UNC Health Talk

The Gift of Transplant

David Gerber first witnessed the gift of transplant as a medical student. Today, as chief of abdominal transplant surgery at UNC Hospitals he performs transplant surgeries for patients and as a Lt. Col. in the Air Force Reserves serves as a valuable resource of transplant services for military families.

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.

The Air Force didn’t immediately need his services, the recruiter said—they had plenty of general medicine officers available during that time—but they could always use more surgeons in the long term. They’d love to have the commitment, even if it meant waiting until he completed residency.

“He was very good,” says Gerber, smiling. “I got the bug, and it didn’t take long before I felt that joining was the right thing to do. My commissioning date was September 18, 1990—you never forget your commissioning date.”

David Gerber, MD, on his way to visit patients in transplant services at UNC Hospitals.
David Gerber, MD, on his way to visit patients in transplant services at UNC Hospitals.

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’d had the opportunity to witness the work of Dr. Starzl, a pioneer in organ transplantation who was on the Pittsburgh faculty.

“I 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,” recalls Gerber. “Transplant was at its infancy, but was rapidly growing. It was truly incredible, and I decided then that I wanted to do it professionally.”

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—specifically to surgeons and intensivists—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’d developed training residents by working with surgeons who were coming through Womack Army Medical Center (WAMC) at Fort Bragg in Fayetteville, North Carolina.

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.

“From 2001 on, surgeons were on a series of deployments,” says Gerber. “Doctors were funneling through bases, making it very easy to lose track of patients. Doctors who weren’t 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.”

Transplant Services for the Military

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.

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.

“He could not have cared less which branch of the military I was from,” says Gerber, who had become chief of abdominal transplant surgery at UNC. “They 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.”

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’s list for transplant.

“It was a great fit,” he says. “My 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.”

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.

“They view themselves as family,” he continues. “When they’re able to receive kidneys from other military donors, it closes the circle—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.”

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.

“Having someone who’s from outside that can provide support helps them along the way,” he says. “I’m able to lower the burden for them so that they can focus on their patients.”

New Limbs for Service Members

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.

“It’s not a high-volume transplant area, but it’s extremely complex,” says Gerber. “Because the military population is so diffuse, with patients in San Diego, Mississippi, Bethesda, and so on, I’m working to help establish the processes around the military’s VCA program.”

Their goal is to make sure that everyone is getting a timely referral—that everyone is being treated the same and is able to access state-of-the-art care.

They view themselves as family. When they’re able to receive kidneys from other military donors, it closes the circle—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.

“The government is worried that military patients aren’t getting provided the same resources as patients in the civilian sector or in non-military areas,” he says. “We’re 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.”

Gerber believes that he can be effective in his role as chair of the VCA board because of his unique identity in multiple camps.

“I 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,” says Gerber. “I don’t have a dog in the fight, which brings credibility.”

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.

“Most donor families are pretty broad with what their willing to donate and they typically consent to all organs and tissues,” Gerber says. “When families get in the mindset of organ donation, most don’t want to be restrictive when they realize what they’re doing and how they’re helping.”

And many recipients do well with their new extremity.

“Functionally, on a scale of 1-100, some are in the high 90s range of mobility, some are in the 70s or 80s,” says Gerber. “Everyone has their different sets of challenges, however. There’s a psychological component to getting an extremity transplant. You look down and it doesn’t look the same. The patient is pretty far removed from the injury and they have to go through physical rehab.”

A Close Relationship

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.

He has also been able to interact with many military families on a clinical basis.

David Gerber, MD, likes to start every day in his office.
David Gerber, MD, likes to start every day in his office.

“Transplant families and patients are very unique, whether military or civilian,” he says. “They 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’re proud of the institution. That’s 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.”

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.

“We’re a highly specialized resource at UNC,” he says. “There are things we can provide that the VA system doesn’t 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’t have to keep going up to D.C. I think there’s an opportunity for us to look at these partnerships. As a public institution, it’s 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.”