A Model for Success

By Devon McPhee

Michael Abecassis, MD, MBA, goes through the new clinical space of the Comprehensive Transplant Center (CTC) pointing out the offices of Northwestern University Feinberg School of Medicine employees, Northwestern Medical Faculty Foundation (NMFF) members, and Northwestern Memorial Hospital (NMH) employees which, unusual for the three institutions, sit side by side.

Dr. Dixon Kaufman (left), Dr. Michael Abecassis (seated), and Dr. Jayesh Mehta help lead the year-old Comprehensive Transplant Center, which includes researchers and clinicians from the medical school, hospital, and faculty foundation that are all working on transplantation.

“We’re not worried about who works for whom on this floor. We’re all working together toward the same goal,” says Abecassis, director of the center and the James Roscoe Miller Distinguished Professor of Medicine.

These new offices – and the sense of shared purpose they inspire – stand as a symbol of the possibilities under Northwestern Medicine, the name given to the collaborative, strategic plan of Feinberg and NMH to become a top 10 academic medical center by the year 2020.

“One of the key success factors of Northwestern Medicine will be the elimination of hurdles that impede collaboration,” Abecassis says. “The transplant center has cut across the walls and silos that exist to move not only toward collaboration, but also to true integration.”

Even the layout of the CTC’s research center, located in the Tarry Building, was constructed for better collaboration. Instead of assigning laboratories to individual researchers, the labs were built around functional cores that serve the needs of several investigators. For instance, there is an immune monitoring lab, a histocompatibility lab, and a microvascular surgery lab as well as a DNA core facility.

“It’s about thinking way beyond the individual, divisional, or departmental purpose to the broad university purpose,” says Dixon B. Kaufman, MD, PhD, the Fowler McCormick Professor in Surgery and deputy director of the CTC.

The Road to the CTC

Launched in October 2009, the CTC serves as the umbrella group for a wide range of multidisciplinary transplantation activities. Clinical work includes adult and pediatric kidney, liver, and intestinal transplantation (with a strong emphasis on living donors), and adult pancreas, stem cell, and islet cell transplantation. Activities include basic, translational, and clinical research as well as training and educational programs.

“We serve as a home for all varieties of work being done in the area of transplantation,” Abecassis says, “and provide a structure and a contact point for future endeavors.”

Though the center officially launched just over a year ago, its creation formalizes relationships that have existed for several years. These alliances developed organically as researchers began to recognize the benefits of working with colleagues across different disciplines.

"Old school research activity tends to germinate from within a single department or division," says Kaufman. "People pursue their research thinking internally about their area; everything is very stove piped.

"About seven years ago, we started branching out, reaching out to investigators in other schools and departments and it turned out to be very exciting. We started interacting with chemists, bioengineers, nanotechnologists, and other researchers outside the medical school. We also expanded interaction with researchers with similar medical interests within Feinberg and found that the team-oriented approach to research was very contemporary and very effective."

As more and more of these transplantation-focused inter- and trans-disciplinary collaborations developed, medical school administration began to take notice. Officials knew that in order to fully realize the potential of these relationships, they needed to unify them and gave development of the CTC the green light.

“It’s a difference of scale and impact,” Abecassis explains. “As a center, we can secure more funding by being more convincing to reviewers, have access to more resources, and are better able to recruit faculty.”

Collaboratives at Work

For example, the Northwestern University Transplant Outcomes Research Collaborative (NUTORC), part of the CTC, includes Feinberg researchers from the Division of Organ Transplantation, the Department of Medical Social Sciences and the Institute for Healthcare Studies as well as researchers from the Robert R. McCormick School of Engineering and Applied Science and the J. L. Kellogg School of Management.

The collaborative focuses on health services and outcomes research related to all aspects of organ transplantation, such as quality of life, safety, clinical outcomes, clinical decision making, and enhanced communication between doctors, patients, and donors.

“NUTORC has been amazingly productive in terms of the number of publications, grants, and presentations at national meetings in a very short time,” Abecassis says.

The CTC also offers a two-year T32 research fellowship to post-doctoral students pursuing a career in transplant nephrology, hepatology, infectious disease, and surgery; or, alternatively, in basic science disciplines related to transplantation. At the end of the program, trainees have enough experience and expertise to pursue further transplant-related research, including health services and outcomes research.

Recently, NUTORC has added the Heller School of Social Policy and Management at Brandeis University to its fold. This new strategic partnership allows the collaborative to extend the depth of its mission, Abecassis says, enabling it to conduct research on healthcare policies that have an impact on transplantation.

“By its very nature, NUTORC brings together people from disparate disciplines and focuses them on transplant issues surrounding health research outcomes, which would not typically be the purview of transplant surgeons and physicians but which do have an effect on their work,” Abecassis says.

Continuing to Build Bridges

Jayesh Mehta, MD, professor of medicine in the Division of Hematology-Oncology, is assistant director of the CTC. The center, which initially focused on solid organ transplantation, now includes a stem cell division.

As a formal entity, the CTC continues to develop. It has seen an important broadening of its scope even within its first year. Originally focused on solid organ transplantation, the center now includes a division on stem cell transplantation.

These two transplantation areas share several goals, says Jayesh Mehta, MD, assistant director of the CTC, and housing them together helps foster collaborations that could accelerate success.

A common area of interest, for example, is the use of stem cell transplantation to help reduce the incidence of one of the most challenging aspects of solid organ transplantation: organ rejection.

When a doctor uses stem cells to treat blood and bone marrow diseases or cancer, the cells introduce an entirely new immune system into the body, Mehta explains. Organ rejection results from a transplant recipient’s immune system attacking the new organ. By transplanting stem cells from the donor along with the organ, doctors and medical researchers hope to encourage the recipient’s immune system to accept the new organ.

Marrying the ongoing stem cell research at the University with that of solid organ transplantation under the CTC’s umbrella means that both areas increase their likelihood of attracting funds and top-notch talent, says Mehta, who is also a professor of medicine in the Division of Hematology-Oncology, and allows the two divisions to share resources more readily. “It just makes sense to collaborate,” he says.

In addition to fostering new research collaborations, the CTC has also built bridges in transplantation education during its first year. “Becoming the most desirable training program in transplantation is a fundamental goal of the CTC,” Abecassis says.

To that end, the center offers several advanced fellowships, such as an American Society of Transplant Surgeons fellowship in kidney, liver, and pancreas transplant surgery; an American Society of Transplantation fellowship in transplant nephrology; and an American Association for the Study of Liver Diseases ACGME fellowship in transplant hepatology, to name a few. “These fellowships reflect the high quality of our programs and recognize our commitment and ability to provide an outstanding educational environment,” Abecassis says. Plans are underway to create a transplant infectious disease fellowship and there is even talk of a transplant medicine fellowship.

Currently, the CTC has a goal of creating an institute of bio-artificial organs and tissues to combat organ and tissue shortages. The institute would expand on the ongoing work at Northwestern focused on regenerating islet/stem cells, blood vessels, heart valves, bladders, ovarian tissue, bone, nerves, and more. It will also house an interdisciplinary training program in this area.

The center has also initiated, in collaboration with the Division of Plastic Surgery and Dr. Gregory A. Dumanian, MD, professor of plastic surgery and neurological surgery, a plan to develop a musculoskeletal composite tissue transplant program whereby hand and face transplants would be performed. The program recently received a grant from the Frankel Foundation to support these transplants as well as studies related to quality of life and health information.

More conceptual goals also exist for the future of the CTC. Administrators want it to become a magnet for investigators who have an interest in transplantation issues, from Medill researchers looking for ways to communicate about transplantation to the public, to law professors studying the ethics behind the procedure, to entrepreneurs in the biomedical field. If it relates to transplantation, the CTC would like to offer its expertise.

Abecassis will not apologize for the high ambitions of the CTC. Thinking big and going beyond what an individual researcher or department could accomplish on its own, he says, is what transplantation and the transplant center is all about. “The more we are willing to think collaboratively, the more endless the possibilities,” he says.

It’s a statement that echoes the potential of Northwestern Medicine.

What is Northwestern Medicine?

Northwestern Medicine is the name attached to the collaborative strategic plan between Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital to transform health care and be among the nation’s top-tier academic medical centers. The enterprise seeks to fulfill its mission by focusing on three integrated goals, which will serve as a roadmap for the next decade:

  1. Deliver exceptional care as evidenced by being among the nation’s safest, quality-driven healthcare organizations for all patients; becoming a recognized destination for patients with complex conditions; earning a distinguished reputation for advancements in core and highly specialized clinical programs; and creating significant improvement in a health issue of importance to our community.
  2. Advance medical science and knowledge by imprinting our research findings and contributions through an increase in top-tier, peer-reviewed publications and increased participation in clinical trials; through innovations that lead to patents and inventions; and through increased funding in strategic areas by the National Institutes of Health.
  3. Develop people, culture, and resources to ensure a solid future for our medical center and achievement of our goals through the recruitment and retention of key faculty leaders in strategic areas; perpetuation of Magnet status for nursing excellence; recognized leadership in diversity practices; top 10 reputational ranking for fellowship and residency programs; high placement of graduates matched to top residency programs; sustainable improvement in campus-wide productivity; and maintaining superior bond ratings.