When Duke surgeon Matthew G. Hartwig, MD, assumed the role of surgical director for the lung transplant program in the fall of 2023, he returned to a familiar position. Hartwig trained under R. Duane Davis, MD, the lung transplant program’s surgical director who is credited with launching one of the nation’s premier programs. When Davis left in 2015, Hartwig stepped into the role of surgical director.
 
“This is a new but familiar experience. Stepping back in is very exciting,” Hartwig says. “It’s a compelling role and a remarkable team. Obviously, lung transplant itself, as well as our program, has evolved a great deal over the years.”
 
A leading transplant researcher who will continue his surgical role, Hartwig offered insights into the priorities for the program as well as key challenges for the future. 

What are the major challenges facing the program?
Organ allocation changes will have a significant impact on all transplant programs. The Organ Procurement & Transplantation Network (OPTN) implemented a new allocation system for lungs in March of 2023 that reflects a great deal of research and analysis known as continuous distribution. This will be new to everyone working in transplant.

Fortunately, I’ve had the opportunity to be involved as vice chair of the UNOS lung committee during 2023. Next year, I will serve as chair of the committee. This will give me an inside opportunity to work toward broadening access to transplant for patients across the nation and focus efforts on enhancing transplantation in the U.S.
 
Will the new allocation plan affect the Duke program in a significant way?
We believe our program will remain relatively consistent. Duke operates as a high-volume center with a commitment to excellent quality of care and we’ve sustained this success for three decades. I fully expect our team will continue to perform a large number of transplants, while continually improving our patient outcomes.

However, the allocation changes will certainly change the way patients are prioritized for transplants. Centers will have to travel further and expend more resources in order to continue providing high-quality care.
 
What will be the key priorities you will bring to the surgical director role?
My focus is to provide leadership and optimize the way our team cares for our patients. We have a strong history of research and innovation in the medical and surgical aspects of transplant as well as a multidisciplinary focus that encourages collaboration with other disciplines, including infectious disease, anesthesia, pathology, and others. All play critical roles in the success of our transplant program.
 
Our most important programmatic priority is to continue our innovative approach to transition research into clinical practice. We will always be committed to multidisciplinary research that emphasizes discovering ways to enhance and improve outcomes for our patients.
 
We must also continue our leadership role as the safest and largest lung transplant program in the nation. Over the history of our lung transplant practice, Duke has performed more procedures than any other center in the nation. We have maintained this volume while providing quality care to all our patients.
 
How can Duke serve as a leader in lung transplant for patients?
As we look at the future, we must continue to incorporate equity and inclusion as principles in offering lung transplant. This will be important for all transplant centers as we begin to transition to a more nationalized transplant environment. How can we make sure we are providing a more equitable allocation process for every patient with end-stage organ disease? 
 
Recent, reputable research demonstrates gaps in the medical system in terms of equity and inclusion and these gaps exist in transplant as well. Many gaps occur because patients are not aware of all their options. We will be committed to increasing awareness. 
 
Some patients with end-stage organ disease may live in a more rural or medically disadvantaged area. We need to implement policies to take advantage of more therapies to help these patients become aware of their options earlier.
 
What will be the key research focus areas in the future?
I want to emphasize several aspects of our research, including:

• Finding better ways to treat chronic lung allograft dysfunction, the most common cause of mortality in lung transplant recipients during the first year after transplantation.
• Developing enhanced donor organ preservation techniques.
• Implementing gene therapy strategies that decrease risk of rejection, infection or malignancies following transplant.