One Flew Over the Cuckoo’s Nest holds special meaning for Richard and Carolyn Smith. Not because of the plot or skill of Director Milos Forman. Not because it gave Jack Nicholson the role that won him his first Academy Award.

Like any good movie, they remember it because of what happened next.

The Smiths were home watching the 1975 classic on March 10, 2021. They remember the date and time – 9:30 p.m. – when the phone rang.

UT Southwestern Medical Center was on the line. Doctors had a donor kidney for Mrs. Smith.

Both born and raised in Buffalo, New York, the self-proclaimed high school sweethearts had moved to the Lone Star State 15 years prior and were living in Lucas, about 30 miles northeast of Dallas. Mrs. Smith had coped with minor problems with her kidneys for two decades, though they never much hampered her lifestyle. Five years ago, her condition worsened. Doctors described it as a kind of kidney failure, concerned that if it progressed, she would have to consider dialysis and a transplant.

“We started looking at facilities throughout the country that were doing kidney transplants,” Mr. Smith said. “UT Southwestern immediately was high on our list because of its extremely good reputation.”

Mrs. Smith was placed on the national kidney transplant waiting list at eight different hospitals, including Mayo Clinic and Houston Methodist Hospital. For her, a transplant was the only option – even with an expected wait time of eight years.

“But if that is how long I had to wait, I’d do it,” she said. “I did not want to do dialysis. I simply didn’t want to be attached to a machine for the rest of my life.”

Over the next six months, the Smiths checked in at each hospital. What made UT Southwestern’s approach stand out was diligence.

“They thought of everything in assessing just how successful a kidney transplant recipient my wife would be,” Mr. Smith said. “They went the extra mile to make extra certain that they were giving a kidney to someone who would take care of such a wonderful gift.”

UT Southwestern placed Mrs. Smith on the kidney eligibility list in December 2020. She was told it might take up to a year to find a donor kidney. Three months later, as Nurse Ratched tried to wrest back control of her wards on the Smiths’ TV, the phone rang.

“I actually thought someone was pranking me,” Mrs. Smith said.

There was no time to waste. Without even grabbing a toothbrush, she and her husband flew out the door. In record time, they arrived at William P. Clements Jr. University Hospital. A nurse and an aide with a wheelchair stood waiting to whisk Mrs. Smith away to her final pre-op tests.

With all checks passed, she was admitted to the hospital at 1 a.m. Five hours later, she had a new lease on life.

After her successful transplant, Mrs. Smith spent the next six months going to UT Southwestern weekly for blood tests. Eventually the visits slowed to every other week, then once every three months. She worked steadily with the post-transplant team overseeing the regimen of up to 18 daily pills and vitamins prescribed to support healing and ensure her body didn’t reject the organ. Her diet included protein, plenty of vegetables, and fruit – except for grapefruit, which can impact the effectiveness of antirejection medications.

“And no more black licorice or Diet Coke – both of which were my guilty pleasures,” she said. “It’s the healthiest diet me and my husband have been on in our entire lives.”

It’s just one of many changes she’s noticed in the years since the procedure.

“Before the transplant, I was a different person – always on edge, it was just horrible,” she said. “Now, life is just better.”

Transplant leader

In recent decades, UT Southwestern has established itself as one of the country’s premier organ transplant centers. Specializing in kidney, liver, heart, and lung – so-called solid organs – transplant teams at the institution give critically ill patients a second chance at life.

But helping people take advantage of an extraordinary gift requires a coordinated team of specialists spanning surgery, intensive care, infectious diseases, nursing, nutrition, and each of the individual organs. Researchers pursue new ways to expand the pool of available organs and find new ways of evaluating, preserving, and transporting them. Surgeons train to handle complex transplant cases that sometimes involve multiple organs. Other care team members assess transplant recipients from initial evaluation through the life of the organ, using detailed protocols to communicate progress and results to physicians. Such a complex team has to function in concert to ensure the best possible outcomes for patients who choose UT Southwestern.

At the center of it all is Parsia Vagefi, M.D., Chief of Surgical Transplantation, Executive Vice Chair of Strategy and Finance, and Professor of Surgery at UT Southwestern. Since joining the institution in 2018, he’s witnessed the program’s incredible growth.

Before he arrived, UT Southwestern, performed a total of 55 kidney and 57 liver transplants. One year later, those figures nearly doubled.

Today, the Medical Center runs the largest transplant program in the region. Last year, it completed a record 473 procedures, a new milestone for the institution and the highest of any transplant program in North Texas for the fourth consecutive year.

“That’s pretty impressive,” Dr. Vagefi said. “The growth we now see is due to recruiting top surgeons, medical doctors, anesthesiologists, and specialized nurses and giving them all the right resources.”

In addition to completing more procedures, the program continues expanding its impact beyond Dallas to satellite clinics across the state in Fort Worth, Tyler, Lubbock, and even El Paso. Physicians also collaborate with local veterans hospitals.

The veterans initiative is a recent development. Most veterans seeking a transplant would have to travel to one of a limited number of hospitals. It often meant that Texas-based veterans needed to uproot to a specialized facility in Houston or beyond, including Nashville, Tennessee; Portland, Oregon; or Pittsburgh, Pennsylvania.

“It’s not an easy task when a veteran patient is dying of liver failure or on dialysis,” Dr. Vagefi said, adding that UT Southwestern has pursued partnerships that allow veterans who call North Texas home to stay here for treatment.

The institution has also worked over the last five years to reduce the time transplant patients stay in the hospital. On average, patients receiving a liver transplant are hospitalized for 10 days. At UT Southwestern, they go home in half the time.

“Imagine the difference in the patient experience if your average stay is five days less,” Dr. Vagefi said. “It means you can go home earlier and return to work earlier, reducing hospitalization costs. And for the hospital, it opens up another bed faster for other patients.”

Out of the cold

In the past six years of Dr. Vagefi’s leadership, UT Southwestern’s transplant program has increased its participation in national clinical trials, working to modernize the preservation and transport of donated organs. The innovations represent a vast improvement over older methods that limited the number of hours an organ could be preserved.

The device attaches to the donated organ, supplying it with oxygenated, warm blood. Mimicking the conditions in a human body, the system ensures the organ continues to receive oxygen and nutrients, so it remains viable longer and is ready for transplant when it arrives in the operating room. Placed in the device, hearts continue to beat, livers produce bile, and lungs expand and deflate.

Things have come a long way from keeping organs on ice.

“It’s comparable to trying to start your car in the dead of winter – it takes a while – as opposed to having it already running and ready to go,” said Dr. Vagefi, comparing the new Organ Care System with previous refrigeration methods. “This new machine expands your donor pool so that, now, you might get a liver from California or a heart from Hawaii. That makes a huge impact on the number of transplants done.”

The device has been approved by the Food and Drug Administration and represents a significant step forward in increasing the number of patients across the country, and perhaps beyond, who can benefit from a transplant, underscoring the Medical Center’s contributions.

“Truthfully, these new preservation-transport machines allow us to push the envelope in how complex a case we are willing to take on and, as importantly, how far we are willing to travel to recover organs,” said Matthias Peltz, M.D., a Professor of Cardiovascular & Thoracic Surgery at UT Southwestern.

Current organ transport technologies allow UT Southwestern transplant teams to travel as far away as 1,500 miles to receive a donated lung and 1,000 miles to transport a healthy heart. New advances in organ preservation will allow the team to recover organs from throughout North America, helping to reverse trends in organ viability. Currently, 70% of hearts are declined for transplant. For lungs, the number is closer to 80%, all because of concerns about whether the organ can be preserved during transport.

Beating the numbers

In addition to being a surgeon, Dr. Peltz also serves as UT Southwestern’s Surgical Director of Cardiac Transplant. The institution’s thoracic transplant teams perform more than 50 heart transplants and nearly 70 lung transplants each year.

A decade ago, doctors often implanted a ventricular heart pump as a temporary solution until patients were deemed ready for a full transplant. As medicine has evolved, fewer patients undergo that interim step. UT Southwestern has gone from an average of 20 heart transplants a year in 2012 to more than 50 today.

As transplant numbers increase, so does the complexity of transplant cases.

“We’re now the only program in North Texas that has combined heart and lung transplantation,” Dr. Peltz said. “When both organs are severely diseased and replacing them is the only way to treat the patient, we literally replace most of the chest contents in one operation.”

Even with the rapid pace of innovation, UT Southwestern continues to put patients first. The one-year survival rate for patients receiving a heart transplant at the Medical Center is almost 95%, exceeding the national average of 91.7%.

“I attribute it to the surgical and medical expertise of our team,” Dr. Peltz said. “We understand how vital it is to avoid complications like organ rejection and other serious infections.”

Future improvements

As a result of their life-altering experience, the Smiths chose to give back to UT Southwestern. Their generosity has supported the doctor who worked closely with Mrs. Smith after her transplant, David Wojciechowski, D.O., Medical Director of UT Southwestern’s Kidney Transplant Program and an Associate Professor of Internal Medicine and Surgery.

With an interest in post-transplant care, Dr. Wojciechowski is mindful of complications and negative side effects that can arise from the number of medications needed after transplant surgery and the reaction of the body’s immune system.

“They went the extra mile to make extra certain that they were giving a kidney to someone who would take care of such a wonderful gift.”

“From the moment someone like Mrs. Smith is discharged from the hospital after the transplant, we see them consistently in clinic,” Dr. Wojciechowski said.

His research focuses on consequences of antirejection drugs most transplant patients need after surgery. Common side effects include nausea, depression, some cancers, and infections.

“Where the Smiths’ philanthropy has had the greatest impact is in helping me look deeper into these post-transplant medical issues,” he said. “And when the Smiths learned that my research involved looking at novel regimens and ways to minimize the toxicity of post-transplant drugs, they made a gift to us specifically to help with that work.”

The gift enabled Dr. Wojciechowski to grow his research team, adding a research fellow to code data and provide statistical analysis for a kidney transplant trial. Funds also supported travel and educational expenses for trainees.

Importantly, the gift creates opportunities to recruit renal and nephrology trainees who aspire to be part of the next generation of transplant surgeons. For Dr. Wojciechowski, one of the main goals of his lab is to help launch aspiring transplant doctors, something that was also important to the Smiths.

During her recovery, Mrs. Smith participated in a clinical trial through Dr. Wojciechowski’s lab that was part of a global study looking at how new antibodies could help prevent post-transplant infections. The family’s philanthropy has provided funding to continue the research team’s work across a number of clinical trials, allowing the team to join national efforts to advance transplantation and provide access to post-transplant therapies.

“We have to give our transplant patients a reason to come to UT Southwestern,” Dr. Wojciechowski said. “And what we offer that is different is the expertise through our clinical trial units, which all help produce new innovations in drugs and cost-effective therapies in transplant medicine.”

Through the studies, UT Southwestern researchers are looking for ways to wean post-transplant patients off medications. The team works with patients who are taking a maintenance regimen of three immunosuppression drugs. By using new diagnostic tools to monitor their immune system’s response, the team hopes to decrease the number of medications down to one, dialing back the need for immunosuppressants and minimizing the risk of toxicity.

“There is no doubt the Smiths’ gift was transformational,” Dr Wojciechowski said. “It allows us to do some invaluable, patient-centric work to help make transplantation better for the future and to make transplant medicine one of the true strengths of UT Southwestern.”

The Smiths could not be happier with the work Dr. Wojciechowski is pursuing to improve the lives of transplant patients.

“I am grateful to UT Southwestern for my life,” Mrs. Smith said. “Where I was hopeless before, I now have hope.”

To learn more about becoming an organ donor, visit organdonor.gov.

• Dr. Peltz holds the Sarah M. and Charles E. Seay Distinguished Chair in Thoracic Surgery.
• Dr. Vagefi holds the Ernest Poulos, M.D. Distinguished Chair in Surgery.