Roanoke’s Carilion gets state OK for kidney transplants

Carilion Clinic has the state’s blessing to move forward with a kidney transplant program, despite public opposition from competitor UVA Health and a 2024 recommendation from the staff of the Division of Certificate of Public Need (DCOPN) that the Roanoke-based health system’s application be denied.

In an email Wednesday, Dr. Karen Shelton, Virginia’s health commissioner, approved Carilion’s application for the program and stated that it meets a public need.

Carilion offering a kidney transplant program, she wrote, will “improve access to renal transplant services for a significant number of end-stage renal disease patients … a large portion of whom live in rural areas and face time-consuming transportation challenges on a daily basis.”

Carilion announced Thursday that it expects to begin offering the surgeries in 2026.

Dr. David Salzberg, lead surgeon for Carilion’s kidney transplant program, emphasized at a press event held Thursday that the kidney transplant program has widespread public support. More than 1,500 community members sent letters to the DCOPN in support of the health system launching a kidney transplant program and 16 localities approved resolutions supporting the application, according to Carilion.

“The people of Southwest Virginia, Roanoke and the surrounding areas have stepped up,” he said. “They, more than anyone, recognize the need for … kidney transplant service in this area.”

Transplant surgeries will take place at Carilion Roanoke Memorial Hospital. The health system will have a transplant clinic in Roanoke and plans to establish another in the New River Valley. Carilion projects the capital cost for the transplant program to be $150,000.

Salzberg has worked at Carilion since 2016 and is the health system’s director of metabolic and bariatric surgery. He completed a transplant fellowship at the Medical College of Virginia in 2007.

Of the state’s six facilities where kidney transplants are performed, none are located west of Charlottesville.

For 79% of kidney transplant patients in Southwest Virginia, accessing services requires a two- to four- hour drive, according to Carilion.

However, UVA Health opened a transplant clinic in Wytheville earlier this year. The Charlottesville-based health system also offers other transplant clinics in Martinsville, Roanoke, Lynchburg, Norfolk, Newport News, Richmond, Arlington and Charlottesville. At clinics, kidney transplant patients can receive testing and consultations prior to surgery as well as post-surgery care; although, transplant surgery is conducted at UVA Health’s Charles O. Strickler Transplant Center in Charlottesville.

In a statement, UVA Health said Thursday that it respects the Virginia Department of Health’s “thorough review process.”

“VDH’s approval reflects Carilion Clinic’s dedication to expanding care options for patients in Southwest Virginia,” UVA Health stated. “UVA Health will continue to provide specialized transplant care close to home at nine locations throughout Virginia, including four outpatient clinics in Southwest Virginia, as part of UVA Health’s 30-year commitment to bringing specialized care to the region’s patients in their home communities.”

In a letter to the state last year, UVA Health raised several objections to Carilion’s proposal for a kidney transplant program, including a concern that it would pull patients from UVA Health’s program.

In a May 2024 analysis, DCOPN staff recommended that Shelton, deny Carilion’s request, noting that a Carilion kidney transplant program “could negatively impact existing providers of kidney transplant services.”

The analysis also pointed out that inspectors at Carilion Roanoke Memorial Hospital in 2023 observed three surgical instrument trays that were identified as sterile and ready to use, but were “found to be contaminated with [an] unknown brownish red substance, spots, staining and a candy wrapper was found inside a sterile tray.” The staff analysis also pointed out, however, that medical regulators had notified Carilion Roanoke Memorial Hospital on May 8, 2024, that the facility had been found “to meet applicable Medicare conditions.”

When asked whether it’s unusual for a state health commissioner to not follow the recommendation of DCOPN staff, Salzberg said he couldn’t speak for the commissioner. “I will tell you that they have worked with us well, and we have reciprocated in kind by delivering the information that they’ve been looking for,” he said.