This story was produced in partnership with MLK50: Justice Through Journalism and co-published with the Commercial Appeal.

On a brisk morning in the winter of 2019, at a standing-room-only reception, a procession of speakers lavished praise on the surgeon who more than tripled the size of the liver transplant program at Methodist University Hospital in Memphis. The lifesaving doctor was receiving an honor often reserved for the dead: Methodist’s leaders announced that the hospital’s new state-of-the-art transplant center would be named for Dr. James Eason.

Eason seemed to have reached the summit of what was then a 25-year career. A decade earlier, he had performed one of the highest-profile liver surgeries in recent history: the transplant that extended the life of Apple co-founder Steve Jobs by more than two years. That operation earned Eason the gratitude of Jobs’ widow, who later donated a total of $40 million to the transplant center he helmed and the medical school where he worked as a professor. At age 58, Eason had become one of the country’s highest-paid transplant surgeons, earning $1.7 million a year, more than anyone at Methodist but the head of its nearly 13,000-employee, six-hospital health system.

But for all the lives the liver transplant program saved, the hospital’s leadership had growing concerns about the number of patients dying on Eason’s watch. During the five years before the renaming ceremony, those deaths had sparked investigations from the federal contractor that oversees transplant centers. They also prompted multiple health insurers to remove the liver program from their preferred networks, according to internal documents.

In 2018, following the most recent investigation, Methodist hired a consulting firm to audit the program. The audit, conducted by peers from other transplant centers, found that numerous errors had contributed to patient deaths — and that to reduce the rate of failed liver transplants, Methodist likely would have to perform fewer transplants overall. But according to the audit, that would be difficult. Staffers felt “powerless to make change due to the resistance of leadership,” who gave the employees the impression that “volume is king,” the audit said.

The audit concluded that “disruptive, disrespectful, non-collaborative individuals” had put the liver transplant program and its patients “in a constant state of risk.”

In December 2018, Methodist University Hospital President Roland Cruickshank wrote a letter to the federal contractor acknowledging the transplant program’s worrisome number of deaths. “The decline in our outcomes is of the utmost concern,” he wrote, “and is not taken lightly.” Weeks later, Cruickshank sat in the front row of the renaming ceremony and stepped up to unfurl a banner with the words “James D. Eason Transplant Institute.”

ProPublica and MLK50: Justice Through Journalism obtained an extraordinary cache of internal records that reveal Methodist leaders failed to comprehensively fix problems with the liver program before the renaming ceremony. The records include the independent audit, detailed internal reviews of patient deaths and the hospital’s correspondence with the federal contractor, a nonprofit called the United Network for Organ Sharing, or UNOS.

One of the documents was an internal analysis drafted at Eason’s behest. In part of the analysis, one of his most senior colleagues determined that between late 2014 and mid 2018, 25 deaths — more than half of the program’s 48 total fatalities — were preventable.

The analysis found that some liver recipients had died after their transplant as a result of “process/protocol issues.” It also found that a portion of patients “should not have been listed” for transplant due to preexisting medical conditions.

Along with the documents, interviews with families of nearly two dozen liver transplant recipients who died over the past decade show that, in some cases, Methodist staffers didn’t tell them about the extent of the problems that contributed to their loved ones’ deaths.

Terry Green, a retired Army noncommissioned officer who donated a portion of his liver to his identical twin brother, did not know that Eason’s team had, according to medical records and internal documents, failed to conduct enough testing to rule out the risks of cardiac and pulmonary complications before Eason himself performed the transplant. His brother died from cardiac arrest in the operating room.

Terry Green donated a portion of his liver to his identical twin brother, Jerry Green.

Stacy Roberts was unaware that, following her father’s transplant, Eason’s team had identified major problems with the donated liver it had placed inside him, issues it may have been able to identify with further screening, internal records show. Methodist had accepted the liver from another hospital, which had failed to spot that the organ bore the early signs of cirrhosis. Days later, after her father experienced serious complications, Methodist providers conducted their own biopsy, discovering the full extent of the damage to the organ. Her father died about a month after the surgery. Hospital records show that transplant program leaders later required surgeons to more rigorously review liver donations before accepting those organs for patients.

For years, Tiffany Garrigus was haunted by the memory of watching her 59-year-old father die just several hours after his transplant. Unbeknownst to Garrigus, a nurse had reported concerns about internal bleeding to the surgical fellow on shift and noted that the doctor failed to quickly alert the attending surgeon. The miscommunication delayed potentially lifesaving care. The independent auditors later determined that Methodist’s own review of Steve Garrigus’ death was a “missed opportunity” to prevent similar issues in the future.

“They screwed up,” Garrigus said after she learned about records that outlined Methodist’s treatment of her father. “No one was held accountable and nothing changed.”

Tiffany Garrigus visits the grave of her father, Steve Garrigus, in Union City, Tennessee.

Garrigus and five other families who spoke with ProPublica and MLK50 signed documents waiving their rights to privacy so Eason and Methodist could answer questions about their loved ones’ deaths. Eason and Methodist declined to address those questions. The hospital and Eason also did not answer specific questions about the dozens of deaths detailed in the investigations, the findings in the audit of the transplant program or the correspondence between the hospital and UNOS.

Spokespeople for Eason and the hospital asserted that ProPublica and MLK50 singled out patients with negative outcomes. Methodist spokesperson Tabrina Davis also said in a statement that the news organizations had “settled on a clear narrative, one which we believe is a misleading and inaccurate portrayal of the institute.” The statement went on to say that “the transplant institute is on a continuous journey of improvement, focused on providing the highest quality care for each patient.”

Eason turned down multiple requests to be interviewed for this story but responded to questions in writing at various points. In one statement, he said that he and his team at Methodist “tried to give every patient the opportunity for transplant.” He also said in that statement that while there were “2-3 unexpected deaths per year” between 2011 and 2018, “we also saved more than 100 lives each year, all of whom would have died without liver transplantation.” Eason’s lawyer, Elizabeth Sacksteder, said in a separate letter that “performing more transplants rather than fewer” and using “the best available organs rather than waiting for the perfect organ” are pivotal parts of Eason’s approach to running a liver transplant program.

Dr. James Eason discusses Methodist’s liver transplant program with the advisory board of the University of Tennessee Health Science Center’s College of Medicine in 2015. Credit: via University of Tennessee Health Science Center’s Facebook

For more than a decade, Methodist liver recipients had a greater-than-expected chance that their liver would not be functioning one year after transplant, a metric used by UNOS to assess transplant centers’ performance. Eason said in his statement that UNOS had overrelied on that metric without taking into account that programs like Methodist have accepted more high-risk patients who would otherwise die imminently. He added that Methodist has excelled at minimizing the extent to which patients die on the waitlist, a metric that is now part of how UNOS evaluates transplant programs.

“I would never choose to let a single high-risk patient die instead of giving that individual a good chance of living,” Eason said in another statement.

Eason, however, is no longer making those choices at Methodist. This past August — after years of investigations and years of Methodist leaders celebrating Eason’s accomplishments — hospital employees were unexpectedly pulled into a conference room at the transplant center. Standing at the front of the room, along with other top executives, was the head of the health system. He shared a brief message that caught employees off guard: Eason was no longer with the James D. Eason Transplant Institute.

Methodist’s Liver Transplant Outcomes Drew Scrutiny From Investigators

The United Network for Organ Sharing launched two investigations over the past decade after Methodist University Hospital’s liver transplant program performed worse than expected.

Credit: Source: The Scientific Registry of Transplant Recipients

Transplant centers report data about their performance to UNOS, which examines whether the performance of transplant programs was worse than expected. To do so, UNOS analyzes the extent to which transplanted livers still functioned one year after a surgery.

Each percentage is based on outcomes over the prior 30-month period. For still-functioning transplants performed in the last six months of the study period, the chance of a liver continuing to function one year after the surgery is modeled after the outcomes of previous transplants in the study period.

The blue line shows the percentage of Methodist patients expected to have a functioning transplanted liver at one year, based on characteristics of the liver transplant program’s prior recipients and donors. The yellow and gray lines show the chance of a patient having a functioning transplanted liver at one year, modeled after real-world outcomes.

Before his arrival at Methodist, Eason led another transplant center that was investigated for its poor performance during his tenure.

In the winter of 1998, Eason left his post as head of a San Antonio military hospital’s transplant center to begin a new job. He now oversaw liver and kidney transplants at the Ochsner Foundation Hospital just outside New Orleans. Eason’s team increased the number of liver transplants Ochsner performed from 23 in 1998 to 76 in 2001. But the rapid growth was followed by higher rates of deaths within a year of transplant, according to data from the Scientific Registry of Transplant Recipients.

One of Eason’s colleagues, Dr. Ari Cohen, subsequently wrote in a presentation to a group of transplant experts that the rate of adult patients living for one year after their liver transplants at Ochsner became “significantly worse than expected” between July 2002 and December 2004.

In 2005, a UNOS committee began investigating the reasons behind poor outcomes at Ochsner, according to an article written by Ochsner doctors that was later published in the health system’s academic journal. The article described the liver transplant program’s culture prior to 2005 in a way that was similar to what Methodist’s audit would turn up years later: A “feeling of fear” had left employees “unable to freely express their views” about the program’s problems.

In response to the UNOS investigation, Ochsner put together a team that determined the transplant center’s leadership was one of the biggest problems contributing to the liver program’s poor patient outcomes.

UNOS spokesperson Anne Paschke said that the organization does not comment on specific investigations. Cohen, along with other Ochsner doctors who contributed to the article, did not respond to emails or phone calls. An Ochsner spokesperson declined to respond to ProPublica and MLK50’s questions or make anyone available for an interview. Eason declined to comment on the UNOS investigation or his former colleagues’ reflections on the program under his leadership. In his statement, he said that he came to Ochsner after the program had been “closed due to loss of leadership” and that the program “went from saving zero lives to saving more than 80 lives each year.”

Before the UNOS committee completed its investigation, Eason accepted an offer that would allow him to return to his home state of Tennessee — and provide an opportunity to take another small liver transplant program and grow it even more dramatically.

In the five years following Eason’s departure, his former colleagues addressed the problems, according to the journal article. They turned Ochsner’s liver program into one of the top performers in the South, according to health care ratings organizations.

When Methodist announced Eason’s hiring in 2006, Dr. Hosein Shokouh-Amiri was deeply concerned. The veteran Methodist surgeon said he had heard about the rapid expansion of Ochsner’s transplant program and was worried that a similar approach might lead to higher rates of failed liver transplants for Methodist patients.

Amiri was afraid that Eason would override clinical decisions that Amiri or his colleagues had determined were in the best interest of patients. And so he decided to leave the transplant program shortly after Eason arrived. Before Amiri’s final day at Methodist, Eason wanted to know if he would reconsider. Sitting in Eason’s office, Amiri asked if Eason would ever require a surgeon to accept a donated liver that the surgeon would rather decline because of poor quality. Amiri recalled that Eason wouldn’t answer at first. Amiri said that when he pressed for an answer, Eason told him that he would do so if he felt it was necessary.

Dr. Hosein Shokouh-Amiri, a former surgeon at Methodist, resigned because of concerns over how Eason might lead the liver transplant program.

As Amiri saw it, Eason’s track record of boosting volume would “bypass the moral and ethical standard we had promised” to Methodist patients.

“He wanted my approval,” Amiri said. “I resigned.”

Eason did not respond to questions about Amiri’s recollections and concerns. Eason’s spokesperson, Stefan Friedman, wrote in an email that Amiri left Methodist “to go to a program that performed only 11 transplants last year with higher deaths on the waitlist and lower one-year survival rates.” Amiri said that his liver transplant program had lower survival rates “because we took sicker patients.” Federal health data confirms that Amiri’s program accepted a higher percentage of patients at high risk of death from liver disease than Methodist.

During his early years in Memphis, Eason led the dramatic growth of Methodist’s liver transplant program. The year before he started, in 2005, Amiri and his colleagues had performed 34 liver transplants. Over the next three years, Eason’s team more than tripled the hospital’s annual number of liver transplants, replacing 117 organs in 2008. Methodist leaders celebrated this growth as a historic achievement — one that allowed the liver transplant program to serve more patients in a majority Black city that had a higher poverty rate than the national average. Eason’s lawyer said in a letter that the population of the Memphis region “disproportionately suffers from co-morbidities associated with poverty” that “heighten the inherent risks of liver transplant surgery.”

By performing 126 transplants in 2009, Methodist became one of America’s 10 largest liver transplant programs. As hospitals across the country expanded their transplant centers, they stood to profit from treating more patients suffering organ failure. According to a 2009 study published in Medical Care Research and Review, the average cost of a U.S. liver transplant and the subsequent days spent recovering in the hospital was about $163,000. Around that time, The Wall Street Journal reported that some hospitals charged nearly three times as much for the surgery. Friedman said in a statement that Eason did not receive additional compensation for performing more transplants, “nor was any aspect of his compensation based on such a metric.” Methodist did not respond to questions about the program’s finances.

The growth of Methodist’s program was fueled in part by a special agreement with federal health officials that allowed the program to obtain livers across the entire state of Tennessee and parts of Arkansas and Mississippi. As the program grew, it began attracting more patients from beyond the greater Memphis area. A central Ohio minister received a liver transplant at Methodist in 2009 after being rejected by three other programs. He lived for another 12 years. A mechanic from San Juan, Puerto Rico, who experienced liver failure received a transplant at Methodist in 2010; in an interview translated by his wife, Carlos Acevedo Martinez told ProPublica and MLK50 that he had no complications and was grateful “Methodist gave him life again.”

Near the end of his third year at Methodist, Eason was in touch with his friend George Riley, a Memphis native whose parents had been doctors at Methodist. Riley, a California lawyer, wanted to know if Eason might help his client. Steve Jobs faced a long wait to get a new liver in his home state of California. His wife, Laurene Powell Jobs, had learned that people could be simultaneously added to waitlists in multiple states. Since Jobs had a plane, he could fly to whichever transplant center was willing to accept him. Tennessee, it turned out, had a shorter waitlist.

One day in March 2009, before dawn, Eason waited for Jobs’ plane at the Memphis airport. “I went to meet him and escorted him to the hospital,” Eason later told WMC-TV. One of Jobs’ biographers, Walter Isaacson, wrote that Eason closely oversaw Jobs’ care after the transplant, assigned nurses solely to his recovery and “would even stop at the convenience store to get the energy drinks Jobs liked.” Jobs later recovered in a 5,784-square-foot mansion in Memphis that Riley purchased through a shell company, according to The Commercial Appeal.

Weeks after Jobs returned home that spring, news broke of his surgery. Media outlets including CNN and The New York Times published articles that explored whether Eason gave preferential treatment to the billionaire. The surgeon pushed back: Jobs was the sickest, most deserving patient on the day that liver became available, he said. Starting that summer, Eason lived on and off in the mansion — a perk he didn’t publicly disclose at the time. Two years later, in 2011, he bought the house from the shell company for $850,000, the same price the company paid for it in 2009. (Home sale prices in the greater Memphis area had fallen in the interim.) Eason did not respond to questions about living in or buying the home.

Eason speaks with a nurse in Methodist’s transplant ward on Aug. 18, 2009. Credit: Lance Murphey/Bloomberg via Getty Images

Around the time of Jobs’ transplant, Methodist’s liver recipients had a better estimated chance of their organs functioning at least one year after a transplant than the national average. But in the years after Jobs’ surgery, Eason’s liver transplant program began to struggle. The rate of failed liver transplants increased between July 2010 and December 2012. As a result, the UNOS committee that had scrutinized Ochsner’s performance under Eason opened an investigation in early 2014. The committee’s work is confidential, but ProPublica and MLK50 obtained records that described the investigation. (UNOS declined to confirm when the investigation ended.)

The UNOS committee, which is composed of several dozen transplant experts who volunteer to review their peers’ programs, can recommend the discipline of transplant centers for their poor performance. But the committee rarely punished programs. In fact, the committee was so toothless that in 2018 the then-CEO of UNOS likened the committee’s investigations to “putting your kids’ artwork up at home.”

“You value it because of how it was created rather than whether it’s well done,” the UNOS leader wrote of the investigative committee. “Only in this case, we persuade ourselves that it’s well done anyway.”

Though Eason now defends the program he led, he acknowledged in an April 2014 letter to the UNOS committee that Methodist’s outcomes “were not as expected.” He pledged to address the committee’s concerns.

According to internal documents from June 2014, Methodist was anticipating potential financial fallout from those poor outcomes. A Centers for Medicare & Medicaid Services official had informed Methodist that its liver transplant program was out of compliance with federal standards because it had “significantly lower than expected” outcomes and did not have an adequate policy for evaluating the reasons behind its failed liver transplants. The official warned that CMS would terminate the liver program’s participation in Medicare, which covered the costs for nearly a third of the liver transplants performed at Methodist, if it failed to correct those problems.

In its written plan outlining how it would fix the problems, Methodist told CMS that one way it would improve outcomes was through Eason encouraging a “higher scrutiny of patients” whose risks of complications outweighed the potential benefits of surgery. Methodist ultimately avoided termination from Medicare.

But records obtained by ProPublica and MLK50 show that Methodist kept accepting patients whose poor health increased the risk of complications after a transplant. Eason’s team soon approved for transplant a 356-pound woman with a BMI of 66 and a woman who struggled so much with drinking alcohol that she only stopped after getting sick from liver failure. The team also signed off on a patient for transplant in spite of the fact that she was septic the day before the surgery. All three died within a year after their transplants.

Dr. Satheesh Nair, one of Eason’s most senior colleagues, later determined in an analysis of patient deaths that Methodist should not have placed these patients on the transplant waitlist. Nair did not respond to questions. Eason did not comment on the findings of the analysis, but said that he asked for it to be done as part of his transplant program’s efforts to improve its quality of care.

Davis, the Methodist spokesperson, also declined to comment on Nair’s findings. She said in a statement that Methodist has turned away liver transplant candidates because they “do not meet the criteria to indicate they would have successful outcomes” after a transplant.

By the time Jerry Green arrived at Methodist in 2016, the 46-year-old minister from West Memphis, Arkansas, was experiencing symptoms of liver failure, including fatigue and jaundice. As Green underwent a battery of tests, the evaluation revealed potential signs of pulmonary hypertension, according to hospital records. That condition can increase the risk of death from a transplant.

Medical experts have written in journal articles that when a transplant candidate has signs of pulmonary hypertension, additional testing, including what’s known as a right heart catheterization, should be done to more precisely determine the risk of complications during or after a transplant. If the risk is too great, liver transplant programs can either reject the patient or postpone the surgery until the patient receives care to improve their health. But “no further assessments were made,” according to an internal analysis of Green’s treatment that the liver transplant program later conducted.

Methodist doctors calculated that Green had a strong chance of surviving for three months without a transplant. But that also meant he was unlikely to get a liver from a deceased donor because he would be low on the waitlist. According to hospital records obtained by ProPublica and MLK50, Eason encouraged Green to get a transplant immediately the only way he could: by finding a living donor. Green was reluctant. But when he gave in, he asked his twin brother, Terry. He agreed.

First image: Terry Green shares a photo of himself and Jerry with their mother. Second image: Terry and Jerry as babies.

In the summer of 2016, as the Green family packed inside Methodist to support the twins, a surgeon sliced open Terry’s abdomen. It was one of the first living liver donor transplants ever performed at Methodist. Once they started Jerry’s surgery, his pulmonary arterial pressure rose so much that surgeons considered halting the transplant. Methodist providers gave Jerry medication that lowered his pressure. According to an operative report from a surgical fellow, Eason “had extensive discussion with his family, where they strongly hoped to undergo the surgery with any possible measures.” (Jerry’s wife, Jacqueline Green, said that she was notified about the concerns over his pressure but did not have an in-depth discussion with Eason about the risks of proceeding with the surgery.) Eventually, surgeons began replacing his liver with a segment of Terry’s.

Once Terry woke up, Eason stopped by to check on his abdomen. The surgeon then shared the worst news of Terry’s life. Jerry’s heart had suddenly stopped. The staff tried to revive him in the operating room but could not pull him back from the brink of death. “His heart wasn’t strong enough,” Terry remembers Eason saying. “What we learned here will help others in the future.”

After the funeral, Jacqueline met with Eason to learn more about what went wrong. As Jacqueline asked questions about Jerry’s death, Eason said that the liver transplant was successful. “It was just his heart” that failed, she recalled Eason saying.

Jacqueline Green at home next to a burial flag for her husband, Jerry Green, who served in the Marines.

The following year, Methodist enacted several new policies designed to more rigorously test patients’ cardiac and pulmonary risks ahead of a liver transplant. In the program’s internal analysis, Nair later determined that Green’s death was preventable. Jacqueline said Eason never told her about that finding.

Not long after Jerry Green’s death, Eason and nearly two dozen colleagues gathered for a confidential meeting. A familiar problem that had dogged the program was now resurfacing.

Four years earlier, in December 2012, CMS had announced it would cut off a crucial part of Methodist’s organ supply from central and east Tennessee. Some transplant experts praised the decision because they felt Methodist had unfairly benefited from an old policy that provided access to more high-quality organs from a large geographic area. To avoid shrinking what had become the nation’s fourth-largest liver program, Methodist accepted more livers that posed a higher risk of complications for their recipients. Eason’s transplant quality director later wrote in a document responding to the UNOS committee’s investigation that the strategy was justified as the country faced a chronic organ shortage. As the quality director explained, the additional risk was in “balance against the risk of candidate death on the waitlist.”

At the confidential meeting, Eason and his staff focused on a case that exemplified the perils of such risk-taking. That July, Methodist had received a liver offer from a North Carolina hospital. The liver had belonged to a 34-year-old military veteran who had struggled for years with use of hard drugs and alcohol. The way that he died required that his liver be removed after his heartbeat stopped, known as a donation after circulatory death or DCD. Such donations involve an organ that has been deprived of sufficient oxygen between the time of death and the organ’s removal. As a result, these donations can elevate the risks of complications for a recipient. That year, about 6% of U.S. liver transplants involved DCD organs, according to data from the Scientific Registry of Transplant Recipients. The data also showed Eason’s team accepted DCD livers at a percentage nearly triple the national average.

The night that Methodist received the liver offer, one of Eason’s surgeons described the donor’s history to Eugene Willard, a 61-year-old grandfather who served as the mayor of his small town of Amagon, Arkansas. Willard wanted to reject the offer, according to his daughter, Stacy Roberts. Two weeks earlier, another Methodist doctor had determined Willard would be a “suitable candidate for liver transplantation providing he loses weight,” records show. That doctor had encouraged Willard to slim down to lower his risk of complications whenever the transplant did happen. But with the offer on the table that night, the surgeon urged Willard to accept the liver, his daughter recalled. “If you don’t do it, you’re going to die,” she remembered the surgeon saying. Willard followed the surgeon’s advice and agreed to accept the organ.

After Willard’s new liver showed signs of poor function, Methodist providers ordered another biopsy to better understand his complications. This time, they saw that the donated liver had so much scarring that the early stages of cirrhosis were present. He died about a month after the surgery.

At the confidential meeting, the team concluded that the North Carolina hospital’s biopsy of the donated liver “may have been inadequate.” Eason’s team responded by approving a policy change that required surgeons to more rigorously examine biopsies before accepting livers. Nair’s analysis later determined that Willard’s death was preventable, citing “donor selection” issues.

Data from the Scientific Registry of Transplant Recipients shows that Methodist continued to accept DCD livers in 2017 and 2018 at rates higher than twice the national average. Eason’s transplant quality director later explained in the response to UNOS that Methodist’s surgeons accepted more high-risk livers because they had “access to fewer local organs than the national rate,” leaving the program little other choice for saving patient lives. The quality director defended the practice as one that “represents our effort to provide care to an underresourced patient population.”

“Most have no other opportunity or hope of transplantation,” the quality director wrote.

Over the course of 2018, Methodist’s transplant center leaders were confronting a new round of scrutiny. After a period of improved patient outcomes following the UNOS committee’s investigation four years earlier, the liver transplant program’s failure rate had again worsened. As a result, the UNOS committee opened another investigation.

Methodist responded with a step intended to help its struggling program. It hired the transplant consulting firm Guidry & East to conduct an audit of its liver transplant program’s operations.

Five transplant experts — including doctors affiliated with medical schools at the University of California, San Francisco and Cornell University — traveled to Memphis in October 2018 for the two-day audit. They toured the center’s halls, interviewed employees and reviewed liver transplant records. The experts wrote a 35-page report, a final draft of which was obtained by ProPublica and MLK50, that identified a list of problems that they said contributed to patient deaths.

Excerpt from Guidry & East’s 2018 audit of Methodist’s liver transplant program Credit: highlights added by ProPublica

The audit stated that Eason’s program appeared to “maximize the number of transplants by disregarding flags” as to whether patients were suitable candidates for surgery and, according to one Methodist doctor, was “currently accepting less than ideal donor organs for transplantation.” It also determined that the program had failed to thoroughly review the causes of patient deaths in order to prevent repeat mistakes with future patients, a problem previously identified during federal inspections.

To better protect patients, Eason would need to improve its policies in a way that would limit surgeons from operating on patients unlikely to survive long after transplant, in addition to limiting the number of high-risk organs the program accepted, the experts’ audit determined.

The experts also flagged problems with the hospital’s oversight of its liver transplant program. The audit noted the stark “disconnect” between Eason’s team and hospital leadership. “There is a lack of transparency in what is reported,” the experts determined.

After the audit, Methodist University Hospital President Cruickshank pledged in a letter to the UNOS committee that senior hospital leadership would “work closely” with Eason’s team to adopt Guidry & East’s recommendations. Those changes, Cruickshank said, would “once again allow us to meet the UNOS requirements and our own expectations of exceptional outcomes.” (Cruickshank, who has since left Methodist, did not respond to multiple requests for comment.)

Eason at the transplant center renaming ceremony at Methodist University Hospital in 2019. Credit: via Methodist Le Bonheur Healthcare’s Facebook

In February 2019, less than two months after Cruickshank’s letter, Eason stood at the renaming ceremony before his supporters, including Laurene Powell Jobs, an internationally known philanthropist who has donated to a wide variety of causes. (Powell Jobs’ social impact organization Emerson Collective contributes to numerous media organizations, including ProPublica and MLK50, and owns a majority stake in The Atlantic. Through a spokesperson, Powell Jobs declined to comment about her support of Eason and Methodist.) In the halls of Methodist’s new $275 million nine-story tower, a portion of which would be home to the transplant center that had received her donation, Eason and Powell Jobs posed for a photo before a wood-paneled wall lettered with the surgeon’s name on it.

Later that month, Methodist received a letter from the chair of the UNOS committee overseeing the investigation, whose members had met to review the Guidry & East audit. The letter stated that “recent outcomes do not seem to be improving.”

In April 2019, as Methodist was about to welcome patients to its new transplant center, Eason wrote in a letter to the UNOS committee that the liver transplant program was headed in the right direction. To address the committee’s concerns, Eason presented a detailed plan that outlined how Methodist was overhauling policies within its liver transplant program. He attached newly written guidelines that directed the program to be more stringent in accepting high-risk patients and livers. He also noted that transplant leaders were routinely holding conferences where staffers more thoroughly reviewed cases with bad outcomes, openly discussed medical mistakes and identified ways to prevent repeat errors.

“We believe our team has made tremendous progress in improving the outcomes of our Liver Transplant Program,” Eason wrote.

Davis, the Methodist spokesperson, said in a statement that Methodist “considered every recommendation” from Guidry & East and enacted some of those policies “right away.” Neither Eason nor Nair responded to questions about the Guidry & East report.

After the new transplant center facility opened that spring, the liver program’s numbers did, in fact, begin to turn around. The program’s rates of failed liver transplants continually improved in 2019 and 2020. But they did not improve enough to clear the threshold that the UNOS committee typically required to close an investigation.

In 2021, UNOS rewrote the rules for investigating transplant programs. Ian Jamieson, then the chair of the investigative committee, said that judging programs on post-transplant outcomes alone had created a “disincentive to transplantation.” To remove that barrier, UNOS leaders decided, a program would have to have far worse rates of failed liver transplants before UNOS would automatically step in to investigate.

UNOS touted the policy as “a more holistic approach” to evaluating transplant programs, since the committee would now also consider the extent to which patients were dying on the waitlist. The changes were not universally praised: Critics worried that the policy would lead to fewer transplant programs being held accountable.

Around the time the new UNOS policy began to take effect last year, the committee ended its investigations into numerous transplant programs, including the liver transplant program at Methodist.

Eason and a spokesperson for Methodist said that the investigation was closed because the program’s outcomes had improved. (UNOS declined to comment on the reason.) Eason said in his statement to ProPublica and MLK50 that UNOS’ new policy was recognition that UNOS had been relying on a transplant metric that was “outdated and invalid.” He sees that decision as part of a broader shift in which federal transplant policy is falling more in line with his philosophy to offer transplants to as many people as possible.

With outcomes improving and policy shifting, Eason seemed poised to keep leading his team at the center that bore his name. But one morning this past August, Methodist transplant center employees were unexpectedly summoned into a meeting down the hall from where the renaming ceremony had taken place. For the prior week, Eason hadn’t made his usual rounds through the halls of the transplant center. His staff even had to postpone a living donor transplant because of his absence.

Once the seats were filled, Michael Ugwueke, the president and CEO of Methodist’s six-hospital health system, asked for everyone’s attention. He informed them that Eason was no longer with the transplant center. When staffers asked what happened, Methodist executives said they couldn’t provide any details. As part of the decision, the transplant center suspended conducting liver transplants for living donors.

Methodist and Eason declined to answer questions about his departure. Methodist has scrubbed many mentions of Eason from its website. In the six months following Eason’s departure, he remained employed as the director of the Transplant Research Institute at the University of Tennessee Health Science Center, the medical school affiliated with Methodist. In late February, he retired from his tenured position, according to emails obtained through an open records request. UTHSC spokesperson Peggy Reisser declined to comment on the retirement.

So far, no hospital has publicly announced that Eason will lead its transplant center. Medical board records show that he has obtained licenses in Ohio and Pennsylvania. When ProPublica and MLK50 asked about Eason’s departure and search for a new job, his lawyer, Sacksteder, responded in a letter on March 15 that he is a “highly respected” liver transplant surgeon whose name still graces the transplant center he had helmed.

Just a few weeks later, Methodist employees noticed something had changed at the hospital. Workers had removed several signs throughout the facility. The words “James D. Eason Transplant Institute” are no longer affixed to the front of the building.

A new sign simply reads: “Methodist Transplant Institute.”

First image: The exterior of Methodist, showing the James D. Eason Transplant Institute sign, on Feb. 17. Second image: The exterior of Methodist, without Eason’s name sign, on April 18. Credit: Andrea Morales for MLK50

Tell Us About Your Experience With the Organ Transplant System

Wendi C. Thomas and Jacob Steimer, MLK50: Justice Through Journalism, and Mollie Simon, ProPublica, contributed reporting.

Design and development by Allen Tan.