HMC’s closure leaves hundreds of transplant hopefuls in limbo [Honolulu Star-Advertiser (HI)]

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Esther Aiolupotea, a 35-year-old Kalihi resident, was prepared to get a bone marrow transplant Monday for an aggressive form of leukemia when she was blindsided by news that her procedure was canceled as a result of the closure of the Hawaii Medical Centers.

"This is a matter of life -- my life was in (HMC's) hands," she said. "Now it's a waiting game. As I'm waiting I don't know what my body is going through."

Hundreds of patients with organ failure and a number of others with aggressive cancers in need of transplants are in limbo as Hawaii's medical providers scramble to get a new transplant center up and running.

HMC, which is closing the former St. Francis Medical Centers in Liliha and Ewa over the next few weeks, operates the only organ transplant center in the Pacific. The Transplant Institute of the Pacific shut down on Friday when HMC's Liliha hospital stopped admitting patients.

For some critical patients who were ready to get organ or bone marrow transplants within the next few weeks, the loss of the transplant center is a huge setback and potentially life-threatening.

"This is a crisis for our cancer patients who need bone marrow transplants," said William Loui, chief of oncology for the Queen's Medical Center and medical director for HMC's bone marrow transplant program. "They could die within weeks to a few months."

One Honolulu resident suffering from end-stage liver disease was transported over the weekend by air ambulance to a mainland institution, said Whitney Limm, Queen's vice president of clinical integration and HMC's kidney transplant director. Another patient is being prepared this week for possible transfer to the mainland while organs donated by a family last weekend were transported to the East Coast.

Queen's said Tuesday it has applied to create an organ transplant program in the wake of the pending closures. But it could take up to six months before it is operational, and Queen's has only committed to providing organ transplants, leaving patients waiting for bone marrow procedures no alternatives in Hawaii.

About 100 organ transplants are performed each year in Hawaii, although nearly 450 residents are on the waiting list, mostly for kidneys. Roughly 5 percent of wait-listed patients needing kidney transplants die each year.

An additional 15 patients are in need of bone marrow transplants, the majority of whom must be treated within the next one to two months because of the aggressive nature of their cancers.

Aiolupotea found her match with her sister and was scheduled on Monday to begin a weeklong, high-dose regimen of chemotherapy before the transplant surgery. She is now waiting for her insurer to approve her transfer to a Seattle facility. Even then she still has to come up with the money to get there.

"This is such an emotional time for all of our families," said Jane Lee, HMC's liver transplant coordinator. "Everybody from the sickest patients to the most stable are frightened."

Sandra Teer, a 64-year-old Hilo resident with cancer of the plasma cells in bone marrow, had scheduled a second transplant Jan. 6 after her first procedure failed to rid her of the disease. She is now praying for a miracle.

"I need to get rid of it completely, otherwise it will start growing again and attack different parts of my body," she said. "I just want it to be done and over with. If I want more quality time with my family, then I must have it done. I always leave it in God's hands."

Without a transplant facility, both organ and bone marrow patients will be forced to travel to the mainland. The process is complicated because of the short shelf life of organs, ranging from five hours for hearts to 36 hours for kidneys.

Transplant centers typically require patients to live near the facility, so many patients and their caregivers might need to relocate while waiting for organs.

Traveling is significantly more costly for patients. Private insurers and Medicare -- which covers seniors -- do not pay for transportation and lodging.

Medicaid, a publicly funded health insurance program for the indigent, pays for travel-related costs for transplants, though at the expense of taxpayers. Transplant procedures cost on average $150,000 to $300,000, not including travel expenses.

"The cost to the state and to the taxpayers is going to be enormous," said Cathy Bailey, HMC's transplant manager.

While there are no other options but transplants for heart and liver failure, patients suffering from kidney disease can be treated for years with dialysis, the clinical process of purifying the blood. Likewise, patients needing a new pancreas can live on medications such as insulin.

Kidney dialysis services separately operated by Liberty Dialysis LLC will continue at private facilities on the Liliha and Ewa hospital campuses.

Meanwhile, the state and federal Centers for Medicare & Medicaid Services said it will expedite the approval process for a new organ transplant program.

"We're doing the best we can to prevent the crisis," said Donalyn Dela Cruz, spokeswoman for Gov. Neil Abercrombie's office, which met with medical providers Tuesday to ensure hospitals have the capacity for additional patients.

Rapid-response sessions will help address unemployment claims

The state Department of Labor and Industrial Relations said it will make its rapid-response services available to the nearly 1,000 Hawaii Medical Center employees who will lose their jobs when the company closes its two hospitals on Oahu in the coming weeks.

The DLIR will hold a total of 24 sessions today and Thursday at the HMC locations in Liliha and Ewa to provide information on applying for unemployment benefits, health insurance options, work-force training programs and other services.

There will be six sessions daily at each hospital starting at 6:30, 7:15 and 11:30 a.m. and 12:15, 2:30 and 3:15 p.m.

HMC employees will be advised to file their unemployment insurance claims online and to wait until they are officially separated from employment before submitting the claims, DLIR officials said.

"Our hearts go out to the nearly thousand employees and their families who received this news during the holiday season," said Dwight Takamine, DLIR director. "We hope the rapid response will help alleviate the uncertainty for employees and their families in this difficult time."

Star-Advertiser staff

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Credit: Kristen Consillio