AOA News + OPTI Updates
The Hero Next Door...
By Carolyn Schierhorn
This article is part of a series, The Hero Next Door, on osteopathic physicians who are quietly transforming health care in their communities and beyond. Read the first article.
Some physicians send out press releases and update their websites and social media pages after every new job appointment or award. The opposite is true of Alan N. Langnas, DO. Though a leader in the field of transplant surgery, with hundreds of published articles to his name, Dr. Langnas doesn’t seek publicity and is less well-known than he could be in the osteopathic medical profession.
“I’m very fortunate because I’ve had a wonderful career,” says Dr. Langnas, a U.S. News Top Doctor. “I’m a man of a certain age, but I still enjoy going to work and doing what I do.”
As the director of his hospital’s Center of Transplantation, Dr. Langnas oversees all liver, kidney, intestinal and pancreas transplants at the University of Nebraska Medical Center (UNMC) in Omaha. In a more hands-on role, he directs the center’s liver and intestinal transplantation programs, spending much of his time in the operating room. He also supervises several treatment programs for people with liver, pancreatic or intestinal diseases who don’t need transplants.
During his nearly 25 years with UNMC, Dr. Langnas has assumed progressively greater administrative responsibilities. And since 1997, he has been the program director of the transplantation surgery fellowship that he himself completed a decade prior.
“Alan Langnas has an incredible amount of enthusiasm for and involvement in the field of transplant surgery, but he is not someone who goes around boasting of his accomplishments,” says Glenn Fosdick, CEO of the Nebraska Medical Center, UNMC’s teaching hospital in Omaha. “I remember one scenario in which we were doing four pediatric liver transplants on the same day, using four teams. I suspected this was a first for any medical center in the U.S. and suggested to Alan that we get the word out to the press. He initially said, ‘Maybe next time.’ I had to push for him to speak to the media.”
UNMC does approximately 120 liver transplants a year, drawing patients from all over the country, and has developed an international reputation in both pediatric liver and small bowel transplantation. Dr. Langnas expanded UNMC’s liver transplantation program and pioneered its intestinal transplantation program, one of only a handful of such programs in the country.
“It was really by chance that I got into transplant surgery,” says Dr. Langnas, who trained in general surgery at Botsford Hospital in Farmington Hills, Mich. “I had already accepted a job as a general surgeon but learned of an unexpected opening in a transplant surgery fellowship at Henry Ford Hospital in Detroit and decided to go for it.” Afterwards, he completed a second fellowship, at UNMC, his passion for transplantation growing ever-stronger.
“For all of us in medicine, the most gratifying part is being able to help people. In transplantation, this feeling can be even more intense,” Dr. Langnas says. “Because we are taking care of people who are terribly sick and giving them a life-saving organ transplant, the results we see in patients and their families can be quite dramatic. From the practitioner’s point of view, this is very rewarding.”
“Dr. Langnas is just outstanding—compassionate, diligent about details, a very good leader,” says Joann Schaefer-Haines, MD, one of his liver transplant patients. “He is also very humble.”
Afflicted with a hereditary liver disease, Dr. Schaefer-Haines first saw Dr. Langnas for a pre-transplant procedure to buy her more time before the actual transplant, which he performed in 2008. She had life-threatening complications after the transplant, which he successfully addressed.
“Dr. Langnas definitely takes care of the whole patient,” she says, noting that he showed interest in her quality of her life, not just the condition of her liver. “I am a runner and have other interests, and he cared about these things. He cared about my getting back to a normal life.”
Dr. Schaefer-Haines, who belongs to the same gym as Dr. Langnas, encounters him periodically as she goes about her daily routines. “When he sees me working out on the treadmill, he’ll get on the treadmill next to mine and start chatting,” she says. “He’ll ask me what I’ve been up to and how I’m feeling. I don’t see a lot of physicians who’ll do that.”
“I’m running marathons now. I feel like a million bucks—the healthiest I’ve ever felt in my entire life,” Dr. Schaefer-Haines adds. “I owe so much to Alan Langnas. He is a stellar physician.”
Transplant surgeons provide their patients with lifelong care. Even when patients come from other states or countries, Dr. Langnas monitors their laboratory results, adjusts their anti-rejection medication, consults with their internal medicine specialists and primary care physicians, and asks to see them at least once a year for a follow-up examination.
“One of the unique aspects of transplant surgery is that you get to know people over the years. Alan receives so many cards from patients, especially those who had pediatric transplantations and are growing up and want to thank him,” says Wendy J. Grant, MD, who trained under Dr. Langnas and has been part of his transplantation team for more than a decade. “We also have a transplant reunion every year. At least 300 patients come to this, and they are so excited to see him. Alan has been involved in all of their care.”
Despite his affable, down-to-earth demeanor, Dr. Langnas has extremely high standards, Dr. Grant notes. “He has high expectations of himself and everyone around him because there is so much at stake,” she says. “This makes us all better at what we do. And he is incredibly proud of all that we have accomplished. I know that none of us would be as successful as we are without his leadership, without him pushing us.”
When Dr. Langnas observes less-than-exemplary work at the Center of Transplantation, he doesn’t hesitate to point this out. “He is a straight shooter, and that’s one of his best qualities,” Dr. Grant says.
Innovations and obstacles
While the broader medical community is struggling to respond to the federal push for electronic health records and accountability for patient outcomes, the field of organ transplantation embraced EHRs, patient registries and outcomes monitoring years ago, Dr. Langnas says.
“All of our results are on public websites and have been for 10 years,” he says. “Everything we do is transparent to patients and the entire U.S. population. As a consequence, we are held accountable, which is as it should be.”
Dr. Langnas notes that one of the Center of Transplantation’s strengths is its robust quality-assurance and performance-improvement program. “We measure everything because if you can’t measure it, you can’t improve it,” he says.
The biggest and most heart-wrenching hurdle Dr. Langnas faces is the shortage of donated organs. “At least 10% of patients waiting for a liver, heart or lung transplant die before one becomes available,” he says.
According to the organization Donate Life America, 120,000 men, women and children in the U.S. are awaiting organ transplants.
The availability of organs has not kept pace with technological and procedural advances in transplantation. Dr. Langnas attributes this to Americans’ lack of comfort with the concept of organ donation and the government policies that reflect such uneasiness.
“In some other countries, there is presumed consent. Everyone is presumed to be an organ donor unless a family specifically opts out,” Dr. Langnas says. “In the United States, we have to opt in.”
Organ selling is illegal in the U.S., but Dr. Langnas believes that there may be a role for carefully “incentivizing people to donate organs.”
“But such a change must not lead to rich people approaching poor people for organs,” he says. “It would have to be a transparent, monitored, government-regulated process. The person donating the organ might get a payment, but that payment cannot come directly from the person in need of the organ.”
Considered an innovative administrator because of his commitment to team-based care, Dr. Langnas is also highly regarded as a mentor of younger faculty members and trainees.
“He sets a great example for his fellows, residents and students,” says Dr. Schaefer-Haines, who until recently served as Nebraska’s chief medical officer, a position she held for several years.
What advice does Dr. Langnas give his youngest trainees? “I tell students, ‘Follow your dreams. Follow your heart. Do what is right for you because becoming a practicing physician is a very long haul. You will have worked extremely hard to get there, so it’s important to pick what you love.’ ”
For students who shy away from surgery out of fear of long hours, he doesn’t mince words.
“ ‘In high school, did you work really hard to get good grades?’ I’ll ask. They’ll say yes. ‘In college, did you work really hard to get accepted into medical school?’ Again, they’ll say yes. ‘Now in medical school, are you working really hard?’ Of course. ‘So why, when you finally get to decide what you are going to do for the rest of your life, would you pick your second choice instead of your first choice?’
“You have to be true to yourself. Otherwise you’ll pick a field you don’t
love. And you’ll be 40 years old and bored out of your mind and miserable. So
stick with what you love. The quality-of-life stuff will sort itself out.”