Atoosa Rabiee, MD, chief of transplant services at the Washington, DC VAMC
WASHINGTON, DC — Each year, approximately 1,800 veterans are evaluated by VA for eligibility to receive an organ or bone marrow transplant, with approximately 450 veterans actually undergoing transplantation.
The much greater distance between VA patients and transplant centers compared to patients using private insurance—282 miles versus 22 miles for those seeking kidney transplants—has resulted in lower transplant rates in VA than in the private sector, however.
Thanks to the work of Atoosa Rabiee, MD, chief of transplant services at the Washington, DC VAMC, those barriers to transplantation are shrinking for liver and kidney candidates in the Northeast. In November, VA added the MedStar Georgetown Transplant Institute (MGTI) to VA’s list of approved transplant centers, making it only one of five in the country to offer both kidney and liver transplants.
“Over the [six years] since I started at the DCVAMC, a collaborative relationship developed out of necessity of having mutual patients,” Rabiee explained. “Whether they were already transplanted at Georgetown and wanted to come back to VA and use their veterans’ benefits, or we had patients who wanted to be evaluated for a transplant and wanted a local option.”
Before this unofficial relationship developed, VA patients were referred out of the area for a liver or kidney transplant, sometimes requiring patients to travel hundreds of miles. Not only does Georgetown represent an option of convenience, but VA and university staff have worked to make the transition of care between the two different healthcare systems as seamless as possible.
“The faculty are completely different, and VA staff don’t really spend time at Georgetown,” she said. “So we’ve developed a standard operating procedure and tried to streamline the process.”
Asking for an official VA transplant center designation from VA’s National Surgery Office was the natural next step. It was officially added to the registry for liver transplants in November 2022, with kidney transplants coming online in April 2023.
“This is a very difficult time in a patient’s life,” Rabiee noted. “They’re sick, and they need to undergo a very complicated evaluation. They need multiple clinic visits, requiring interacting with different disciplines. We hope that the inclusion of Georgetown will make it easier for those veterans not just within our VISN but on the East Coast.”
As a transplant hepatologist, much of Rabiee’s day-to-day time is spent in the clinic, evaluating patients who are in need of a liver transplant or reevaluating patients who have undergone the procedure.
“That’s the most joyful visit,” she declared. “They’re literally like a new person post-transplant.”
As chief, her role is much more complex, and for the last two years Rabiee has had weekly meetings with the MGTI administrative officer and his team to refine the hand-off between DCVAMC and Georgetown.
“I oversee and attend a lot of administrative meetings in order to streamline the evaluation and transplantation steps,” she explained. “That includes getting patients here and making sure there’s a plan in place to get them [and their support person] here when an organ becomes available, then making sure there’s a smooth transition back to the VISN post-transplant. A lot goes into basically making sure that whatever is going on the medical side, [the patient] doesn’t feel a broken step.”
As for the future, Rabiee hopes to see DCVAMC increase its capacity to evaluate new transplant patients and care for patients post-transplant.
“Space has always been an issue for us, but we want to have clinics that we can access on an urgent basis and accommodate these patients if there’s a critical need to be seen quickly. Hopefully that will come within the next couple of years,” she said. “There’s also a steep learning curve for in-patient services, ER staff, and ICU staff to feel comfortable taking care of patients who are sick and on a transplant list or have been transplanted. There are intricacies that you always have to be aware of when taking care of these patients. I want [taking care of these patients] to be more common.”
During her interview with U.S. Medicine, Rabiee received news that Georgetown’s status as an official VA transplant center had just reached a very significant milestone.
“We’ve listed a lot of patients [since adding MGTI to the list of approved centers], but I just got the email that our first patient is actually in the operating room getting a liver transplant,” she declared. “The veteran traveled from Syracuse for the procedure. A lot of care coordination went into making that possible.”
