor, their lung doctor isn't in the community. We've seen patients that call up and just want to say, "Hey, I want to speak to somebody that can give me more information about lung transplant," and, "Hey, am I a candidate? What makes a good candidate? What doesn't?"

Interviewer: Yeah. Obviously, you know all those things. You live it every day. Let's say a patient has been told that they are a candidate for a lung transplant, or maybe that's an option they should consider. Based on what you just said, maybe a patient thinks that a transplant would be a good option for them. Does the patient get to pick the medical center where the procedure is done, or is it kind of when I've got a cold, I'm going to go to the nearest InstaCare?

Dr. Morrell: Well, patients, yes, they have the option of choosing where they want to go to get their lung transplant. Insurance sometimes does dictate where they can go, but honestly, if a patient says, "Hey, I want to come to University of Utah," they just talk to the provider, and that provider can make that referral down to us.

Interviewer: So that's great that a patient gets to choose. In a way, that's great, right? But it also comes with a lot of decisions that have to be made, a lot of things that have to be weighed. So what would you say to a patient that's trying to make that decision of choosing a center? What are some of the things they should consider?

Dr. Morrell: Well, honestly, you want to look at the center's history. How long has that center been doing lung transplants? How many patients have they transplanted? How many patients do they transplant a year? Are they doing research in the field of lung transplantation at that institution?

And also, talk to patients that have actually had transplants there. We can give you the names of a couple of patients that have had transplants and you can call them, speak with them, and they can tell you their personal opinion about how that process was for them.

You can speak to a coordinator and get your questions addressed even before even coming to the University of Utah. And when you do come for your initial appointment, it's mostly a meet-and-greet. No pressure. It's just an information gathering. How do you feel? Have you made that bond with that physician? Is that physician someone who you can trust? Is that someone who you want to be your advocate for you going forward as you get evaluated for lung transplant?

Interviewer: One of the challenging things for lung transplantation is you're on that waiting list and you're waiting for that match, that donor match to come. And sometimes, it can just by chance come very quickly, or sometimes it might take a while. Are there things that are done at particular institutions such as University of Utah that could help increase the chances that a lung donor gets a match more quickly?

Dr. Morrell: Oh, absolutely. So we are the only lung transplant program in the Intermountain West. So that means that not only do we see a lot of patients from not only inside of Utah, but the surrounding states, Colorado, Nevada, Oregon, Idaho, Montana, parts of Arizona. We're getting patients referred to us.

On top of that, we have to get donors. If there's a donor that is in another state, that does come to us. So we do have a lot more access to some of these donors versus if you were living in a city like Los Angeles. There are a lot of other centers there. There's a handful of lung transplant centers.

And so there's a lot of competition when a donor becomes available to try and match that to a recipient versus us. We're it in the Intermountain West. So if you get evaluated and get placed on the list, your chances of getting a transplant are pretty good.

Interviewer: Another consideration with lung transplant is rejection. But technology and techniques are improving. Tell me about some of the things that are done at University of Utah Health that help reduce that risk of rejection and help treat rejection.

Dr. Morrell: We are very aggressive once a patient gets a transplant in terms of keeping an eye on someone's lung function, on their blood work. We have patients coming pretty frequently after surgery for follow-up when rejection is the highest. So if rejection is going to happen, we catch it firsthand and we deal with it.

We're involved in some of these research trials for some of these new medications to treat rejection. So if rejection is going to happen, we catch it early, we handle it, we treat it, we resolve it. And for those patients that may have rejection that is more difficult to control, we're using the cutting-edge research technology to cure rejection, to overcome it, and to improve survival.

Interviewer: Another component of lung transplantation is the average life expectancy after a lung transplant, which kind of shocked me. It's about five years. I thought it was a lot longer than that. But are there some things that you can do that actually will help stretch that out?

Dr. Morrell: We are very vigilant at catching problems if they do happen. We have access to nutritionists, a physical therapist that if someone has something that could affect their overall survival, we have access to state-of-the-art therapies even outside of lung transplant here at the hospital that can really help and improve survival.

Interviewer: What I'm really getting about lung transplantation, the skill of the team that is doing the transplant is super important. But with lung transplantation, it sounds like the work that's done before the transplant, and even the work after the transplant, is really important. And that a patient should feel as though when they're at an institution, that if they have an issue, they're going to be able to contact somebody, and that they're going to hear back from the department. I mean, it sounds like that could be a matter of getting more years out of your transplant or not.

Dr. Morrell: Exactly. There's always a nurse coordinator here on call 24/7. There's a pulmonologist on call 24/7. And along that pre-transplant side of things, as you mentioned, I want to add that we encourage patients to come early for their evaluation so we can take a look at you. And if there is a problem, if there's something we can work on, if you're a little bit overweight, we can address that, get you to lose weight. If you need some exercise, some rehab, we get you plugged into that too. If your heart needs to be looked at, we get you into the cardiologist.

We want to have that time to really optimize you, to get you in the best shape you can be prior to your surgery, prior to your transplant, to really have you be that patient that exceeds that average survival, that you're that patient that 25 years out from transplant, you're loving life, you're active, you're traveling, you're living life to the fullest, and you're as healthy as you can be.

Interviewer: So the average time of survival is five years, but you just mentioned 25 years.

Dr. Morrell: Oh, yeah.

Interviewer: It can go much longer than that.

Dr. Morrell: Oh, yeah. That's the average survival. You take everyone that's had a transplant.

So sometimes in transplant . . . and again, not just here, this is everywhere in the world. Sometimes patients are super sick at the time when they go on that list. They may have some medical problems that ultimately recur after transplant, and sometimes they die within that first year.

On the opposite end of the spectrum, we have patients that are over 20 years out. It's so rewarding to me to see these patients that are doing so well. It's wonderful. That's why I do what I do.

Interviewer: Are you pretty good at being able to determine when a patient gets a lung transplant kind of what the average survival rate might be for that particular patient?

Dr. Morrell: Yeah, I think we get a general sense when someone does come. We take a look at somebody, we know their medical history, we go into very, very good detail, and so we do know risk factors. "Hey, I say because of X, Y, and Z, because of your previous chest surgery, because you're on this medication, this specific one, that you do fall into this high-risk category. You may be somebody that we really have to hope for the best for after transplant. If we choose to put you on the list, complications may happen."

When patients come for their evaluation, we don't want to commit them to a transplant early. We don't want to potentially shorten your survival by saying, "Hey, we're going to do a transplant even though you're not quite sick enough for a transplant." We do these early referrals that allow us to work on some of these modifiable risk factors that can influence survival.

But if we have time beforehand, we'll say, "Hey, you know what? Things look good right now, but let's have you come back in six months and if you start getting sicker, if you start needing more oxygen, and if your lungs start limiting your activity level, you may kind of be pushed into that gray zone where we say, 'Okay, now is the time. Now is the time when we need to get you on that list because based upon my assessment, you may not live without a transplant longer than a year. So now may be the time to get you on the list to really improve . . .'" The goals of transplants are improve longevity, improve quantity of life, and also improve quality of life.

Interviewer: If you want to learn more, just Google "lung transplant at University of Utah Health." There are a lot of great resources on that page there, including types of lung disease and the transplant surgeries that you might need for those. There's "The 10 Things to Know About Lung Transplant," patient stories about their transplant experience at University of Utah Health. Again, just Google "lung transplant University of Utah Health" to get those stories.

Dr. Morrell, thank you very much.

Dr. Campsen: If you are being evaluated for an organ transplant, you're going to come in to the University of Utah for a full day workup, and one of the people that you'll meet is our social worker. Today, we're going to talk about that part of the organ transplant visit.

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Dr. Campsen: My name is Jeff Campsen. I'm a transplant surgeon at the University of Utah and I'll be talking with Melissa Morales, one of our social workers at the University of Utah Transplant Clinic.

So we have people that come in who are in organ failure and need an organ transplant and we try to have them come in during a full day visit to meet a medical doctor, to meet our financial advisors, but also to meet you as the social worker. And I'd like to talk to you a little bit about what that visit's like and what is your role in that visit?

Melissa: Anytime I've kind of explained to patients what I do, I sort of start with, "I'm here to make sure that they are a good candidate and I want them to not be at risk." I take a detailed social history and some of the things that we talk about is their mental health history. We talk about having adequate support, this is family support, emotional support, making sure that they have sufficient resources. A lot of our patients are from out of state and so they have to stay here for up to four weeks.

And overall, it's about compliance. It's about making sure that they are going to be a good candidate, they're going to follow the medical team's recommendations so they have excellent results after transplant.

Dr. Campsen: So that's what they can expect from your visit. Is there anything else that they should be prepared for when they come in?

Melissa: I think it's important for them to know that the reason why we're here is because we want successful results. This isn't necessarily to rule someone out or to find out anything negative about them but it's really to see who they are and what resources they already have in place and what's available to them, how we can further help them if they need to be.

Dr. Campsen: So once you see them, you're going to give them recommendation to the Transplant Selection Committee on whether or not they should receive an organ transplant. And based on what you're saying, have you ever actually said no to somebody? And if you have, are there avenues for them to change and then proceed with their organ transplant?

Melissa: So I actually haven't ever said no. I would say that most of the patients are doing well. Again, they have this support, these resources in place. There are times where patients come in with unmanaged mental illness and they need additional support from either an individual therapist or a psychiatrist, and we help make those referrals to community services and get the help that they need.

Dr. Campsen: So as part of the transplant team then, how does your interview really affect the transplant process?

Melissa: So I sort of serve a dual role. I am there to evaluate and to assess how I think that they would do post-transplant. But I also am there to advocate, to link them to these community resources, to refer them out if they need to be. You know, we see these patients about once a year, and so there are times where I have to follow up with them more than that if there are any concerns on my end. So we get to build a connection, a relationship throughout their listing, and it's great.

Dr. Campsen: But this dual role is interesting because not only are you an advocate for the transplant program and helping the transplant program select the right people to give organs to, you're also a member of the team of the patient. And how do you navigate that dual role?

Melissa: You know, my goal, my purpose is to make sure that patients are successfully transplanted in a safe way and that they have the resources and support that they need, making sure that they're linked to exactly what they need that will help them have successful results.

Dr. Campsen: Well, I know what advice you've given me. What advice would you actually give a patient that was coming in to clinic to see you?

Melissa: I think something really important that I like patients to know is that their mental health really affects their physical health. If they are depressed or have anxiety, all those things are going to exacerbate especially after transplant, and I want them to know that we have these resources, we have ourselves, and we're available to help them through any sort of difficulties that they might have from an emotional, psychosocial side. You know, I really like making these connections with patients. Sometimes I do wish that I had more interaction with them than just once a year. But just seeing how successful they are, see how different their lives can be, a lot of them go back to work after several months and, you know, they talk about how grateful they are for our team and really for this process and having gone through that.

Dr. Campsen: I know that I always like to say that basically, once a patient gets listed and they get an organ, they're always a member of our team and they always have medical resources. But they also have social resources, correct?

Melissa: Right. Yeah, so we're available to them post-transplant. You know, we usually say for about a year after but we're happy to meet with patients any point whether it's been years out or, you know, within a few months.

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