Henry Ford Health System Transplant Institute

150 Years of Frankenmuth Insurance

1868–2018

The story of Frankenmuth Insurance began 1849—Students
in 1868, when the town of Frankenmuth was and teachers at
filled with hopes and dreams. Seeking to Hart School Haus.
spread their faith and create a better life in
America, a handful of German immigrants
founded the town in 1845. Through hard
work and strong bonds of community, the people of
Frankenmuth soon carved a new life from the Michigan forests.

The town was growing and the future looked bright, but there were
trials. When a storm or fire damaged a barn or a home, the farmers
couldn’t dial up their agent or reach out online. They relied on their neighbors.
Pledging to help each other in times of need, the people of Frankenmuth
formed a mutual alliance of support which would one day become Frankenmuth
Insurance.

In many ways, we’ve come a long way from that small-town pledge. But in one
important way, we haven’t. We’re still neighbor helping neighbor, providing the
peace of mind that only the most trusted friends can offer.

In celebration of all our neighbors, we bring you this 150-year history
of Frankenmuth Insurance.

1

The first neighbors: 1868

Sprechen Sie Deutsch? In 1868, if you couldn’t understand this question —
and answer “Ja!”— you could not be a part of the Deutschen Frankenmuther
Unterstützungs-Verein (the German Frankenmuth Aid Association),

the group that became Frankenmuth Insurance. The verein
was a true mutual insurance society. Members listed the
buildings and goods they wished to insure. When a member
had a loss due to fire or lightning, the other members all
contributed to cover it, knowing they would be supported the

same way in their time of need.

The association had written rules and bylaws, trustees
appointed to handle business dealings, and restrictions on
membership. Only German-speaking members were allowed, all members
had to be Lutherans in good standing, and those with questionable morals
were barred from joining. One man was denied membership because he
once held a dance in his house; after promising never to repeat the offense,
he was given membership. Since the agreement relied on all members
to help when other members sustained losses, the character of its members
was a critical concern.

These requirements didn’t limit the growth of the association; by the late
1870s, German-speaking Lutherans from as far away as Birch Run and
Saginaw were joining up. Soon the association had nearly 500 members —
more than double its original roster — and was insuring property worth about
a half-million dollars.

2

Early 1900s —
Barn raising at
the Henry Poellet
family farm.

3

Carl Nuechterlein (right)
and Norman Felgner
(left), accompanied by
three policyholders in
the mortuary building
office of the insurance
company.

4

Frankly speaking, in English

Modest but steady growth continued for the
association. In 1910, the name was changed to
Frankenmuther Feuer Unterstützungs-Verein. In
1924, to accommodate the growing number of
non-German-speaking residents of the area,
the company eliminated the German-language
requirement and the organization became known in English only as
Frankenmuth Fire Aid Association. But records continued to be kept in German,
and business continued as usual. The association was not a flashy enterprise;
their business “headquarters” was in a back room of the Nuechterleins’
mortuary. Carl Nuechterlein, who helped run the mortuary, was also Secretary
(CEO) of the Fire Aid Association from 1925 to 1941, and helped organize the
Frankenmuth Mutual Auto Insurance Company in 1921 (see “A new business
hits the road” on page 9).

One day in the late 1930s, a team of examiners from the State Insurance

Department came to audit the association’s books. Carl Nuechterlein was busy

with a funeral, but let the examiners in, telling them all the association’s records

were in a box in the back room. The “box,” the examiners discovered, was a

spare wooden coffin, and the records were all neatly handwritten in German.

FUN FACT: Carl returned and interpreted for them, and though the examiners
The company’s 1931 annual found the records to be error-free, they suggested Carl find a
report lists numerous claims for more suitable file cabinet. They also insisted the records be
barns lost to fire, cows struck by kept in English from then on, and made it a directive for all
lightning, and one $15 claim for
insurance companies in the state. The association’s minute book
“damage to cheese.”

for 1939 was the first major record in which English replaced German.

5

From association to corporation

The year 1941 brought a major milestone for the association.
The Frankenmuth Fire Aid Association became the Frankenmuth
Mutual Fire Insurance Company, a corporation operating in three

counties with 12 agents in the field. To make it even more official,
the company moved its offices out of the mortuary and into
the Fechter Hardware building at 112 South Main Street
(now Gill-Roy’s Hardware).

Though the association was now a licensed corporation,
its conservative practices, cautious willingness to try new
ventures, and strong sense of community remained.
These principles served the new corporation well. In just seven
years, the company more than doubled its total in-force insurance,
going from $29 million in 1941 to $59 million in 1948, with 10,700
policies in 12 counties. With business prospering, the company
relocated again, this time to its own office building at 130 West
Tuscola Street.

New innovations kept the business growing. The company issued
the first non-assessable policies in 1952, which meant that
policyholders did not pay when others had a loss, but rather paid
premiums up front and relied on the company to pay loss claims.
The company was one of the first in Michigan to begin writing fire
and related insurance lines on farm, commercial and dwelling risks,
and introduced a combination fire and windstorm policy.

6

1940s—Frankenmuth Mutual Fire Insurance
Company office, at 112 South Main. Pictured
from left to right: Arnold C. Nuechterlein, Irene
(Reichle) Szymanski, Lydia (Geyer) Ruff, Lorna
(Schreiner) Bernthal. This location is now
home to Gill-Roy’s Hardware.

7

1940s—Cars and horses share
the road on Main Street after a
blizzard. Geyer Brothers Brewery
Company is in the background,
and Star of the West Milling
Company is to the left.

8

A new business hits the road

Fifty-two years after the association began, another company was born
in Frankenmuth: the Frankenmuth Mutual Auto Insurance Company.

It was 1920, and though the town’s horses were a long way from being put out to
pasture, more and more of Frankenmuth’s citizens owned automobiles. Many of
these were insured by a company in Bay City, 30 miles north of Frankenmuth.

When the Bay City company went bankrupt, a group of car owners—including
Carl Nuechterlein—formed a committee to discuss creating an auto insurance
company. In September of 1921, the Frankenmuth Mutual Auto Insurance
Company was organized. A board of directors was named, which in turn elected
the company’s first officers, including Leonard Reichle as President, Carl Ortner
and Bernhard Schaefer as Vice Presidents, and the ever-present Carl Nuechterlein
as Secretary-Treasurer, who was designated to actively manage the company.

Regulations required that the company have 200 subscribers before it could
issue its first policy. The Board of Directors became the company’s first agents,

and by March of 1922, the 200 subscribers were enrolled. The first
official policy was issued to John A. Geyer on a Dodge Brothers

car, for a premium of $7.50 (plus a $1.00 policy fee). Geyer was a
company founder and also served on the Board of Directors.

The modest conservatism which had marked the beginnings of the association
was a hallmark of this new company as well. The commission paid to agents was
$1 per policy. The company’s office, like the office of the association, was housed

9

in a room of Carl Nuechterlein’s mortuary, for which he was paid $1 a month in rent. And
for the first ten years of business, the company insured vehicles only in Frankenmuth and
surrounding rural areas. City dwellers, vastly more likely to be involved in auto accidents,
were judged to be a riskier investment.

By 1930, the company had over 3,000 policyholders
and a surplus of more than $80,000, which prompted
directors to relax the restriction on “city folk.” Policies
were soon being written for drivers as far as 30 miles

away in Bay City and Flint.

FUN FACT: Growth continued throughout the 1930s and ’40s.
The late 1940s were especially eventful:
A 1923 Dodge Brothers
car owned by John A. Geyer, 1945: The auto company issued its first non-
insured on the company’s first assessable policies, permitted by the Insurance
auto policy, is on display in Commission after an examination of the company’s
financial health.
the corporate
offices.

1948: The company was reincorporated, and its
charter was expanded to include coverage for comprehensive personal liability, family
liability and farm liability, which prompted a name change — the word “auto” was
dropped, marking the first use of Frankenmuth Mutual Insurance Company, the legal
name still in use today. Also in 1948, the company reached $1 million in assets.

1949: The company moved into its own home office building at 140 West Tuscola
Street — right next door to the Frankenmuth Mutual Fire Insurance Company.

10

Neighbors joining neighbors: the 1958 merger

They grew up in the same town. Their work brought them to the same counties. It was
probably inevitable that the two companies would come together to form one big happy
family.

It was a match made in heaven: The Frankenmuth

Mutual Fire Insurance Company was the second

largest company of its kind in Michigan, with over

16,000 policyholders and 50 agents. Their next-door

neighbor, the Frankenmuth Mutual Insurance Company,

provided auto and casualty insurance to over 40,000

policyholders and had 110 agents. And Carl Nuechterlein

served on the boards of both companies.

FUN FACT:

Merging the two companies allowed for new efficiencies, The company’s
home office would be expanded

since both businesses had many common policyholders. By working four times, in 1973, 1980, 1994 and
2008, and still serves as the
together, they were able to lower costs and provide better service
company’s home office

to all their customers. The merger became effective December 31, 1958. today.

The new corporation, with combined assets of $6 million, chose the name of the

Frankenmuth Mutual Insurance Company.

Milestones of the 1960s and ’70s

1960: The newly merged company moved into a new headquarters designed specifically
for the operation, with two levels of 12,000 square feet each and architecture incorporating
the diamond shapes in the company logo.

11

1968: Frankenmuth Mutual acquired the business of the Michigan Mutual Hail Insurance
Company of Lansing, to begin offering protection against crop damage.

1970–1975: Continuing to expand geographically, the company extended its operations to
Indiana, Ohio and Wisconsin.

Throughout the 1970s: The company was successful in its efforts to diversify the
business, as the increasing costs of repair parts, labor and medical fees negatively affected
the auto insurance portion of the company. By growing the property and commercial lines,
the company became stronger financially.

Making the grade in the 1980s and ’90s

The company’s emphasis on conservative underwriting practices and prudent financial
management paid off with increased growth, and an A+ “Superior” rating from A.M. Best
every year of the ’80s and ’90s. The company developed new products and expanded
commercial lines, with policies tailored to meet the needs of the burgeoning commercial
market.

Rave reviews kept coming, as multiple rating services gave the company the insurance
equivalent of “two enthusiastic thumbs up.” In 1991, Frankenmuth Mutual not only
maintained A.M. Best’s A+ rating, it was also recognized by Ward Financial Group as one
of the Top 50 property-casualty insurers in the United States (an honor the company has
earned 15 times), was given an A” (Double Prime — Unsurpassed) rating by Demotech,
Inc., and earned an A+ (Excellent) from Weiss Ratings, LLC.

12

Throughout the ’90s, research and innovation 1999—The former
in product design and customer service helped First of America
Frankenmuth Mutual continue to thrive, while Bank building on
continued investment in automation kept Main Street became
improving efficiencies. A $14 million expansion the home of the
of the home office was completed in 1994 to Claims Department.
make room for the growing company. By the
end of 1995, the company had direct written
premiums exceeding $150 million, and in
the late 1990s, the company began writing
insurance policies in Illinois and Virginia.

The expansion of the home office wasn’t
enough to keep pace with the company’s
rapid growth. So, in 1998, Frankenmuth
Mutual bought the First of America Bank
building on Main Street, renovated it,
and made it the new home of the Claims
Department in 1999. Also in 1999, two wholly owned subsidiaries
were formed to help the company expand into new states:
Ansur America Insurance Company and Fortuity Insurance
Company. ASure Worldwide Insurance Company was added in
2002 to continue the geographic expansion.

13

Notable Neighbors Frankenmuth Insurance Chief Executive Officers

Over 150 years, many While the title “Chief Executive Officer” was not officially used until
extraordinary neighbors 1968, each of these men served as the head of the company during
have worked together to different eras of its development.
make Frankenmuth Insurance
the company it is today. It’s Note that three generations of the Nuechterlein family headed
impossible to thank every one the company, beginning with Christoph Nuechterlein in 1896.
of them, but here the company Carl Nuechterlein, Christoph’s son, was a pivotal figure in Frankenmuth
honors the names that loom Insurance history. He helped organize the Frankenmuth Mutual Auto
largest in its history. Insurance Company in 1921 and served as Secretary (CEO) for both
companies before they merged in 1958. Carl was succeeded by his son,
Arnold Nuechterlein.

Johann Adam List Johann Georg Rummel Christoph Nuechterlein Carl Nuechterlein Arnold C. Nuechterlein

Years served: 1868–1874 Years served: 1875–1896 Years served: 1896–1925 Years served: 1921–1959 Career at Frankenmuth
Insurance: 1935–1982
Years served as Secretary (CEO) of
Frankenmuth Fire: 1925–1941 Years served as Secretary
(CEO) of Frankenmuth Mutual
Years served as Secretary (CEO) Fire: 1941–1958
of Frankenmuth Mutual Insurance
(pre-merger): 1929–1954 Years served as President of
Frankenmuth Mutual
Years served as President of (post-merger): 1959–1968
Frankenmuth Mutual
(post-merger): 1958–1959 Years served as CEO
(post-merger): 1968–1976
Years served as Chairman of
the Board of Frankenmuth Mutual Years served as Chairman of
(post-merger): 1959-1968 the Board (post-merger):
1968-1978

14

A fourth generation, attorney Christopher Nuechterlein, served on the board of directors
from 1976 to 2000.

The Michigan Insurance Hall of Fame

These Frankenmuth Insurance officers were inducted into the Michigan Insurance Hall
of Fame, which recognizes individuals making a significant contribution or special impact
on the ability of the insurance industry to serve the public in Michigan.

• Harvey E. Kern, Chairman of the Board and CEO — Inducted in 1997
• Morrall M. Claramunt, Executive Vice President and Secretary — Inducted in 2004
• James E. Wilds, Senior Vice President — Inducted in 2010

Norman Felgner Arnold M. Krueger Harvey E. Kern Gerald L. Stanton John S. Benson

Career at Frankenmuth Insurance: Career at Frankenmuth Career at Frankenmuth Career at Frankenmuth Career at Frankenmuth
1929–1981 Insurance: 1949–1983 Insurance: 1960–2001 Insurance: 1966–2012 Insurance: 1996–Present
Years served as CEO:
Years served as Secretary (CEO) of 1976–1978 Years served as CEO: Years served as CEO: Years served as CEO:
Frankenmuth Mutual (pre-merger): 1978–1996 1996–2008 2008–Present
1954–1958 Elmer P. Simon
Years served as Chairman of Years served as Chairman of Years served as Chairman of
Chairman of the Board the Board: 1987–2001 the Board: 2001–2012 the Board: 2012 to Present
from 1978–1987.

15

Being good neighbors

The founding of the company was based on neighbor helping neighbor. And FUN FACT:
that tradition continues. Over the years, the company has contributed to In 1996, when
various community and industry causes, such as schools, universities, a tornado hit Frankenmuth
community projects and United Way, which remains a major fundraising and cut off power at headquarters,
project each year. Additionally, officers and employees regularly give their time company adjusters went door to door
in a golf cart to find
policyholders

in need.

and talents in many volunteer positions, including city and statewide committees,

local fire departments, Habitat for Humanity, and civic groups of all kinds.

In 1992, the company began its Student Associate program, which gives internships to
promising college students seeking to learn more about the insurance industry.

In 2009, the company created an endowed scholarship at Olivet College, with similar scholarships
created at Northwood University in 2016 and Ferris State University in 2017. The scholarships
give preference to students studying insurance and risk management, but are also available to
other majors employed in the insurance industry, such as IT, marketing and accounting.

In 2016, Frankenmuth Insurance created the Insurance Leadership Academy in partnership
with Northwood University, the Tuscola County Intermediate School District, Frankenmuth

Public Schools and InsuringMIFuture.org,
to introduce high school students from
surrounding communities to the
insurance industry.

In 2017, the company created the
Frankenmuth Insurance Foundations,
three separate foundations dedicated

16

to preparing students for careers in the insurance industry, 2017—Employees
providing scholarship grants and contributing to charitable volunteering at
organizations in the communities where it does business. the Auto Fest Big
Block Party.
Frankenmuth Insurance has a longstanding commitment to
ongoing education of its employees, and provides convenient
opportunities to participate in clubs like Toastmasters,
Chartered Property Casualty Underwriters and International
Association of Insurance Professionals.

Independent agents: Some of our most important neighbors

Without the independent agents who represent Frankenmuth Insurance, the
company would not have expanded beyond its home town. The company’s agency
partners have helped Frankenmuth Insurance grow and prosper beyond the original
founders’ expectations. When the company began in 1868,
the members themselves spread the word about
the association. By 1941, the company had 12
agents. Today it is represented by 600 independent
insurance agencies in 15 states.

Frankenmuth Insurance is extremely proud of the
longstanding relationships it has with the highest quality agency partners.
Some, such as Seelbinder Agency, appointed in 1928, have represented the
company for 75 years or more. The company is selective, choosing only the
most professional and trustworthy agents, and then
working to build strong relationships that stand the test of time.

17

Taking advantage of technology

Frankenmuth Insurance has always had a conservative business
philosophy, but when it comes to taking advantage of technological
innovations, the company has never been afraid to step forward with
the times — especially when the result is improved
customer service.

The company’s earliest records were handwritten,
and then later typed. By the late 1970s and early
1980s, computer terminals were used for the entry
of some statistical data, but it was a slow process
by today’s standards, and one row of terminals
was shared by the entire company. When a
special light was on over the row of terminals,
the system was unavailable. When this light
turned off, a stampede of workers bolted for
the row to get their chance to enter data.

By the 1990s, there was a personal
computer at every work station, which made
data entry far easier and more efficient (though perhaps less
aerobic!). By the late 1990s, electronic document imaging further
streamlined the system and helped the company go paperless.
Also in the ’90s, agencies were able to download policy information
directly from the company for the first time, improving efficiency

18

and customer service. And, Interactive Voice Response allowed agents and
policyholders to get billing information by phone.

The agency automation begun in the 1990s continued into the 2000s with the
introduction of the iBIS new business system, which allows agency partners
to perform real-time rating and automated insurance
solutions over the Internet, 24 hours a
day, seven days a week.

Continuing the quest for greater
efficiency, in 2014 the Board of Directors
approved a five-year project to replace the
core operating systems used by the company
and its agents to quote business, write
policies and pay claims.

The company continues to seek out new
technological innovations that will make
service faster, more accurate and more efficient
(for example, the company acquired three drones
in 2017 to help inspect loss claims more safely).
These days, no records are stored in a coffin in the
back room of a mortuary.

19

New millennium, new neighbors

The company’s efforts to stay at the forefront of technology in the insurance industry
were ready to pay off. For both agency partners and the company as a whole,
the new technology meant greater speed and accuracy, reduced expenses and
enhanced productivity. The result: direct written premium soared from $269 million
in 2000 to almost $364 million in 2005.

The company was licensed in 37 states, but as of 2000, was doing
business in only six: Michigan, Illinois, Indiana, Ohio, Virginia and
Wisconsin. It became a company goal to not only increase business in those
states, but also to expand into others. From 2004 to 2006, the company
began writing commercial lines products in Georgia, Tennessee, North Carolina
and South Carolina. In 2009, Kentucky and Alabama were also added.

While moving south, the company also looked to the northeast to meet some
new neighbors. A merger with Patriot Mutual Insurance Company, a personal lines
property and casualty insurer, occurred in July 2007. During this time of growth and
change, the company adopted the logo that is in use today and began calling itself
simply Frankenmuth Insurance. Similarly, Patriot Insurance Company was adopted as
the subsidiary’s business name.

New life for the company

Patriot Insurance does business in Maine, New Hampshire and Vermont, and also
had a small dormant life insurance subsidiary, Patriot Life Insurance Company.
In 2010, Patriot Life was relocated to Michigan, and issued its first policy on
December 6, 2010.

20

November 2017—
Patriot Insurance
unveiled its new
34,500-square-foot
headquarters in
Yarmouth, Maine.

21

2013 —Taken after the
company was given the
PIA National Company
Award of Excellence.

22

Recent history — and a promising future

2015: The company welcomed the Claims Department back to
the main headquarters. After a 50,000-square-foot expansion of
the headquarters building in 2008 and increasing ranks of remote
employees, there was plenty of room for continued growth.
Also in 2015, the company launched a corporate branding initiative,
using the tag line, “Let’s have a frank conversation.” The tag line not
only reminds consumers of the company name, it also conveys the
way it has always done business — with straightforward candor and
personal service.
2016: Always looking for new opportunities to grow, Frankenmuth
Insurance extended its product line into surety bonds with the
creation of Frankenmuth Surety. The new division provides a wide
array of construction, commercial and subdivision bonds, and is
approved by the U.S. Department of Treasury.
Ground was broken in 2016 for a new Patriot Insurance Company
headquarters in Yarmouth, Maine; the company moved into the new
building in November 2017.
In 2017, Frankenmuth Insurance was named to Ward’s Top 50
(property and casualty) for the 15th time.

23

2018 and beyond

Frankenmuth Insurance looks forward to the future with anticipation,
knowing the company will embrace it with the same values its founders
did: a concern for their neighbors, a willingness to venture into new
territory, and the wisdom to preserve and expand the operation for
future generations.

These ideas have guided the company to financial
strength and steady growth through the last 150
years. From the back room of Nuechterleins’
mortuary with just 200 charter members,
Frankenmuth Insurance now writes 325,000
policies per year representing nearly $700 million
in premium. It is ranked among the largest and
most stable property-casualty companies with
more than $1.5 billion in assets, and continues to
bring peace of mind to its policyholders.

It is this ability to succeed while remaining firmly committed to its
principles — the simple desire to do right by its neighbors — that is the
foundation of the company’s success. Neighbor helping neighbor. It’s not
just a slogan. It’s the way Frankenmuth Insurance has done business
since 1868.

24



1 Mutual Avenue, Frankenmuth, MI 48787
fmins.com

COORDINATED TRANSPLANT CARE

The Henry Ford Liver Disease Center Improving Transplant Outcomes
No one is better equipped to manage patients with complex liver conditions than the Liver The Henry Ford Liver Transplant program offers outstanding outcomes and consistently
Disease Center at Henry Ford Hospital — one of the nation’s largest and most experienced reports graft and patient outcomes consistent with national outcomes. Ongoing quality
centers of its kind. Every year, thousands of patients receive care from our comprehensive team initiatives have been successful in decreasing rejection rates, length of stay and readmission
of diagnostic, medical, interventional, surgical and transplant specialists, who provide advanced within 30 days after discharge. Skilled management by our highly experienced hepatology
diagnostic studies and a wide range of therapies matched to each patient’s condition. team has resulted in the lowest death rate and highest transplant rate among patients
awaiting liver transplant in Michigan.
With the incidence of obesity, type 2 diabetes and high cholesterol on the rise, so too are
the rates of nonalcoholic fatty liver disease (NAFLD) and other metabolic conditions. Today, EVALUATION
NAFLD is the most common chronic liver disorder in the United States and the fastest rising
diagnosis for liver transplant waitlist. The shorter the wait, the greater chance of success. With Henry Ford’s FAST Track process,
our liver transplant team can complete all required medical tests and psychological
Hepatitis assessments in one to two days. With results in hand, we can place patients on the
Our experienced hepatologists have clinical and research capabilities unmatched in the region national transplant waitlist as soon as possible.
and participate in one of the country’s most active programs dedicated to viral hepatitis. Our
experience led to the development of transplant protocols for patients with hepatitis B and C, Our vast clinical expertise has allowed us to develop transplant protocols for the following
although the need for transplant in these patients is declining due to the success of curative diagnoses:
therapies we helped develop through research and a clinical trial at Henry Ford Hospital.
• viral hepatitis B or C
Malignant and Benign Tumors • primary biliary cirrhosis
Our liver team is composed of experts who pioneered some of the leading approaches to • primary sclerosing cholangitis
treating hepatocellular carcinoma (HCC) and other malignant and benign tumors. Patients • autoimmune chronic active hepatitis
are reviewed at a weekly liver tumor board to determine the safest and most effective • alpha-1 antitrypsin deficiency
treatment plan. Our five full-time liver surgeons have advanced fellowship training in liver • hemochromatosis
transplant surgery. Patients with tumors that don’t respond to initial treatment or can’t be • fulminant or subfulminant hepatic failure
resected may qualify for transplant. • Wilson’s disease
• steatohepatitis/fatty liver disease
We offer the full range of treatment modalities for liver tumors: • cryptogenic cirrhosis

• robotic or minimally invasive surgery Select patients with:

• interventional radiology such as chemoembolization, radioembolization, • alcoholic liver disease
bland embolization and percutaneous ablation • hepatocellular carcinoma
• benign hepatic tumors
• radiofrequency ablation, microwave ablation and cryoablation • polycystic liver disease
• inborn errors of metabolism
• radiation, including intensity-modulated radiation therapy • cholangiocarcinoma

• treatment with newly approved drugs and through clinical trials

• transplantation

FOR REFERRALS OR
PATIENT APPOINTMENTS:

(313) 916-8865

HENRY FORD TRANSPLANT INSTITUTE 29

LIVER TRANSPLANT OUTCOMES – AT A GLANCE

Liver FIRST TRANSPLANT 3/30/1989 HENRY FORD PATIENT SURVIVAL RATES FOR LIVER TRANSPLANT*
Intestinal &
Multivisceral TRANSPLANTS PERFORMED IN 2017 111 ONE-YEAR 93.71%
93.11%
Kidney LIVING DONOR 9 ^ONE-YEAR EXPECTED
Pancreas 85.79%
DECEASED DONOR 102 THREE-YEAR 84.86%
Lung
Heart ^THREE-YEAR EXPECTED
Bone
Marrow TOTAL NUMBER OF PROGRAM TRANSPLANTS THROUGH 2017 1864 DECEASED DONOR ONE-YEAR 93.24%
93.02%
30 DECEASED DONOR 1756 ^ONE-YEAR EXPECTED
85.28%
LIVING DONOR 108 THREE-YEAR 84.99%

RECEIVED MEDICARE APPROVAL 1/1/1977 ^THREE-YEAR EXPECTED

MEDIAN TIME TO TRANSPLANT< (12.7 MONTHS NATIONALLY) 9.0 months LIVING DONOR ONE-YEAR 100.00%
94.39%
WAITLIST MORTALITY~ (EXPECTED .135, NATIONAL .141) .100 ^ONE-YEAR EXPECTED
TRANSPLANT RATES~ (EXPECTED .444, NATIONAL .519) .577 90.00%
THREE-YEAR 83.79%

^THREE-YEAR EXPECTED

MILESTONES IN LIVER TRANSPLANTATION % 0 10 20 30 40 50 60 70 80 90 100

SEVERAL “FIRSTS” WERE PERFORMED AT HENRY FORD HOSPITAL: HENRY FORD GRAFT SURVIVAL RATES FOR LIVER TRANSPLANT+

FIRST IN Michigan to perform a split-liver transplant from a ONE-YEAR 90.88%

deceased donor (1996) ^ONE-YEAR EXPECTED 91.00% < Patients on the waitlist between 01/01/2012

FIRST IN Michigan to perform an adult-to-adult living-donor liver THREE-YEAR 85.03% and 06/30/2017
82.68% ~ Patients on the waitlist between 01/01/2016
transplant (2000) ^THREE-YEAR EXPECTED
and 12/31/2017
FIRST IN Michigan to perform laparoscopic surgery for living-
* Estimated probability of surviving at one
donor liver transplantation (2008) month and one year, for patients receiving
DECEASED DONOR ONE-YEAR 90.22% their first transplant between 01/01/2015
FIRST IN U.S. to use sofosbuvir, investigational medication for 91.08% and 06/30/2017; and at three years, for
^ONE-YEAR EXPECTED patients receiving their first transplant
hepatitis C post-transplant (2012) 84.43% between 07/01/2012 and 12/31/2014
THREE-YEAR 83.14%
FIRST IN Michigan to perform a lung-liver transplant (2013) ^ Adjusted for patient and donor
FIRST IN Michigan to perform an adult heart-liver transplant (2015) ^THREE-YEAR EXPECTED characteristics
FIRST IN Michigan to perform a heart-liver-kidney transplant (2018)
+ Estimated probability of surviving with
a functioning graft at one month and
one year, for patients receiving their
LIVING DONOR ONE-YEAR 100.00% first transplant between 01/01/2015 and

^ONE-YEAR EXPECTED 89.82% 06/30/2017; and at three years, for patients
receiving their first transplant between
07/01/2012 and 12/31/2014
THREE-YEAR 90.00% Source: Scientific Registry of Transplant
78.85% Recipients, Center and OPO-specific
^THREE-YEAR EXPECTED Reports, based on data available July 31,

2018, released October 9, 2018

% 0 10 20 30 40 50 60 70 80 90 100

HENRY FORD TRANSPLANT INSTITUTE

INTESTINE &
MULTIVISCERAL

TRANSPLANT



Georgio Maggiorino:

M u lt i v i sc e r a l Tr a n sp la n t R e c i p i e n t

Sh elb y To w n sh i p, M i c h i ga n

“I thought to myself, ‘this is crazy,’” recalls Georgio Maggiorino, about the first time he heard doctors mention a multivisceral transplant.
“Removing my liver, pancreas, stomach and small intestine – that sounds like something that happens in movies. I didn’t know they
could do that.”

In 2010, Maggiorino was battling neuroendocrine cancer that had metastasized to his liver. He’d undergone a series of
chemoembolization treatments and surgeries. However, the cancer continued to advance and his liver was failing. Maggiorino’s
interventional radiologist Todd Getzen, M.D., and gastroenterologist Syed-Mohammed Jafri, M.D., suggested he meet with the
multivisceral transplant team.

A novel approach at the time, multivisceral transplant was deemed Maggiorino’s best chance for survival. After almost 18 months on
the waiting list, a suitable donor was found. A team led by Marwan Kazimi, M.D., and Marwan Abouljoud, M.D., conducted the 14-hour
transplant.

As a former residential builder, Maggiorino knows the importance of working with a team of skilled professionals to get the job done.
That’s why Maggiorino credits his medical team – gastroenterologists, oncologists, interventional radiologists and surgeons – who
collaborated to treat his cancer, perform his transplant and manage his care.

“I was in good hands,” says Maggiorino. “I had full confidence in them. It has to be perfect, and it was perfect. I’m living proof they’ve
got it down to a science.”

While the road to recovery was long, Maggiorino says he stayed positive and listened to his doctors every step of the way. Now almost
seven years out, Maggiorino reflects on how his life has changed. In the early days following transplant, he was taking 23 different
medications. Now he’s down to one antirejection pill a day. He’s living an active lifestyle, exercising, traveling, and going out with friends
and family.

“I have a normal life,” he says. “Look at me, I’m alive. It’s been seven years, and I’ll be here for the next seven years.”

HENRY FORD TRANSPLANT INSTITUTE 33

Liver INTESTINE AND MULTIVISCERAL TRANSPLANT COORDINATED TRANSPLANT CARE
Intestinal &
Multivisceral MICHIGAN’S FIRST AND ONLY CENTER FOR INTESTINE AND The Henry Ford Division of Gastroenterology and Hepatology is a national leader in the
MULTIVISCERAL TRANSPLANTATION diagnosis, treatment and management of advanced digestive disorders of the esophagus,
Kidney stomach, intestines, colon and rectum, as well as the liver, biliary tract, gallbladder and
Pancreas The Henry Ford Transplant Institute is among only a handful of transplant centers pancreas. The division’s specialists are aggressively researching and testing new ways to
in the United States, and the only center in Michigan offering comprehensive treat digestive disorders to deliver the most innovative therapies to patients.
Lung intestine and multivisceral transplant in adults. Since pioneering Michigan’s first
Heart intestine transplant, the Henry Ford Transplant Institute continues to build its Intestine Rehabilitation
Bone volume and waitlist, performing 31 transplants through 2017. First and foremost, our goal is to reduce the need for intestine transplant. The Henry Ford
Marrow Intestine Transplant and Rehabilitation Program offers expertise at every step of the care
Intestine transplant is a viable option for people with chronic conditions of continuum. From our nurses, registered dietitians, pharmacists and social workers, to
the small bowel and those dependent on total parenteral nutrition (TPN). Our gastroenterologists, interventional radiologists and surgeons, we are experts in managing
transplant surgeons are experienced in performing the full array of intestine complex intestine failure.
transplant procedures. For candidates needing transplantation of the intestine
along with additional abdominal organs, our highly recognized liver and Intestine rehabilitation aims to prolong or prevent the need for transplant and improves
pancreas programs allow us to offer multivisceral transplants. a patient’s quality of life by reducing the dependence on TPN or intravenous feeding. Our
team of experts offers nutritional counseling and dietary changes, intestine adaption to
Transplants performed at the Henry Ford Transplant Institute include: improve absorption of electrolytes, fluids and nutrients, and medication management.

• Isolated intestine transplant: patients with short bowel syndrome and no liver disease Sometimes, surgery is necessary to preserve the remaining short bowel. The surgical
• Modified multivisceral transplant: patients with short bowel syndrome requiring team at the Henry Ford Intestine Transplant and Rehabilitation Program is highly
experienced in the most innovative surgical techniques.
intestine, stomach and pancreaticoduodenal complex
• Full multivisceral transplant: patients with short bowel syndrome and irreversible liver Improving Transplant Outcomes
Over the last decade, outcomes for intestine and multivisceral transplant have greatly
disease, diffuse portomesenteric thrombosis or low malignant tumor, such as desmoid improved due to advancements in surgical techniques and anti-rejection therapies, as
tumor and neuroendocrine tumor, which require intestine, stomach, pancreaticoduodenal well as reductions in post-surgical infection rates. Since performing the state’s first
complex or liver transplant multivisceral transplant in 2010, the Henry Ford Transplant Institute continues to grow its
transplant volume and waitlist and also reports patient survival outcomes better than
Many times, we see patients with intestine failure who have very national rates. Our multivisceral program is highly committed to advancing the science of
low quality of life, who come to us in desperation. We can offer this relatively new field. The program has demonstrated a year-to-year reduction in the
them hope and turn their condition around. number of recipients discharged home on TPN, among other quality indicators.

— Dr. Yakir Muszkat Fewer than 10 institutions in the country are certified to do intestine
Medical Director, Intestine Transplant and Rehabilitation transplants. Many patients don’t even know it’s an option. First, we
work to improve absorption through rehabilitation. But if a patient
can’t absorb nutrition, we can offer transplant.

— Dr. Shunji Nagai
Surgical Director, Intestine Transplant and Rehabilitation

34 HENRY FORD TRANSPLANT INSTITUTE

INTESTINE AND MULTIVISCERAL TRANSPLANT OUTCOMES – HENRY FORD PATIENT SURVIVAL RATES FOR MULTIVISCERAL TRANSPLANT*
AT A GLANCE
PATIENT
FIRST TRANSPLANT 8/22/2010 ONE-YEAR 51.28%
THREE-YEAR
77.78%

TOTAL NUMBER OF PROGRAM TRANSPLANTS THROUGH 2017 31 % 0 10 20 30 40 50 60 70 80 90 100

RECEIVED MEDICARE APPROVAL 2/8/2013 HENRY FORD GRAFT SURVIVAL RATES FOR MULTIVISCERAL TRANSPLANT+
5.7 months
MEDIAN TIME TO TRANSPLANT<
GRAFT ONE-YEAR 51.28%
COMPARED WITH 6.8 MONTHS NATIONALLY THREE-YEAR 58.33%

WAITLIST MORTALITY~ 0.0

(EXPECTED .25, NATIONAL .057) STATISTICALLY NOT SIGNIFICANTLY DIFFERENT

TRANSPLANT RATES~ 7.71 % 0 10 20 30 40 50 60 70 80 90 100

(EXPECTED 1.79, NATIONAL .405) STATISTICALLY NOT SIGNIFICANTLY DIFFERENT < Patients on the waitlist between 01/01/2012 and 06/30/2017
~ Patients on the waitlist between 01/01/2016 and 12/31/2017
MILESTONES IN * Estimated probability of surviving at one month and one year, for patients receiving
INTESTINE AND MULTIVISCERAL TRANSPLANTATION
FIRST IN Michigan to perform a modified multivisceral their first transplant between 01/01/2015 and 06/30/2017; and at three years, for
patients receiving their first transplant between 07/01/2012 and 12/31/2014
(stomach, intestinal and pancreas) transplant (2010) ^ Adjusted for patient and donor characteristics
+ Estimated probability of surviving with a functioning graft at one month and one
year, for patients receiving their first transplant between 01/01/2015 and 06/30/2017;
and at three years, for patients receiving their first transplant between 07/01/2012
and 12/31/2014
Source: Scientific Registry of Transplant Recipients, Center and OPO-specific Reports,
based on data available July 31, 2018, released October 9, 2018.

FOR REFERRALS OR
PATIENT APPOINTMENTS:

(313) 916-8865

HENRY FORD TRANSPLANT INSTITUTE 35



KIDNEY &
PANCREAS TRANSPLANT



J u v e n a l Sa n t i lla n o & I r m a Sa n t i lla n o

Kidney Transplan t Recipien t and Li ving Kidney Donor

Por t Huron, Michigan

Irma Santillano’s childhood impression of her father, Juvenal, is that of a hardworking father who spent endless hours tending to his
lawn care business. That’s why it was unusual when Irma noticed her father becoming increasingly fatigued. Even activities such as
raking leaves would leave him breathless and with extreme swelling in his legs.

Juvenal went to his doctor, and all tests pointed to a problem with his kidneys. A subsequent kidney biopsy revealed that Juvenal had
LECT2 Amyloidosis. A rare condition mostly seen in individuals of Mexican descent, LECT2 Amyloidosis causes abnormal proteins to
deposit around the body, including the kidneys, liver and spleen. Juvenal learned his kidney function would continue to deteriorate and
his best chance for long-term survival was a kidney transplant.

Knowing the wait for a kidney transplant could take years, Irma volunteered to be tested as a living-donor candidate.

“He’s the best male role model in my life,” says Irma, describing her father. “He shows us how we should treat others, and the
compassion we should have for each other. I love my dad with everything.”

When making the decision, Irma considered not just her father, but the entire family. “I have a younger brother and little sister who
haven’t seen the best of him. [A kidney transplant] means we have more time with him, that we’ll be able to create more memories
with him.”

Irma underwent extensive screening, including tests to ensure she didn’t have LECT2 Amyloidosis or that she wasn’t at risk for
developing the disease because of the condition’s genetic component. She was cleared as a donor and the laparoscopic donation and
transplant took place. Irma’s minimally invasive laparoscopic nephrectomy resulted in a faster recovery and an earlier return to an
active lifestyle than traditional kidney donor surgery.

Since the successful transplant, father and daughter share a special bond.

“I am very thankful. Not everyone decides to give you one of their body parts” says Juvenal about his eldest daughter. “I have an
opportunity to live longer because of her and because of God.”

The transplant journey piqued Irma’s interest in the medical field, and she enrolled in and graduated from an EMT program. The
daughter who credits her father for instilling compassion in her, who selflessly donated her kidney, says she wants to “help people the
way they helped my family.”

HENRY FORD TRANSPLANT INSTITUTE 39

Liver KIDNEY TRANSPLANT ROBOTIC & MINIMALLY INVASIVE KIDNEY TRANSPLANT
Intestinal &
Multivisceral A HISTORY OF EXCELLENCE IN KIDNEY TRANSPLANTATION Kidney transplant with fewer complications, quicker recovery

Kidney Since 1968, Henry Ford Hospital surgeons have transplanted more than 3,300 Continuing a legacy of innovation, surgeons at the Henry Ford Transplant Institute, in
Pancreas kidneys, extending the lives of people with irreversible kidney failure who, without partnership with the Vattikuti Urology Institute at Henry Ford Hospital, have developed
a transplant, would be dependent on dialysis. robotic kidney transplant. We were the first program in Michigan to offer robotic-assisted
Lung kidney transplant surgery. Today about one-third of our kidney transplants are performed
Heart The Henry Ford Transplant Institute offers one of the largest experiences in the robotically.
Bone United States in robotic and minimally invasive kidney surgery. Our dedicated team
Marrow of surgeons and transplant nephrologists partner to deliver exceptional, patient- Compared to traditional kidney transplant, the robotic technique:
centered care.
• expands the criteria for eligible recipients who might not be suitable for traditional kidney
The Henry Ford Transplant Institute performs the full range of kidney, pancreas transplant surgery
and kidney-pancreas transplants:
• offers greater mobility and faster recovery
• living-donor kidney transplant • decreases chance of wound complications
• living-related donor kidney transplant (LRD) • results in less incisional pain
• living-unrelated donor kidney transplant (LURD)
• kidney paired donation (KPD) Our surgeons pioneered a cooling technique that has been shown to help preserve kidney
• nondirected altruistic living-donor kidney transplant tissue and increase the likelihood of a successful transplant. The living-donor kidney is
• deceased-donor kidney transplant wrapped in a specially designed gauze pouch and placed in a sterile ice mixture. A sterile ice
• simultaneous pancreas and kidney transplant (SPK) mixture is also injected into the recipient’s body cavity before inserting the kidney.
• pancreas after kidney transplant (PAK)
• pancreas transplant alone (PTA) LIVING KIDNEY DONATION

Providing unparalleled support for donors

Minimally Invasive Living-Donor Nephrectomy

The Henry Ford Transplant Institute was among the first centers in the country to
perform laparoscopic kidney removals. Today, we remove most living-donor kidneys
using either robotic or laparoscopic nephrectomy. These minimally invasive approaches
result in less internal scarring, less pain, a faster recovery and an earlier return to an
active lifestyle for the donor.

While the Henry Ford Transplant Institute offers both deceased-donor and living-donor
kidney transplants, graft survival statistics for living-donor transplant remain superior.

40 HENRY FORD TRANSPLANT INSTITUTE

HENRY FORD CENTER FOR LIVING DONATION IMPROVING KIDNEY TRANSPLANT
OUTCOMES
The Henry Ford Center for Living Donation is one of the first of its kind in the United States
to offer a highly structured, concierge-style approach to facilitate living kidney donation Henry Ford’s kidney transplant team is
and provide our living-donor “heroes” the care they deserve. continuously identifying ways to improve
outcomes. Initiatives through our outreach
A multidisciplinary screening clinic provides prospective donors with medical and clinics to provide closer post-transplant care
psychological evaluation in one convenient visit. We help donors understand the risks have resulted in a steep reduction in incidence
involved with surgery, prioritize their comfort and safety, and provide education, of delayed graft function. For diabetic patients
support and expert medical care before, during and following surgery. undergoing transplant evaluation, additional
cardiac screening helps ensure better outcomes.
The growing disparity between available, compatible kidneys and the number of The newly launched Henry Ford Center for Living
patients awaiting transplant has prompted creative options for living kidney donation. Donation is focused on increasing living donation
The Henry Ford Transplant Institute offers: and kidney paired donation, which correlate
to better outcomes than deceased-donor
Direct donation: The most common form, a friend of family member is a good transplants.
match and donates directly to the recipient.
EVALUATION
Kidney paired donation: If a willing donor and recipient are not compatible, a
computer system matches them with other donor/recipient pairs. This program Candidates who meet the necessary criteria are scheduled for an evaluation within two
works to find the best outcome for all parties involved while arranging the most weeks following referral. Evaluations are conducted at the Henry Ford Hospital campus
transplants possible. In fall 2017, the Henry Ford Transplant Institute participated in clinic building and at eight Henry Ford Transplant Institute outreach clinics located
an eight-kidney paired exchange. conveniently throughout Michigan.

Voluntary exchange: Two living donors agree to swap recipients with whom they We perform kidney transplant for patients with the following
are better matches, so that both may have the best opportunity for a successful primary diagnosis:
transplant.
• polycystic kidney disease
COORDINATED TRANSPLANT CARE
• nephrosclerosis
The Henry Ford Transplant Institute’s multidisciplinary care model allows for highly
coordinated care of patients with comorbid conditions. The Henry Ford Division of • chronic pyelonephritis
Nephrology and Hypertension is a national leader in treating chronic kidney disease
at all stages, as well as complications from diabetes, kidney stones, hypertension and • glomerulonephritis
electrolyte disorders.
• diabetes mellitus
Our nephrologists manage complex, advanced kidney failure. Our experience helps us
identify patients for pre-emptive kidney transplant even before their condition deteriorates • kidney stones
and requires dialysis.
• renal cell carcinoma
For patients with renal cancer, Henry Ford’s Vatikutti Urology Institute is the first in the
world to perform robotic procedures which can reduce complications and recovery time • Lupus
compared with traditional surgeries.
• hypertension

• focal segmental glomerulosclerosis (FSGS)

• IgA nephropathy

FOR REFERRALS OR
PATIENT APPOINTMENTS:

(313) 916-1269

HENRY FORD TRANSPLANT INSTITUTE 41

Liver KIDNEY TRANSPLANT OUTCOMES – AT A GLANCE 1/4/1968 MILESTONES IN KIDNEY TRANSPLANTATION
Intestinal & 1 09
Multivisceral FIRST TRANSPLANT 49 SEVERAL “FIRSTS” WERE PERFORMED AT HENRY FORD HOSPITAL:
TRANSPLANTS PERFORMED IN 2017 60
Kidney LIVING DONOR ONE OF THE FIRST IN Michigan, and one of only two dozen
Pancreas DECEASED DONOR 3,328
TOTAL NUMBER OF PROGRAM TRANSPLANTS THROUGH 2017 1,138 in the country, to perform a cross-racial living kidney
Lung LIVING DONOR 2,190 transplant (1996)
Heart DECEASED DONOR 1/1/1977
Bone RECEIVED MEDICARE APPROVAL 43.5 months ONE OF THE FIRST adopters of laparoscopic kidney removal
Marrow MEDIAN TIME TO TRANSPLANT< (60.5 MONTHS NATIONALLY) .207
WAITLIST MORTALITY~ (EXPECTED .178, NATIONAL .181) .062 from a living donor
TRANSPLANT RATES~ (EXPECTED .051, NATIONAL .055)
FIRST IN Michigan to perform robotic kidney transplantation (2014),

second-largest program in the nation

FIRST IN Michigan to perform a heart-liver-kidney transplant (2018)

HENRY FORD PATIENT SURVIVAL RATES FOR KIDNEY TRANSPLANT* HENRY FORD GRAFT SURVIVAL RATES FOR KIDNEY TRANSPLANT+ < Patients on the waitlist between 01/01/2012 and
06/30/2017
ONE-YEAR 95.67% ONE-YEAR 94.52%
97.65% 95.36% ~ Patients on the waitlist between 01/01/2016 and
^ONE-YEAR EXPECTED ^ONE-YEAR EXPECTED 12/31/2017
93.19% 88.93%
THREE-YEAR 92.82% THREE-YEAR 87.34% * Estimated probability of surviving at one month
and one year, for patients receiving their first
^THREE-YEAR EXPECTED ^THREE-YEAR EXPECTED transplant between 01/01/2015 and 06/30/2017;
and at three years, for patients receiving their
DECEASED DONOR ONE-YEAR 93.08% DECEASED DONOR ONE-YEAR 91.47% first transplant between 07/01/2012 and 12/31/2014
96.76% 93.89%
^ONE-YEAR EXPECTED ^ONE-YEAR EXPECTED ^ Adjusted for patient and donor characteristics
89.47% 83.43% + Estimated probability of surviving with a
THREE-YEAR 90.95% THREE-YEAR 84.46%
functioning graft at one month and one year, for
^THREE-YEAR EXPECTED ^THREE-YEAR EXPECTED patients receiving their first transplant between
01/01/2015 and 06/30/2017; and at three years, for
LIVING DONOR ONE-YEAR 100.00% LIVING DONOR ONE-YEAR 100.00% patients receiving their first transplant between
99.08% 97.93% 07/01/2012 and 12/31/2014
^ONE-YEAR EXPECTED ^ONE-YEAR EXPECTED # Patients on the waitlist between 01/01/2017 and
100.00% 100.00% 12/31/2017
THREE-YEAR 96.23% THREE-YEAR 93.13% Source: Scientific Registry of Transplant
Recipients, Center and OPO-specific Reports,
^THREE-YEAR EXPECTED ^THREE-YEAR EXPECTED based on data available July 31, 2018, released
October 9, 2018

% 0 10 20 30 40 50 60 70 80 90 100 % 0 10 20 30 40 50 60 70 80 90 100

42 HENRY FORD TRANSPLANT INSTITUTE

PANCREAS TRANSPLANT OUTCOMES HENRY FORD SURVIVAL RATES FOR PANCREAS TRANSPLANT

A LIFE-CHANGING OPTION FOR PEOPLE WITH DIABETES ALL PANCREAS ONE-YEAR 100.00%
TRANSPLANTS 97.50%
For more than three decades, the Henry Ford Transplant Institute has (PAK, SPK, PTA)* ^ONE-YEAR EXPECTED
92.86%
provided pancreas transplant as an option to patients with severe diabetes. THREE-YEAR 95.33%

We are one of only two hospitals in Michigan performing pancreas and ^THREE-YEAR EXPECTED

kidney-pancreas transplants. SPK ONE-YEAR 100.00%
96.73%
COORDINATED TRANSPLANT CARE (SIMULTANEOUS ^ONE-YEAR EXPECTED
PANCREAS-KIDNEY)* 90.00%
The Henry Ford Division of Endocrinology, Diabetes and Metabolism is nationally THREE-YEAR 93.30%
recognized for diabetes care, and our transplant team works closely with
endocrinologists and nephrologists to help patients who may require a ^THREE-YEAR EXPECTED
pancreas transplant. Henry Ford endocrinologists are pioneers in type 1 and
type 2 diabetes management and research. We have Michigan’s largest patient PAK ONE-YEAR 100.00%
experience in the use of insulin pumps, and we continue to advance diabetes 98.23%
care through new medications, intensive glucose management and state-of-the- (PANCREAS AFTER ^ONE-YEAR EXPECTED
art continuous glucose monitoring devices. KIDNEY TRANSPLANT)* 100.00%
THREE-YEAR 100.00%

^THREE-YEAR EXPECTED

PANCREAS TRANSPLANT – AT A GLANCE 5/11/1987 PTA ONE-YEAR 100.00%
5 100.00%
FIRST TRANSPLANT (PANCREAS ^ONE-YEAR EXPECTED
TRANSPLANTS PERFORMED IN 2017 158 TRANSPLANT ALONE)*
TOTAL NUMBER OF PROGRAM TRANSPLANTS THROUGH 2017 7/1/1999
RECEIVED MEDICARE APPROVAL % 0* rEescteimivai1nt0gedthperoir2bfa0irbsiltittyrao3nfs0spularvnitvib4neg0twateoenne50m10/0o1n/2th01a65n0adnodn0e6y/73e00a/r2, f0o1r7;8paa0ntdieanttst9hr0ee 100

years, for patients receiving their first transplant between 07/01/2012 and
12/31/2014

^ Adjusted for patient and donor characteristics
Source: Scientific Registry of Transplant Recipients, Center and OPO-specific
Reports, based on data available July 31, 2018, released October 9, 2018

FOR REFERRALS OR
PATIENT APPOINTMENTS:

(313) 916-1269

HENRY FORD TRANSPLANT INSTITUTE 43

Liver
Intestinal &
Multivisceral

Kidney
Pancreas

Lung
Heart
Bone
Marrow

44 HENRY FORD TRANSPLANT INSTITUTE

LUNG
TRANSPLANT



Debora Dearring

Lung Transplan t Recipien t

So u t h fi eld, M i c h i ga n

When Debora Dearring received a diagnosis of sarcoidosis, she had no idea that it was the beginning of a journey that would lead to a
double-lung transplant.

“My chronic coughing was disruptive in church, in conversations and in my daily life,” says Dearring. “My chest would hurt, and it would
be hard to speak, to raise my arms, to get dressed. Everything was hard.”

As her lungs deteriorated, Dearring required a portable oxygen tank. She says she knew she was getting worse as she required more
oxygen. She had to think about tasks before she did them, to conserve energy and maximize her available oxygen.

During one visit to Henry Ford Hospital, she collapsed and woke up intubated in the ICU. Doctors told her she wasn’t leaving without a
lung transplant. Dearring spent seven months as a patient at Henry Ford Hospital. She played games and watched movies. The nursing
staff helped her celebrate every major holiday — Christmas, New Year’s, Easter, and they even planned a surprise anniversary party for
her husband.

“My saying was that it’s not time for a pity party. It’s time for a passion party,” recalls Dearring.

All along, Dearring stayed prayerful that she would receive the lung transplant she so desperately needed. During the darkest times,
most often when she was alone at night, she would turn to the hundreds of words of encouragement posted on her hospital room
walls.

“I asked every visitor, from members of my church to interns and residents, to write something for me,” says Dearring. “It was from
those messages that I drew the strength to stay positive.”

Her daily routine included walking the length of the unit around the nurse’s station. Eventually, the walks grew shorter and shorter.
One particular day Dearring will never forget, she was having trouble making it just one lap around the unit. She was back in bed when
the transplant coordinator entered the room, beaming.

“I took one look at her smile and I knew they had lungs for me,” says Dearring. “I would’ve screamed if I could!”

One week following her transplant, Dearring was in the hospital for Thanksgiving, and the staff planned another “passion party.” With
family gathered at her bedside, her son offered a marriage proposal to his girlfriend. Dearring’s grateful to have had the opportunity
to celebrate many more occasions, from the wedding of her son to the birth of a grandchild. Every year, she also celebrates the
anniversary of her transplant, with a “rebirthday” cake for the lung transplant team and nursing staff at Henry Ford Hospital.

HENRY FORD TRANSPLANT INSTITUTE 47

Liver LUNG TRANSPLANT COORDINATED TRANSPLANT CARE
Intestinal &
Multivisceral OFFERING NEW HOPE FOR END-STAGE LUNG DISEASE The nationally renowned Henry Ford Division of Pulmonary and Critical Care Medicine
receives patient referrals from all over the Midwest. Together, our transplant
Kidney The Henry Ford Transplant Institute at Henry Ford Hospital has long been pulmonologists and cardiothoracic surgeons manage a wide range of respiratory disorders
Pancreas and perform transplant for complex pulmonary conditions.
Detroit’s only center for single- and double-lung transplantation. Our team
Lung Henry Ford’s four transplant pulmonologists offer the most sophisticated care for
Heart of skilled cardiothoracic surgeons performs lung transplant for advanced, advanced lung disease and pioneer new treatments that extend the lives of patients
Bone throughout the transplant continuum.
Marrow end-stage lung disease, managed by a highly experienced team of transplant
Our highly structured outpatient Pulmonary Rehabilitation program is offered five days
pulmonologists. a week to enhance patients’ endurance prior to transplant and support their ongoing
recovery. A new on-site Pulmonary Rehabilitation area in the Henry Ford Transplant
Capabilities for Complex Cases inpatient unit allows patients to begin their therapeutic exercises in the days immediately
following transplantation.
The Henry Ford Transplant Institute has the capabilities to transplant complex, high-risk
patients. As a comprehensive transplant center, we can help patients requiring multi-organ Nutritional support services are delivered by registered dietitians specializing in transplant
transplants, including lung-liver, liver-heart and liver-kidney. for patients requiring weight loss prior to waitlisting, and to meet the dietary needs of
pre- and post-transplant patients to maximize their nutritional status.
It’s also not uncommon for our highly skilled cardiothoracic surgeons to address cardiac
conditions by replacing a heart valve or performing coronary artery bypass at the time of Our active Lung Transplant Support Group meets monthly to share expertise from our
transplant. transplant team on topics ranging from medications to diet and exercise, as well as advice
and support from lung transplant recipients and their families.
ECMO
IMPROVING TRANSPLANT OUTCOMES
We employ extracorporeal membrane oxygenation (ECMO) as needed before and after
transplant to support patients who are in critical condition without a ventilator. By The lung is the organ most vulnerable to bacteria and viruses in the environment and
oxygenating the body while resting the lungs, ECMO reduces complications associated entails the greatest use of immunosuppressants. Our transplant pulmonologists work
with a ventilator, sustains the patient in better condition leading up to transplant and closely with immunology specialists to improve outcomes with protocols to reduce risk of
allows the lungs to heal following transplantation. infection and to identify and treat any signs of rejection as early as possible.

Less-Invasive Approach Our outcomes continue to improve with quality initiatives focused on discharge planning.
Whenever possible, Henry Ford lung transplant surgeons perform a minithoracotomy for Inpatient nurses, residents and case workers provide additional education on medication
lung transplant. This approach eliminates the need to sever the breastbone and involves compliance and follow-up care.
only two six-centimeter incisions on the side of the chest. Compared with traditional lung
transplant surgery, a minithoracotomy is advantageous because it provides lung recipients
with less external and internal scarring, reduced pain and a faster recovery.

Ex vivo Lung Perfusion
Our lung transplant program has been involved in a clinical study of ex vivo lung perfusion
(EVLP). Donor lungs are placed on the lung perfusion machine, which warms them and
provides fluids, nutrients and oxygen. In addition to improving the health of donor lungs,
EVLP allows our doctors to transplant donor lungs previously considered unfit due to poor
oxygenation.

48 HENRY FORD TRANSPLANT INSTITUTE

EVALUATION LUNG TRANSPLANT OUTCOMES – AT A GLANCE 10/20/1994
26
With our FAST Track program for evaluating lung transplant candidates, patients FIRST TRANSPLANT
who meet transplant criteria can have their entire evaluation completed within TRANSPLANTS PERFORMED IN 2017 268
two weeks. Our process improvements have allowed us to increase the number TOTAL NUMBER OF PROGRAM TRANSPLANTS THROUGH 2017 2/1/1999
of candidates evaluated for transplants. In addition, a new reporting mechanism RECEIVED MEDICARE APPROVAL 9.4 months
has enhanced communication and coordination of patient care with referring MEDIAN TIME TO TRANSPLANT< (60.5 MONTHS NATIONALLY)
physicians. WAITLIST MORTALITY~ (EXPECTED .212, NATIONAL .181) STATISTICALLY AS EXPECTED .212

We perform lung transplantation for patients with the following primary HMEINLREYSFTOORNDEPSATIINENLTUSNUGRVTIVRAALNRSATPELSAFNOTRALTUIONNG TRANSPLANT*
diagnosis:
SOENVEE-RYEAALR “FIRSTS” WERE PERFORMED AT HENRY FO9R2D.2H2O%SPITAL:
• emphysema
• pulmonary fibrosis DOENTER-YOEAIRT’ESXPFEICRTESDT^ lung transplant performed8a8t.9H1e%nry Ford Hospital (1994)
• sarcoidosis
• bronchiectasis FIRST IN Michigan to use donation after cardiac death for lung transplant (2007)
• cystic fibrosis l6u8n7.g115.-4l%i38v%8er.9t1r%ansplant
• pulmonary hypertension FTIHRRSETE-YINEARMichigan to perform a (2013)
THREE-YEAR EXPECTED^
FOR REFERRALS OR
PATIENT APPOINTMENTS: % 0 10 20 30 40 50 60 70 80 90 100

(313) 916-1269

HENRY FORD PATIENT SURVIVAL RATES FOR LUNG TRANSPLANT* HENRY FORD GRAFT SURVIVAL RATES FOR LUNG TRANSPLANT+

ONE-YEAR 92.22% ONE-YEAR 92.38%
ONE-YEAR EXPECTED^ 88.91% ONE-YEAR EXPECTED^ 88.29%

THREE-YEAR 71.43% THREE-YEAR 69.23%
THREE-YEAR EXPECTED^ 68.15%88.91% THREE-YEAR EXPECTED^ 67.00%88.91%

% 0 10 20 30 40 50 60 70 80 90 100 % 0 10 20 30 40 50 60 70 80 90 100

HENRY FORD GRAFT SURVIVAL RATES FOR LUNG TRANSPLANT+ < Patients on the waitlist between 01/01/2012 and 06/30/2017
~ Patients on the waitlist between 01/01/2016 and 12/31/2017
ONE-YEAR 92.38% * Estimated probability of surviving at one month and one year, for patients receiving their first transplant
ONE-YEAR EXPECTED^ 88.29%
between 01/01/2015 and 06/30/2017; and at three years, for patients receiving their first transplant
THREE-YEAR 69.23% between 07/01/2012 and 12/31/2014
THREE-YEAR EXPECTED^ 67.00%88.91% ^ Adjusted for patient and donor characteristics
+ Estimated probability of surviving with a functioning graft at one month and one year, for patients
receiving their first transplant between 01/01/2015 and 06/30/2017; and at three years, for patients
receiving their first transplant between 07/01/2012 and 12/31/2014
Source: Scientific Registry of Transplant Recipients, Center and OPO-specific Reports, based on data
available July 31, 2018, released October 9, 2018

% 0 10 20 30 40 50 60 70 80 90 100 HENRY FORD TRANSPLANT INSTITUTE 49

Liver
Intestinal &
Multivisceral

Kidney
Pancreas

Lung
Heart
Bone
Marrow

50 HENRY FORD TRANSPLANT INSTITUTE