For Marie Twyman, choosing a kidney transplant program close to her home was about more than just convenience; it was about reclaiming her independence. Living in New Castle, Delaware, the Christiana Care Health System’s Newark campus was a mere 10-minute drive. Traveling to a hospital in Philadelphia for similar care would have meant relying on others for transportation, a significant barrier to managing her health and daily life.
The proximity of Christiana Care also fostered a deeply personal relationship with her healthcare team. Twyman values the candid and direct approach of her Medical Director, Dr. Stephanie Gilibert. “She will say, ‘Miss Marie, do you want to keep your kidney?’” Twyman recounts, emphasizing the close, supportive bond she shares with Dr. Gilibert, whom she affectionately calls her “buddy.”
Ten years prior, on January 15th, Marie Twyman made history as the first adult kidney transplant recipient at the Christiana Care Kidney Transplant Program. Since that pivotal moment, over 250 individuals have been given a renewed lease on life through kidney transplantation at Christiana Care.
Kidney transplants are not just life-saving procedures; they are transformative. Before her transplant journey at Christiana Care, Twyman’s quality of life was severely diminished. Even simple pleasures like watching food commercials on television triggered debilitating nausea. Incontinence added another layer of anxiety, making every outing a source of worry.
Post-transplant, Marie experienced a remarkable turnaround. Her appetite returned, and she even lost weight, a testament to the restored health. “When I walk, I walk with a strut,” she proudly states, highlighting her regained vitality and confidence.
The Christiana Care Kidney Transplant team, including Ryan Haydu, MBA, administrative director; Velma Scantlebury, M.D., FACS, Associate Chief of Transplant Surgery; and Stephanie Gilibert, M.D., Medical Director of the Kidney Transplant Program, exemplify the expertise and dedication behind the program’s success.
While the transplant surgeries themselves are understandably captivating, the true measure of the Christiana Care Kidney Transplant Program lies in its comprehensive, ongoing patient management. For every patient who receives a kidney transplant each year at Christiana Care, the program actively manages approximately 35 additional patients. This holistic care encompasses thorough screenings for new patients, diligent health management for those on the transplant waiting list, and continuous post-transplant monitoring.
“We consider this a lifelong commitment to them,” affirms Dr. Gilibert, underscoring the program’s dedication to long-term patient well-being.
A Vision for Local Kidney Care in Delaware
The genesis of Christiana Care’s Kidney Transplant Program was rooted in a straightforward yet powerful concept: Delaware residents requiring kidney transplants should have access to comprehensive care – from screening to transplantation and follow-up – within their own state. Approximately 55 Delawareans annually need kidney transplants, and the Christiana Care program was designed to meet this critical local need. Kidney transplantation is not a singular event but an ongoing journey demanding frequent testing and monitoring, both before and after the surgery. For individuals already burdened by chronic kidney disease, the prospect of long-distance travel for care adds significant strain. Furthermore, when a donor kidney becomes available, the window of opportunity is often narrow, and lengthy travel times can become a disqualifying factor.
Insurance coverage complexities also played a role in establishing a local program. Some insurance plans may not fully cover, or may offer reduced coverage for, out-of-state transplants, creating financial barriers to essential care.
Dr. S. John Swanson III, M.D., FACS, currently the Chief of Transplantation Surgery at Christiana Care, was instrumental in bringing this vision to life. After a distinguished two-decade career with the Department of Defense, Dr. Swanson seized the opportunity to spearhead the development of Christiana Care’s Kidney Transplant Program. Becoming the program’s first employee in July 2006, he laid the foundation for what would become a leading center for kidney care.
Celebrating a milestone in paired kidney donation are key figures: S. John Swanson, III, M.D., FACS, Chief of Transplantation Surgery; Emily Pruitt, MSN, RN, Living Donor Coordinator; kidney donor Susan Karlson; and transplant recipient Rosalie Corbett, highlighting Christiana Care’s leadership in innovative transplant solutions.
Dr. Swanson’s extensive experience, combined with the expertise of other seasoned professionals, quickly established the program’s clinical capabilities. The initial challenge was not the ability to perform transplants, but rather building public trust and confidence in a new program. Choosing a transplant program requires a significant leap of faith from patients, who must believe in the program’s capacity to secure a donor kidney and be prepared to perform the complex surgery with timely precision.
Earning this trust was paramount. While assembling a team of medical experts and achieving transplant success rates on par with the best institutions in the region was crucial, Christiana Care recognized that competence alone was not sufficient. Building genuine relationships with patients, getting to know them on a personal level, became a cornerstone of the transplant program’s culture.
“They see us as their family,” Dr. Gilibert notes, illustrating the deep bonds formed between the care team and their patients. Some patients even visit the center simply to connect with their caregivers, sharing coffee and conversation, reinforcing the sense of community and personalized care.
The Crucial Role of Patient Trust and Comprehensive Care
Cultivating strong patient relationships serves a vital medical purpose as well. Trust is fundamental in all aspects of healthcare, but it is particularly critical in the context of transplant medicine. Patients on the transplant waiting list might understandably hesitate to disclose emerging health concerns, fearing it could jeopardize their position on the list. However, the open and trusting environment fostered at Christiana Care encourages transparency, as patients learn that proactive communication about their health is beneficial.
“It’s easier for me to take care of you if you don’t get really sick,” Dr. Gilibert explains, emphasizing the importance of early intervention and preventative care for transplant candidates.
For the approximately 300 patients on the waiting list at any given time, comprehensive health management is paramount. These individuals may develop various medical conditions that, if left unmanaged, could compromise their eligibility for a donor kidney.
Gerard J. Fulda, M.D., FACS, FCCM, FCCP, Chair of the Department of Surgery, underscores the critical importance of comprehensive patient health management in ensuring successful transplant outcomes.
Dr. Gerard J. Fulda, M.D., FACS, FCCM, FCCP, Chair of the Department of Surgery, highlights this point: “A patient whose health is not well managed — if they are hospitalized for another reason, for example — may not be medically ready to accept a kidney.” Ensuring patients are in optimal health to receive and benefit from a donated organ is a critical aspect of responsible organ stewardship.
The rigorous medical oversight of transplant candidates and donors at Christiana Care has yielded unexpected but positive side effects, including referrals for weight loss and bariatric surgery, as well as the early detection of various cancers, according to Aline Stant, MSN, Transplant Coordinator and Quality Assurance and Performance Improvement Manager.
“People have no idea how much work it takes to transplant someone,” Stant remarks, emphasizing the complexity and dedication involved in the transplant process.
Today, the Christiana Care Kidney Transplant Program provides care for over 1,100 patients. Since its inception, the program has screened more than 4,500 individuals. Due to the program’s growth and accessibility, nearly 90% of Delawareans with health insurance are now covered for kidney transplantation at Christiana Care, significantly expanding access to this life-saving treatment within the state.
Looking Ahead: Prevention and Expanding Access
Reflecting on the first decade of the Kidney Transplant Program, Dr. Swanson envisions a future with an even stronger focus on prevention. “We all love to do a transplant, but we prefer not to have to do them,” he states, highlighting the program’s commitment to public outreach and proactive kidney health management. Empowering Delawareans to take control of their kidney health can ultimately reduce the need for transplantation.
Population health, a holistic approach that considers the health of the broader community, will be an increasingly central focus for the Kidney Transplant Program, aligning with Christiana Care’s overall population health initiatives.
The program is actively involved in research, including a study examining the link between hypertension (high blood pressure) and kidney health among African Americans, a population group at higher risk for hypertension and kidney disease. “Our focus will be on patient-based research,” Dr. Swanson emphasizes, indicating a commitment to advancing knowledge and improving outcomes through clinical investigation.
Christiana Care is also dedicated to raising awareness and promoting living kidney donation. Living donation offers a remarkable opportunity to save two lives: the recipient of the donated kidney and another individual on the waiting list who moves up to receive the next available deceased donor kidney.
Living donations are “not only a huge humanitarian gesture but significantly help reduce the number of folks waiting,” Dr. Fulda emphasizes, underscoring the profound impact of living donation on expanding the pool of available organs and shortening wait times for those in need.
From Dialysis to Independence: A New Lease on Life
For Marie Twyman, the path to transplant began years earlier, in 2001, when she first consulted a Christiana Care nephrologist. For a time, medication and lifestyle adjustments managed her kidney condition. However, as her health deteriorated, the looming prospect of dialysis became a stark reality. Twyman had witnessed firsthand the toll of dialysis, observing her mother and sister-in-law endure the thrice-weekly procedure.
While dialysis is a critical and necessary treatment for patients with chronic kidney failure – and Christiana Care’s nephrology care is nationally recognized as among the top 50 in the U.S. by U.S. News & World Report – it imposes a significant burden on patients’ lives. Hemodialysis, the most common form, requires patients to spend three to four hours in a clinic multiple times a week. The treatments are often physically draining, with recovery taking more than a day, only to face another session soon after. Despite its life-sustaining role, hemodialysis is not a long-term solution; only about 35% of hemodialysis patients survive beyond five years. Furthermore, it carries a substantial annual cost, averaging around $90,000.
“I would say, ‘Oh Lord, I’m coming to D-Day,’” Twyman recalls of her apprehension about starting dialysis.
Then, the life-altering call came. Sitting at home, she received the news that a kidney was available. After hanging up, she and her sister shared a moment of prayerful anticipation. Arriving at the hospital for what she believed would be a routine blood test, Marie was surprised to see a flurry of white coats approaching her in the parking lot as she was about to leave. The transplant operation was to take place that very day.
Marie Twyman’s historic transplant on January 15, 2007, marked a new era of kidney care in Delaware, offering hope and life renewal to countless individuals through the Christiana Care Kidney Transplant Program.
The transplant surgery was successful. On January 15, 2007, Marie Twyman became the first adult to receive a kidney transplant in Delaware. Just eight days later, the program achieved another milestone, performing the state’s first adult living-donor kidney transplant.
Marie’s recovery unfolded over the following months, marked by gratitude for the compassionate nurses and doctors who provided exceptional care. “They make you feel wanted,” she says, reflecting on the supportive environment at Christiana Care.
A decade later, Marie Twyman remains healthy and independent, living in the same peaceful New Castle neighborhood she has called home for 40 years.
As the Christiana Care Kidney Transplant Program progresses toward its goal of providing a kidney transplant for every adult in Delaware who needs one, Dr. Gilibert emphasizes that the patient-centered approach that began with Marie Twyman will continue to define the program’s ethos.
“I can’t not see or remember my patients,” Dr. Gilibert says, highlighting the personal connection she maintains with each individual under her care. “They are our neighbors.”
In the close-knit community of Delaware, Dr. Gilibert and her colleagues frequently encounter their patients in everyday settings – grocery stores, shopping malls, and movie theaters. Caring for their neighbors is, in essence, “The Christiana Care Way.”
“Are we expected to take ownership for the health of our patients?” Dr. Gilibert poses, then emphatically answers, “Heck yeah.”
