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The Story of the Howard University Transplant Center (A Project of the People)

Clive O. Callender, MD and Patricia A. Apaulding, BC Washington, DC

It took almost two years for Howard University Hospital to receive certification as a kidney transplant hospital under the federal government's end-stage renal disease program, although Howard had a transplant program that was comparable to many in the country.

By the time the Department of Health, Education, and Welfare approved Howard's program, many successful transplants had already been carried our there, largely on indigent patients who probably could not have received transplants elsewhere or on patients whose chances of survival, because of other complications, were so risky that other hospitals had turned them down. At first the high cost of these operations had to be asorbed by the University since the government reimbursed only those hospitals which had an approved transplant program.

Howard University hospital has been approved by the Department of Health, Education, and Welfare (HEW) as a Kidney Transplant Center under the federal government's end-state renal disease program. the HEW certification, coming almost two years after Howard first applied for it, is the direct consequence of the hard work of many Howard University employees and friends.

Howard first applied for temporary certification in 1973 immediately after the passage of federal legislation HR-1. HR-1 authorized the Social Security Administration to develop a program which would provide kidney transplant and dialysis for United States citizen in need of them, despite the patient's inability to pay the exorbitant costs involved. HR-1 provides for federal payment for such treatment, but only to certified transplant centers.

According to HEW guidelines set up by a Steering committee comprised of the Regional Medical Program Services and the Joint Commission on Accreditation of Hospitals, the temporary certification was to be effective until HEW could identify the hospitals in an area capable of providing the most advanced diagnosis and treatment techniques and methods fo end-stage kidney diseases. The Committee proposed that there be one kidney transplant ceter per every two million people in the United States. This meant that Washington could eventually have only two centers. The HEW guidelines, however, did not stipulate the number of centers which could receive temporary certification. Even though more transplants were done there in 1974 than in other civilian hospitals in the area, no on-site evaluation was ever done at Howared to determine whether or not its kidney program was one of the most advanced.

Although Howard qualified for temporary certification according to the guidelines, which state that consideration for certification be given to those hospitals that had made commitments to develop kidney transplant programs prior to the passage of HR-1, its request was turned down and no specific reason was given for not granting the certification. A "grandfather" clause in the guidelines provided for interim certification to those hospitals which had already performed at least one kidney transplant (Georgetown and George Washington).

Georgetown, George Washington, and the Hospital Center all received certification in 1973, although federal officials later declared that the Hospital Center's certification was granted in errors because it had not performed kidney transplants prior to HR-1.

It is hard to state precisely when the idea of transplant activity first began at Howard but, in 1964, Dr. William E. Matory of the Department of Surgery performed the first animal kidney transplant and also was firs to use the artificial kidney in dogs in Howard's Surgical Research Laboratory. Following a priod of preceptorship in the dialysis unity at the Washington Veterans Administration Hospital in 1966, Dr. Matory initiated the hemodialysis program at Howard University. He initiated the use of arteriovenous shunts in patients needing chronic dialysis in 1969. This pioneering work then served as the foundation for the kidney transplant activity which was to follow.

The work begun by Dr. Matory was continued by Dr. Oswald Warner, a thoraic and cardiovascular surgeon, who returned to the Howard University faculty in July 1970. It was he who mastered the problems of vascular access which allows patients with kidney failure to be kept alive on artificial kidney. No less important was the pioneering work of nephrologists, Dr. Edward Chappelle, Dr. Ddrian Hoston and Dr. Martin Dillard, all of whom were on the Howard University staff and who developed and sophisticated the  hemodialysis program. These doctors fought to have Howard University participate in the planning of a regional transplant program even before the University had a transplant surgeon.

Dr. Burke Syphax and Dr. LaSalle D. Leffall, Jr., former chairman and present chairman of the Department of surgery, respectively; Dr. Charles S. Ireland, Dr. Vincent J. Roux hospital director and medical director, respectively; and Dr. Carlton P. Alexis, vice president for health affairs, were key figures in the development of the kidney transplant program at Howard University.

In 1971, Dr. Clive O. Callender, who was Howard's chief surgical resident in 1968-1969, was sent to the foremost kidney transplant center in the world at the University of Minnesota to train as a Clinical Transplant Fellow. In July 1973, he returned as transplant director at the Howard University Hospital which was then Freemen's Hospital. His return occurred at the same time that the federal government had stepped into kidney transplant activity.

The initial refusal of certification to Howard as a transplant center was viewed with some pessimism and many fel that there was little likelihood that Howard woul ever recieve approval. Fortunately, this was not the view of the administrators of the hospital who endorsed this embryonic transplant program without reservation. Upon Dr. Callender's return, the support given him by the hospital's administratiors, the nursing administration, the chairman of the Department of surger, and the Department of Anesthesiology was invaluable.

The initial planning and training of the transplant team were assisted in great measure by the procurement of a $500 grant for th Kidney Foundation, and $20,000 grant from the Regional Medical Program. This money was used to assist in the training of the nursing and surgical transplant teams. Particularly important at this stage was the cooperation of Maude Jennings, associate director of Nursing, in charge of the operating room; Thomasina Wigfall, head nurse of the Annex Operating Room; Gwendolyn Webster associate director of Nuring, The initial phases required the cooperative efforts of these nurses as well as the nursing teams on the wards. Here, Charlotte Reid and Geneva Greene, head nurses on the renal units, played vital roles in the development of the Transplant Services. Of equal importance were the services provided by the hospital security guards in the procurement of organs from other hospitals. These services were provided under the leadership of Captain Roy Williams. No less important was the role of the environmentalists in assuring that the role of the environmentalists in assuring that the rooms were appropriately cleaned and sterilized in the wards as well as in operating rooms. This general cooperation was typical in every department that was called upon to assist the transplant team in its development. The role of the urological team, as provided by Dr. George Jones and Dr. Aaron Jackson, was overwhelming.

With the foundation having been laid and preparatory operations having been