Breakthroughs in Action: Transplant Articles from Ochsner Health Experts

Expert Tips for Discussing Kidney Transplant

Primary care physicians and nephrologists are on the frontlines of treating patients with or at risk for chronic kidney disease. They are also the clinicians best positioned to counsel patients early on about the benefits of a kidney transplant. Longtime Ochsner Medical Center - New Orleans transplant nephrologist Jorge Garces, MD, understands the importance of these initial conversations. Dr. Garces is the director of Ochsner’s Transplant Nephrology Fellowship and an assistant professor at LSU and the University of Queensland.

“I chose transplant nephrology because it unites science with second chances,” Dr. Garces said. “Over 23 years at Ochsner, mentors taught me that education and teamwork change trajectories. I’ve seen how early, honest conversations can turn fear into a plan, especially with African American and Hispanic patients who carry higher risks for chronic kidney disease, hypertension and diabetes. Our transplant team is committed to patient-first care, walking families through complex decisions with clarity and compassion.”

For referring physicians, knowing when and how to discuss kidney transplant with patients can be challenging. Dr. Garces serves as an expert resource, offering advice on navigating the conversation.

The importance of early normalization

Dr. Garces recommends starting the kidney transplant conversation once chronic kidney disease reaches a sustained estimated glomerular filtration rate (eGFR) of 30 or shows clear signs of progression.

“Don’t wait for a crisis,” he said. “Normalize the topic as part of standard chronic kidney disease care. Discuss options, timelines and required evaluations, and invite the transplant team to join in early. Doing so helps patients and families prepare, identify potential living donors and address barriers to transplantation.”

Identifying transplant candidates

Determining early on who might benefit from a transplant can improve survival, reduce complications and, potentially, expand transplant options to include preemptive and living donor transplants.

“Early patient education about transplantation reduces dialysis exposure, hospitalizations and frailty, and it empowers families to mobilize support,” Dr. Garces said. “The sooner we align primary care physicians, nephrologists and the transplant team, the better the outcomes and patient experience.”

According to Dr. Garces, the criteria for a good transplant candidate include:

• A low frailty level
• Manageable cardiovascular risk
• Motivation and willingness to reliably adhere to treatment recommendations
• No active advanced malignancies or untreated serious infections
• Robust social support

“A potential living donor can streamline care, but it is not required,” Dr. Garces said. “At Ochsner, we prioritize safety and realism. We accept higher-risk patients when we can understand and mitigate their risks. However, active substance use, severe uncontrolled cancers or infections, a lack of social support, and untreated serious mental illness are contraindications. Our kidney transplant criteria aim for fairness, patient-centeredness and durable outcomes.”

Talking points

When discussing a kidney transplant, Dr. Garces recommends establishing an ongoing dialogue that occurs over several visits. Use clear, understandable and hopeful language, underscoring how, compared with long-term dialysis, a transplant can enhance survival, quality of life and independence.

“Explain the evaluation, surgery and medications in simple steps, and highlight the transplant team’s role in support, education and follow-up,” Dr. Garces said. “Invite questions, involve the patient’s family and connect patients early with transplant coordinators and social workers.”

The prospect of a kidney transplant can prompt numerous patient concerns, from finding a living donor or obtaining a deceased donor kidney to the risks of surgery and organ rejection. To address some of the most common concerns, Dr. Garces suggests:

• Being reassuring and transparent in discussing how the transplant team minimizes risks, and providing supporting data
• Connecting patients with financial counselors early to help them understand their insurance benefits and find resources that can provide financial assistance
• Discussing how the transplant team helps ensure the safety of and advocates for living donors
• Explaining the role of each person in the patient’s medical and support teams, and providing a timeline of how the transplant process will unfold
• Explaining tools and best practices for managing transplant-related medications, such as medication monitoring and adherence tools

Prioritize living donation

Approximately 30% of kidney transplants at Ochsner are living donor transplants. Living donation offers organ recipients several benefits, including shorter wait times, more time for the transplant team to plan the surgery, fewer complications and a better chance of graft survival. Consequently, Dr. Garces advises primary care physicians and nephrologists to prioritize living donation in their discussions with patients about their options.

“Stress donor safety, the thorough evaluation process and ethical safeguards of living donation,” he said. “If a living donor isn’t available, reassure patients that a deceased donor transplant remains effective, and that our team will guide them through the process of getting listed for a deceased donor organ and preparing for what happens if they are matched with an organ.”

When should patients consider preempting dialysis with a transplant? 

Having a kidney transplant before dialysis becomes necessary is relatively uncommon, but for the right patients, preemptive transplants can be beneficial. They enable patients to avoid dialysis and its associated complications, reduce the risk of organ rejection, and may improve quality of life. Preemptive transplants may also improve survival, although a 2025 study found that early preemptive transplants do not lower patients’ risk of death.

Dr. Garces recommends discussing a preemptive transplant “for patients with rapidly progressive chronic kidney disease or an eGFR of less than 20 to 25 with clear decline, especially those with a potential living donor.”

Enhancing outreach to referring physicians

From providing continuing medical education opportunities and rapid e-consults to creating shared care pathways and hosting co-management clinics, Ochsner transplant nephrologists are deepening their outreach to community physicians. They will continue to be a resource to their peers, helping to ensure more patients can experience the benefits of kidney transplantation.

“We provide concise referral checklists, tele-education for medical practices, patient-ready materials in English and Spanish, and direct coordinator access for quick scheduling,” Dr. Garces said. “We also engage via electronic platforms and community talks to normalize early transplant discussions and strengthen our relationships with primary care physicians.”

How to Refer

Learn more about our transplant program, or refer a patient.

How Is Machine Perfusion Changing Transplants?

According to the United Network for Organ Sharing, liver transplants in the U.S. surpassed 10,000 for the first time in 2023. That was also the year the Ochsner Transplant Institute first performed normothermic regional perfusion of the liver—artificial blood circulation to the organ in vivo during the process of recovering it after a donor’s death.

In 2025, the year after liver transplants surged beyond 11,000 nationally, Ochsner took an even more significant step: The health system became the first in Louisiana to perform normothermic machine perfusion for liver transplant (ex vivo perfusion of a donor liver with a perfusate, preserving it before transplantation). This technique has the potential to improve access to lifesaving donor organs at a time when demand continues to outstrip supply.

“Until the arrival of machine perfusion, standard preservation for livers following donor recovery was static cold storage in an ice-cold solution,” said Ochsner liver transplant surgeon Jenny Ngo, MD. “Cooling the organ allows for decreased metabolic demand. However, this is time-dependent and can result in ischemia-reperfusion injury, leading to a decrease in graft survival. With normothermic machine perfusion using oxygenated blood-based perfusion, we can reduce the injury that was applied with cold storage, thus minimizing its time constraints.”

With a longer preservation runway, the transplant team has more time to assess the organ’s viability and optimize surgical logistics.

Recreating ‘a normal physiologic environment’

For Dr. Ngo, each liver transplant is not only an opportunity to prolong the recipient’s life and enhance their quality of life, but also to honor the donor and their family’s wishes. Normothermic machine perfusion offers more opportunities to do both.

The process begins following the removal of the deceased donor’s liver. Before attaching the organ to the perfusion machine, the surgeon dissects the hepatic artery, inferior vena cava and portal vein. Then, they insert cannulas.

“Once the liver is cannulated, the machine starts perfusing normothermic blood through the liver, thus mimicking a warm, oxygenated environment—a normal, physiologic environment—despite being ex situ,” Dr. Ngo said. “While the liver is on pump, we can perform dynamic serial evaluations, such as obtaining and testing arterial blood gases, glucose, lactic acid and bile. These biochemical markers serve as indicators of liver viability and function. We can also obtain tissue biopsies if needed.”

These tests help the transplant team determine whether to transplant the organ, reject it or allow it to remain on the pump longer for further resuscitation and recovery.

The benefits of normothermic machine perfusion in liver transplants

Facilitating the use of biomarkers to assess a donor liver’s viability is one of the chief benefits of normothermic machine perfusion.

“Biochemical markers like arterial blood gases, glucose utilization and lactic acid clearance can indicate how the liver is metabolizing and if its hepatocytes are viable,” Dr. Ngo said. “We can also assess bile production and measure the organ’s pH and glucose, which are surrogate markers for cholangiocyte health. All of our abdominal transplant surgeons are proficient at using this technology, from placing a liver on machine perfusion and assessing its viability to troubleshooting the organ while on the pump and, ultimately, transplanting it.”

According to Dr. Ngo, using the pump to enhance organ preservation allows clinicians to consider transplanting otherwise marginal livers that might have been discarded without the machine. This capability can reduce wait times and discards.

“Before, we were bound by distance and its effect on cold ischemic time, which is how long a liver spends sitting in cold static storage,” Dr. Ngo said. “Now, however, machine perfusion can buy us time and facilitate the use of organs coming from longer distances. We have more time for hepatectomies in complex recipients, and we can schedule transplant cases in a more controlled setting, such as in the daytime when more resources are available.”

Furthermore, Dr. Ngo stated that normothermic machine perfusion may reduce intraoperative blood loss and operation time. It may also minimize early allograft dysfunction.

From evaluation to augmentation?

In the future, clinicians may be able to do more than determine whether a donor organ is a good fit for a recipient while on the pump. The machine may also allow them to improve the organ’s quality. Dr. Ngo calls the potential to augment on-pump livers “the next frontier for machine perfusion.”

“In addition to assessing organ viability, machine perfusion offers a dynamic platform to possibly rejuvenate the liver,” Dr. Ngo said. “For example, can we defat livers that have concerning levels of steatosis? Can machine perfusion enable us to regenerate the liver and facilitate the repair and reconditioning of injured livers? Gene therapy and immunomodulation are also considerations. Right now, we’re using machine perfusion for assessment and viability testing, but I believe the next step will be an actionable treatment application.”

Expanding opportunities and reducing wait times 

In the meantime, normothermic machine perfusion can be a key tool for ensuring patients who need a new liver spend as little time on the transplant waiting list as possible.

“With machine perfusion, we hope to expand our donor organ pool by utilizing livers that otherwise may have been discarded,” Dr. Ngo said. “This technique also has the opportunity to give us more information about the organ, thus affording some predictability we didn’t have before. We can be more confident in the livers we choose, especially when we reach the era where livers can also be augmented while on machine perfusion.” 

How to Refer

Learn more about our transplant program, or refer a patient.

Elevating Living Kidney Donation

Ochsner Health has a long history of performing kidney transplants, having completed more than 3,500 kidney and kidney-pancreas transplants since 1973. After more than 50 years, the kidney transplant program, part of the Ochsner Transplant Institute, continues evolving and excelling. In 2025, the program received the prestigious ELITE status from INTERLINK COE Networks & Programs, a sign of high-quality results and exceptional care. 

Much of the innovation in the kidney transplant program involves living donations, which comprise approximately 30% of kidney transplants at Ochsner. Living donation is a critical tool in the face of a shortfall of deceased donor kidneys. For patients on or nearing dialysis, a living donor kidney provides a solution that can be implemented quickly and has the potential to endure for years. 

“Most patients would likely wait on the deceased donor list a long time, and their condition could worsen over that period,” said Dennis Sonnier, MD, a transplant surgeon and surgical director of kidney transplant at Ochsner Medical Center - New Orleans, and surgical clerkship director for the University of Queensland-Ochsner Clinical School Program. “On the other hand, a living donor transplant can take place within weeks, allowing patients to discontinue or avoid dialysis, and eliminate the risk of never getting a transplant.” 

Adding Detail to Donor Evaluations

A passionate advocate for living kidney donation, Dr. Sonnier has helped streamline the process for donors and recipients in numerous ways, including introducing 3D visualization to donor evaluation. 

Every prospective donor receives a high-quality, multiphase, contrast-enhanced CT scan to help the transplant surgeon understand their anatomy and choose the optimal surgical approach. Anatomical variations, such as multiple arteries or veins serving a kidney, can complicate surgical planning. When that’s the case, Dr. Sonnier partners with neurological rehabilitation specialist Korak Sarkar, MD, MHDS, FAAN, and the Ochsner BioDesign Lab to create a virtual reality model of the organ for enhanced visualization. 

“Having 3D visualization in the form of a VR model helps the surgeon and the rest of the team understand the structure of the arteries, veins and kidneys, which allows us to make the best decisions for both donor and recipient,” Dr. Sonnier said. “In addition, the model is a useful communications tool because the entire team can look at a monitor together and see the same thing. Otherwise, we might look at different parts of the CT images or interpret them differently.” 

Robotic Surgery’s Next Step 

Around 15 years ago, Ochsner transplant surgeons began performing minimally invasive robotic living donor nephrectomies. Robotic technology, Dr. Sonnier said, allows patients to donate their kidneys with minimal pain and a speedy recovery. Now, living donor recipients can also enjoy the benefits of robotic surgery. 

“In 2025, we started performing robotic minimally invasive transplant procedures for recipients as well as robotic nephrectomies for donors,” Dr. Sonnier said. “The recipient operation involves a lot of complex suturing and positioning. As the field of minimally invasive surgery has grown, so has our comfort with using the robot. That, in turn, allowed us to refine the techniques to offer robotic recipient surgery. The technical aspects of the two procedures are quite different for the surgeon. Donors and recipients, though, enjoy similar benefits, including small incisions, fewer wound complications and a quick recovery.” 

Honing High-Stakes Surgical Skills 

To build proficiency in performing robotic transplant surgery for recipients, Dr. Sonnier turned to another product of collaboration with the BioDesign Lab: a 3D-printed kidney transplant simulator. A box-like reproduction of the surgical field, the simulator features a replica kidney and latex tubes that mimic the associated vasculature. 

Dr. Sonnier honed his robotic surgery skills by practicing on the simulator with the robot. Medical trainees also use the simulator to practice sewing blood vessels from the donor kidney to those of the recipient’s abdomen. 

“Many residents come to our service without experience in kidney transplantation, but they have to assist us in the operations and perform critical, time-sensitive steps,” Dr. Sonnier said. “Allowing trainees to practice on the simulator on their own time or with us in the simulation lab enhances their learning and, in turn, patient care.” 

Groundbreaking Achievement 

Ochsner transplant surgeons’ commitment to pushing the field forward has yielded notable accomplishments, including Louisiana’s first international paired kidney donation. 

The 2022 transplant saw a 19-year-old Louisiana woman with polycystic kidney disease receive a kidney from a Danish woman. The latter wasn’t a match for her husband, who also needed a kidney transplant, but enrolling in an international registry yielded the new kidney he needed. The registry required his wife to enroll as a living donor, which led to the match with the Louisiana patient. 

“This case was an interesting opportunity that occurred through our partnership with the Alliance for Paired Kidney Donation,” Dr. Sonnier said. “We work with the organization to facilitate live donor transplants in our patients who have a live donor, but the two aren’t compatible. The Alliance finds a match with a donor/recipient pair at another center who are also incompatible. The organization’s algorithm identifies a match between our donor and their recipient, and their donor and our recipient.” 

For Dr. Sonnier, the 2022 case speaks not only to the kidney transplant program’s close partnership with the Alliance but also to the team’s commitment to pursuing any opportunity that may help a patient get a transplant. 

Passionate Advocate for Living Donation 

Increasing living kidney donation at Ochsner even further, Dr. Sonnier said, requires educating patients at multiple touchpoints. 

“We have to reach patients where they are and help them understand the need for a living donor,” he said. “We educate patients about what it means to be on the wait-list for a deceased donor organ and the potential consequences of that, which helps them understand the benefits of live donation. We emphasize the safety of a loved one potentially donating a kidney to them. Living donation is at the forefront of everyone’s mind in our transplant division.” 

Referring physicians are key in taking living kidney donation to the next level. 

“If a primary care physician or another clinician has a patient with kidney failure, I hope they would encourage them to find a live donor,” Dr. Sonnier said. “Advise them to talk to their family, friends or contacts at school, work or in their faith community, whatever they can do to advocate for living donation.” 

How to Refer

To refer a patient or learn more about the kidney transplant program, email kidneytransplant@ochsner.org or call 504-842-3925.

Leading the Way for Living Liver Donation

Ochsner Health’s Ochsner Transplant Institute has long been one of the premier liver transplant centers in the U.S. Once the national leader in liver transplant volumes, Ochsner has performed more than 3,000 surgeries, including Louisiana’s first, since 1984.

The liver transplant program is building on this legacy by quadrupling its living donor liver transplants over the past three years, increasing from one every other year to as many as 10-plus annually. John Seal, MD, surgical director of the living donor liver transplant program and pediatric liver transplant program, has helped drive the increase.

Swift pivot to transplant surgery

As a young physician interested in pediatric surgery, Dr. Seal viewed transplant surgery as “very esoteric and almost unattainable.” That changed during his residency at the University of Chicago Medical Center in the late 2000s and early 2010s. The medical center was the site of the first successful living donor liver transplant in the U.S. in 1989.

“I rotated onto the transplant surgery service and received real exposure to what it was all about,” Dr. Seal said. “It was an exciting time, with exciting people doing transplant surgery. I had some important mentors during that period, and I pivoted from pediatric surgery to transplant surgery pretty quickly.”

Ensuring donor safety

Donor safety is of paramount importance in living donor liver transplantation because, as Dr. Seal pointed out, donors do not derive a physiologic benefit from the surgery. To ensure high safety standards and eliminate bias, the Ochsner living donor liver transplant program features separate teams for donor evaluation and recipient management and surgery. The donor evaluation process includes:

• A general health assessment by an internal medicine physician
• A liver health assessment (with a focus on the donor’s risk of developing fatty liver disease and other liver conditions later in life) by a hepatologist
• Image-based mapping of the liver’s bile ducts and blood vessels, and the creation of a 3D liver model (used to plan complex cases in virtual reality simulations) in partnership with the Ochsner BioDesign Lab
• Psychosocial counseling to evaluate donors’ motivations for donating and family support

“I perform the donor operations and am involved with their evaluations to determine whether we can do the surgery safely from a technical standpoint,” Dr. Seal said. “We need to know some fundamental things about the liver anatomy to determine that. First, we must ensure the piece of liver we leave behind in the donor will be at least 30% of the organ’s volume. Second, the portion of the living donor liver must be large enough to meet the recipient's needs, around 0.8% to 1% of their body weight.”

Innovation in open donor surgery

In the future, Dr. Seal envisions robotic surgery becoming part of the living liver donation process, as it has for living donor kidney transplants at Ochsner. First, though, surgeons will need to optimize the safety of robotic liver surgery, which Dr. Seal expects will occur in the years ahead.

“The liver is, essentially, a blood sponge, with many large internal blood vessels,” he said. “We have decades of experience performing the operation through an open approach. We routinely perform liver surgery for cancer and other indications safely. Dividing the liver for the purpose of transplanting the portion that is removed is a much higher technical standard. So, until we perfect the robotic approach for living liver donation, I have to ensure I perform the safest possible surgery for donors and recipients.”

In the meantime, rather than perform the open donor surgery through a large subcostal incision, Dr. Seal has modified the approach. He accesses the liver through a relatively small midline incision stretching from the base of the breastbone to the top of the belly button. This approach does not cut the abdominal muscles, resulting in faster recoveries and minimal scarring.

Handling complex cases 

Most people who need a liver transplant are eligible for living donation, and the Ochsner team can successfully perform living donation surgery on almost any patient. This includes complex recipients with conditions such as morbid obesity or portal vein thrombosis.

“For patients with portal vein thrombosis, we can connect a cannula to the portal vein and bypass the blood back to central circulation,” Dr. Seal said. “That relieves the portal hypertension, decreases congestion in the bowels and takes us off the time clock. Normally, we clamp those vessels and have 30 to 45 minutes to sew the donated liver in. With a bypass in place, we have more time to be meticulous and do the vascular reconstructions without much stress on the recipient.”

Collaborating across specialties & building buy-in

Decades of experience with liver transplantation have allowed Ochsner to develop specialized and integrated cross-specialty collaborations. The living donor liver transplant team works closely with infectious disease specialists, anesthesiologists, interventional radiologists and endoscopists, to name a few.

In what Dr. Seal calls a “sea change” in recent years, hepatologists and other specialists now recognize living donation as the fastest and most reliable path to liver transplantation. Plus, more referring specialists are aware of Ochsner’s ability to transplant practically any patient, leading the living donor liver transplant program to transcend the Model for End-Stage Liver Disease (MELD) score norms for transplant candidacy.

“Historically, a score of 15 [on a 6-to-40 range] was the point at which you have more benefit from a transplant than risk,” Dr. Seal said. “That’s an old figure based on data from the 1990s. Instead of looking for that magic number, we regard anyone with significant symptoms of liver disease, regardless of MELD score, as a candidate for a transplant. That’s a big deal because it allows us to transplant patients earlier in their disease progression and produce better outcomes.”

Overcoming barriers to further growth

Dr. Seal has significant goals for living donor liver transplantation at Ochsner, from enhancing clinician and patient education about living donation to creating a registry of potential living donors for pediatric recipients. To keep growing the program, Dr. Seal and the rest of the team are finding solutions to the challenges facing living liver donation in Louisiana, including donor obesity.

“We’re pushing the boundaries regarding donor weight,” Dr. Seal said. “Many centers won’t select donors with a body mass index greater than 30. We work with donors to lose weight if they’re otherwise healthy. The majority of our donors have had a BMI over 30.”
If a donor isn’t healthy enough to donate, the living donor liver transplant program will empower them to become a donor champion. The team will educate them on identifying potential donors using friend networks, social media and other avenues.

How to Refer

Refer a patient or learn more about the liver transplant program by emailing refliver@ochsner.org or calling 504-842-3925.