St. Vincent Health is moving aggressively to expand its transplant program in a direct challenge to Clarian Health’s dominance in the field.

The Indianapolis-based hospital system, via its 2-year-old partnership with the Cleveland Clinic, filed in July for permission to conduct pancreas transplants in Indianapolis. And down the road, it’s eyeing liver and maybe even lung transplants.

Dr. Paul W. Nelson, director of transplant services at St. Vincent Indianapolis Hospital, said he hopes to begin performing pancreas transplants before the end of the year. Liver transplants will take more time, probably three to five years, he said.

“We’re on an upswing,” he said, adding, “We want to grow our market share.”

Right now, St. Vincent has a paltry share of Indiana’s organ transplant procedures. Only three hospital systems perform such procedures in Indiana: St. Vincent, Clarian and Lutheran Hospital in Fort Wayne.

In 2009, Lutheran performed 37 transplants, St. Vincent 45 and Clarian a whopping 483.

St. Vincent and Lutheran do only heart and kidney transplants, whereas Clarian also performs liver, pancreas, lung and intestine transplants.

Growing in transplants could bring St. Vincent more prestige, which could help it attract patients to the rest of its services, said Ed Abel, a hospital accountant at Indianapolis-based Blue & Co.

“What St. Vincent is trying to do is show that they offer the same services and capabilities that Clarian does,” he said. “They are trying to establish themselves as being able to do anything anybody else can do.”

The competition between St. Vincent and Clarian—Indiana’s two largest hospital systems—always has been vigorous. But it’s become even more heated lately as the two systems have been building up larger networks of hospitals around the state.

Nelson came to St. Vincent in April from Kansas City, where he performed kidney transplants at the University of Missouri School of Medicine. He and his partner, Dr. Alvin Wee, are both technically employed by the Cleveland Clinic.

St. Vincent contracts with the Cleveland Clinic to provide the doctors to perform its transplant surgeries.

Nelson and Wee have been traveling to St. Vincent’s hospitals—including its newest acquisitions in Salem and Bedford—to try to gin up physician referrals to its transplant program.

There are more than 100,000 people nationally waiting for some kind of organ transplant, but only about 28,000 get new organs each year.

That means any new patients St. Vincent attracts, it will have to essentially take from either Clarian or Lutheran.

“We’re trying to compete for patients,” said Nelson, referring specifically to Clarian.

He and Wee are making some progress. Since first offering kidney transplants in 2009, St. Vincent had performed 42 procedures through the end of May. Its share of the kidney market grew from 10 percent last year to 13 percent so far this year.

In heart transplants, which St. Vincent has been doing for more than 20 years, it is the state’s leader. Last year, St. Vincent performed 17 heart transplants—or nearly 43 percent of the state total.

This year, its share is 47 percent.

So far, St. Vincent’s gains have not come at Clarian’s expense. It has held steady in kidney and heart procedures at about 80 percent and 40 percent of the market, respectively. But Lutheran’s market share has declined this year.

Clarian’s transplant program is the oldest in the state, dating to 1965 when transplants nationally started to shift from being experimental to being more routine.

Clarian’s Methodist Hospital performed the state’s first heart transplant in 1982.

The director of Clarian’s transplant program, Dr. Joseph Tector, was out of the country and not available to comment.

He has grown Clarian’s program dramatically since he arrived in 2001. Last year, Clarian ranked as the sixth-busiest transplant center in the country.

Tector and Clarian have developed a reputation for their willingness to take a second look at organs that doctors in other states reject. That has given them more organs to work with. They have been successful—keeping patient survival rates near 90 percent—although they have also been criticized for using the rejected organs in healthier patients in less need than others.

There’s a lot of money in transplant procedures.

Hospitals’ billed charges are, on the low end, $260,000 for a kidney transplant and $275,000 for a pancreas transplant, according to a 2008 report by Milliman Research. On the high end, hospitals bill more than $500,000 for liver transplants and nearly $800,000 for heart transplants.

And for double transplant procedures—such as the heart-kidney transplant done by St. Vincent earlier this summer—charges can top $1 million.

After negotiated discounts and significant costs, the profit margins aren’t huge on most transplants. However, Nelson noted, if a hospital can be more efficient than most transplant centers, it will be rewarded financially.

“Transplants can be very lucrative,” he said.•