In 2024, Nashville-based Vanderbilt University Medical Center’s heart transplant team set a world record by performing 174 heart transplants.

One of the leaders behind the record is Kelly Schlendorf, MD. She serves as medical director of Vanderbilt’s adult transplant program alongside Ashish Shah, MD, who serves as the heart transplant program’s surgical director and the Alfred Blalock Endowed Director and chair of the department of cardiac surgery.

Dr. Schlendorf, who is also section chief for heart failure and transplantation, said the health system’s heart transplant success reflects a number of moving parts fitting together seamlessly to drive the program forward.

“In order to achieve the volumes that we have over the past few years, there’s really no one person or operation or innovation that makes that happen,” she told Becker’s. “There are individual leaders and thoughtful strategies and innovative technologies that help to make it happen, but it’s really only those things combined with everything else — and ‘everything else’ is a lot — that has allowed for our success.”

Dr. Schlendorf and Dr. Shah oversee a multidisciplinary team of about 150 people per transplant, spanning physicians and surgeons, pharmacists and social workers, financial and organ procurement coordinators, and nursing and operating room staff.

Dr. Schlendorf told Becker’s maintaining a shared vision and purpose, “which is ultimately just to do right by our patients and by the donors and their families who have chosen to give the gift of life,” has allowed the team to be successful.

In fiscal 2025 — July 2024 to the end of June 2025 — the Vanderbilt team performed 184 heart transplants.

Those kinds of numbers, Dr. Schlendorf said, are not the result of one star surgeon or one piece of technology.

“I spend a lot of my time reminding people that there’s a lot more to [transplant programs] than surgery,” she said. “My fantastic surgical colleagues get and deserve a lot of credit, but there are so many other people involved who are deserving of credit, and sometimes I think those people get under-recognized.”

She highlighted the operational commitment required to coordinate each patient’s care as key to the VUMC heart transplant program’s success.

“One of the things people often forget is that in order to perform a lot of transplants, you have to have patients on your wait list,” she said. “One of the things that we’ve done very successfully on the operational front — which is maybe not so innovative, but rather just speaks to our operational successes — has been developing a really well-oiled machine that we’ve tweaked over and over again during the years to make sure that we: one, identify as many patients as possible with advanced heart failure who need transplant, including patients who live very far from Nashville, Tennessee; two, put them through a pretty exhaustive evaluation as expeditiously as possible to ensure that they’re well enough to undergo transplant and that they’ll be good stewards of a scarce resource; and then finally, most importantly, take care of them during this process, because most of these patients have very advanced heart failure and some of them really are on death’s doorstep.”

That “well-oiled machine” enables Vanderbilt surgeons to develop innovative techniques and organ preservation methods that allow for an expanded donor pool. One method — rapid recovery with extended ultra-oxygenated preservation — flushes the donor heart with a cold oxygenated preservation solution, preserving it for more than four hours and to as many as eight.

The team began using the preservation method in November 2024 and has seen success rates “similar to, if not better than, the existing techniques,” according to a July 17 news release from VUMC.

“As a program, we’re always looking forward and remaining curious,” Dr. Schlendorf said. “Our goal is to continue to innovate, to push the envelope a little bit, and also just to refuse to accept that just because something has always been done a certain way, that it’s the only way or that it’s the best way.”

The team’s innovation and growth move forward alongside an intensive reflection process, ensuring patient safety and outcomes, which Dr. Schlendorf said the team spends “a lot of time” reviewing and learning from.

“We try to translate those lessons into action items or improvements in the way that we do things going forward,” she said. “As in any growth setting, we’re looking for ways to be more efficient, but always with patient safety first and foremost in our minds.”

Dr. Schlendorf said her biggest piece of advice for health systems looking to grow their transplant programs is to seek guidance from and visit large-volume centers. She recalls spending a few days with the transplant team at Los Angeles-based Cedars-Sinai being “hugely helpful.” Years later, Vanderbilt now hosts groups in the same vein.

Despite the well-oiled operational machine and the dedication to innovation, Dr. Schlendorf said the VUMC heart transplant team was still surprised when it broke the heart transplant world record in 2024, a mark she said the team may surpass in 2025.

“I think Ash and I would both agree that we’ve just been incredibly lucky in bringing together this amazing group of individuals and a very supportive health system,” she said. “It’s amazing what can happen when you bring together the right group of people with a unified vision. It’s been pretty incredible to be a part of. Of all the hats I wear at Vanderbilt, this is certainly the most rewarding.”

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