{"id":3408,"date":"2015-02-19T19:58:26","date_gmt":"2015-02-20T00:58:26","guid":{"rendered":"https:\/\/www.med.unc.edu\/surgery\/the-gift-of-transplant-featuring-david-gerber-md\/"},"modified":"2020-12-10T09:24:35","modified_gmt":"2020-12-10T14:24:35","slug":"the-gift-of-transplant-featuring-david-gerber-md","status":"publish","type":"post","link":"https:\/\/www.med.unc.edu\/surgery\/the-gift-of-transplant-featuring-david-gerber-md\/","title":{"rendered":"The Gift of Transplant, featuring David Gerber, MD"},"content":{"rendered":"

\"\"<\/span><\/p>\n

\u00a0<\/span><\/p>\n

David Gerber, MD, had completed his general surgery internship and was beginning his second year of residency at Emory University when he met a recruiter from the United States Air Force. It was 1990, and the Gulf War had just begun. The recruiter made the pitch and Gerber listened.<\/span><\/p>\n

The Air Force didn\u2019t immediately need his services, the recruiter said \u2013 they had plenty of general medicine officers available during that time \u2013 but they could always use more surgeons in the long term. They\u2019d love to have the commitment, even if it meant waiting until he completed residency.<\/p>\n

\u201cHe was very good,\u201d says Gerber, smiling. \u201cI got the bug, and it didn\u2019t take long before I felt that joining was the right thing to do. My commissioning date was September 18, 1990 \u2013 you never forget your commissioning date.\u201d<\/p>\n

After Emory, Gerber returned to the University of Pittsburgh, where he went to medical school, to begin his clinical transplant fellowship at the Thomas E. Starzl Transplantation Institute. As a medical student, he\u2019d had the opportunity to witness the work of Dr. Starzl, a pioneer in organ transplantation who was on the Pittsburgh faculty.<\/p>\n

\u201cI was in my third year, doing rotations in the traditional services, when I came across these very ill, near-death patients who were coming back after the miracle of transplantation,\u201d recalls Gerber. \u201cTransplant was at its infancy, but was rapidly growing. It was truly incredible, and I decided then that I wanted to do it professionally.\u201d<\/p>\n

As he started fellowship in Pittsburgh, his active reservist obligation, through a program called the Individual Mobilization Augmentee (IMA), also began. Directed toward reservists in the medical area \u2013 specifically to surgeons and intensivists \u2013 the IMA program provided him the flexibility of doing twelve consecutive days of active duty per year rather than trying to do a weekend a month. Then, in 1998, he took a faculty position at the UNC School of Medicine, which had a growing transplant program that allowed him to pursue his research endeavors while developing a clinical practice. Being in Chapel Hill brought him closer to military bases where he could use the skills he\u2019d developed training residents by working with surgeons who were coming through Womack Army Medical Center (WAMC) at Fort Bragg in Fayetteville, North Carolina.<\/span><\/p>\n

His efforts were especially needed, he found, after the 9\/11 attacks and the launch of conflicts in Iraq and Afghanistan: the surgeons assigned to WAMC were frequently deployed and continuity of care for their patients became more challenging.<\/p>\n

\u201cFrom 2001 on, surgeons were on a series of deployments,\u201d says Gerber. \u201cDoctors were funneling through bases, making it very easy to lose track of patients. Doctors who weren\u2019t familiar with North Carolina and the health systems had a difficult time figuring out where to refer patients who had more complex health needs that required them to leave the base for care. Functioning as a facilitator, I was able to help doctors place patients in the UNC system, with the appropriate specialists.\u201d<\/p>\n

Transplant Services for the Military<\/span><\/b><\/p>\n

When Base Realignment and Closure led to reduced service options at Womack, Gerber looked for opportunities where he could play to his clinical strength: transplant surgery. Through a professional transplant connection, he met Lt. Col. Ed Falta, who had just become Chief of Transplant at Walter Reed National Military Medical Center, known at that time as Walter Reed Army Medical Center.<\/p>\n

Walter Reed had the only transplant program in the military, and Lt. Col. Falta needed the help of reservists to backfill for active duty physicians who were overseas. Although an Air Force reservist, Gerber was welcomed at Walter Reed.<\/p>\n

\u201cHe could not have cared less which branch of the military I was from,\u201d says Gerber, who had become chief of abdominal transplant surgery at UNC. \u201cThey needed the help. He was rebuilding their program and needed assistance on the administrative side. These kinds of programs need a lot of sunlight and water – a lot of attention – to be maintained because doctors are always coming and going.\u201d<\/p>\n

Gerber was able to be a valuable resource for the organ transplant program at Walter Reed by, for example, helping them with getting the message out about their kidney program. Within the military, if a military service member becomes a deceased donor, typically from trauma, then one of the kidneys goes to the Department of Defense (DoD) and to service members who are on the military\u2019s list for transplant.<\/p>\n

\u201cIt was a great fit,\u201d he says. \u201cMy work as a civilian transplant surgeon and a reservist in the military helped me communicate about transplant with military officials, and it helped in working with organ procurement organizations (OPOs) in North Carolina. We have a lot of military in North Carolina, and we were able to target North Carolina and make sure transplant services were a priority for military families here.\u201d<\/p>\n

Gerber understands what the gift of transplant means to the patient and his or her family, whether civilian or military. But military families, Gerber says, are unique.<\/p>\n

\u201cThey view themselves as family,\u201d he continues. \u201cWhen they\u2019re able to receive kidneys from other military donors, it closes the circle\u2013 it means that military families are helping military families. For me to be able to provide reinforcement, education, and trust because of my positions in the civilian and military role has been rewarding.\u201d<\/p>\n

Now, with appointments with the United Network for Organ Sharing and at Walter Reed, Gerber is able to assist in keeping the military transplant program at Walter Reed operating smoothly, even when military doctors are pulled away for active duty.<\/p>\n

\u201cHaving someone who\u2019s from outside that can provide support helps them along the way,\u201d he says. \u201cI\u2019m able to lower the burden for them so that they can focus on their patients.\u201d<\/p>\n

New Limbs for Service Members<\/span><\/b><\/p>\n

Just as the medical needs of injured soldiers have become more complex, transplantation has become more advanced. The conflicts in Iraq and Afghanistan have left many soldiers without arms, hands, or legs. Recently, Gerber has become involved with Vascularized Composite Allografts (VCA). VCAs can involve the transplantation of extremities, which the military population has the largest need for of any patient population because of the trauma of the past two wars.<\/p>\n

\u201cIt\u2019s not a high-volume transplant area, but it\u2019s extremely complex,\u201d says Gerber. \u201cBecause the military population is so diffuse, with patients in San Diego, Mississippi, Bethesda, and so on, I\u2019m working to help establish the processes around the military\u2019s VCA program.\u201d<\/p>\n

Their goal is to make sure that everyone is getting a timely referral \u2013 that everyone is being treated the same and is able to access state-of-the-art care.<\/p>\n

\u201cThe government is worried that military patients aren\u2019t getting provided the same resources as patients in the civilian sector or in non-military areas,\u201d he says. \u201cWe\u2019re trying to make sure to standardize care within the military, as currently these patients could be seen in a clinic run by a rehab doctor, another by a transplant surgeon, or by a plastic surgeon.\u201d<\/p>\n

Gerber believes that he can be effective in his role as chair of the VCA board because of his unique identity in multiple camps.<\/p>\n

\u201cI have a relationship with the VA system, so I can apolitically help this move along and knock down the barriers that would be based on branch of service or specialty,\u201d says Gerber. \u201cI don\u2019t have a dog in the fight, which brings credibility.\u201d<\/p>\n

Nationally, extremity transplantation services remain rare. Gerber estimates that while roughly 15,000 kidney transplants, 6,000 liver transplants, 1,500 heart transplants, and 1,000-1,200 lung transplants occur each year, fewer than 30 extremity transplants are being done per year. But patients who receive a new limb can do very well after the surgery, and they are available from the donor just as a kidney is.<\/p>\n

\u201cMost donor families are pretty broad with what their willing to donate and they typically consent to all organs and tissues,\u201d Gerber says. \u201cWhen families get in the mindset of organ donation, most don\u2019t want to be restrictive when they realize what they\u2019re doing and how they\u2019re helping.\u201d<\/p>\n

And many recipients do well with their new extremity.<\/p>\n

\u201cFunctionally, on a scale of 1-100, some are in the high 90s range of mobility, some are in the 70s or 80s,\u201d says Gerber. \u201cEveryone has their different sets of challenges, however. There\u2019s a psychological component to getting an extremity transplant. You look down and it doesn\u2019t look the same. The patient is pretty far removed from the injury and they have to go through physical rehab.\u201d<\/p>\n

A Close Relationship<\/span><\/b><\/p>\n

In his seventeen years at UNC, Gerber has seen a lot of support for employees who serve. After the 9\/11 attacks, one of his former partners was an Army reservist who was mobilized to backfill in Fayetteville for 120 days, and the university ensured that his transition was smooth.<\/p>\n

He has also been able to interact with many military families on a clinical basis.<\/p>\n

\u201cTransplant families and patients are very unique, whether military or civilian,\u201d he says. \u201cThey get it. They get where this gift came from. Military families are similar to civilian families, in my experience, in that after transplant, they express their deep connection to UNC. They come in for check-ups wearing UNC gear. They\u2019re proud of the institution. That\u2019s their culture, especially families who have been in the military for decades and moved to multiple bases. That family component around the military is who they are.\u201d<\/p>\n

UNC Hospitals, Gerber says, has an opportunity to continue to build its strong relationship with military families. In the 1990s, as the military was thinking of contracting and going through base reductions, the veteran populations were aging and shrinking. In recent years, however, the veteran population has grown, and many more who have served will need quality health care.<\/p>\n

\u201cWe\u2019re a highly specialized resource at UNC,\u201d he says. \u201cThere are things we can provide that the VA system doesn\u2019t provide, more than just transplant. By working with our active duty population here in North Carolina who were getting their transplants at Walter Reed, I provided UNC as a resource to follow up with patients and to provide their local care so they didn\u2019t have to keep going up to D.C. I think there\u2019s an opportunity for us to look at these partnerships. As a public institution, it\u2019s a very natural extension for us to look at the DoD population or VA population and be consistent with our mission by putting all our patients first.<\/p>\n","protected":false},"excerpt":{"rendered":"

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