Nobody prepares for the transplant conversation. You’re in your doctor’s office, and then everything shifts. Suddenly you’re hearing words like “end-stage” and “waiting list” while your brain is still trying to catch up.

For people in the Black Hills, that moment can feel even more isolating. The nearest major transplant center is hours away. You’re not sure what comes next, or how your family manages the travel, the cost, the whole complicated mess of it.

Here’s what’s changed: Monument Health has built a formal partnership with Nebraska Medicine’s transplant program in Omaha. And it’s not a referral arrangement where your file gets emailed to a stranger. It started as a friendship.

The Doctor Who’s Been Doing This Since 1989

Dr. Alan Langnas is a professor of surgery, director of the Nebraska Center for Transplantation, and chief of Transplantation Surgery at the University of Nebraska Medical Center. He’s led the transplant program since 1997 and has performed around 4,500 liver transplants, about a thousand of them in children.

He didn’t plan any of it. “I was an okay student in college,” he said on Monument Health’s Doc Talk podcast. “I was a backpacking and canoeing guy. I just sort of wandered my way, ended up in medicine.” He became a surgeon because it resonated with him, and transplantation found him from there.

A Partnership Built on an Actual Friendship

The connection between Nebraska Medicine and Monument Health didn’t come from a business development meeting. It traces back to Paulette Davidson, now CEO of Monument Health, who previously served as executive director of transplant at the University of Nebraska Medical Center alongside Dr. Langnas.

“We became thick as thieves,” Dr. Langnas said. “We proceeded to not only do great things together, but we became friends.” When Davidson moved to Rapid City and eventually became CEO, she called him. “She said, listen, we can use transplant up here. What do you think? And I said, yeah, it makes sense.”

He also noted that the two regions aren’t as different as people assume. “Everybody’s farmers and ranchers. We culturally are a good fit and we get it.”

What This Actually Means If You Live Here

The surgeries still happen in Omaha. That’s not changing. But the Nebraska Medicine team flies up to Rapid City twice a month to hold clinic at Monument Health. They see patients, start the screening process, and get as much testing done locally as possible.

“We do a little screening and education here locally and get to know these people and answer important questions,” Dr. Langnas explained. “We try to smooth out the anxiety that they’re going to have. Everybody knows each other. Everybody’s got each other’s phone number, everybody’s texting each other.”

The Technology That’s Changed Everything

Donor organ shortages remain the biggest barrier to transplantation. People still die on waiting lists. What’s changed is how the team evaluates the organs that do become available.

“We have these machines, what we call machine perfusion,” Dr. Langnas explained. “We can hook it up to a machine that will pump human blood at the right temperature, at the right flow rates through these organs.” The machine lets doctors run labs, measure bile production, even do a biopsy before committing.

“We give these organs a test drive,” he said. “We’re kicking the tires, making sure it’s safe.” That’s allowed the program to use organs they previously would have passed on, which means more people get the transplant they need.

What Dr. Langnas Wants You to Know

“When that person shows up in our clinic, you have to understand this is arguably the most dramatic moment in their life. And every minute of this experience is going to be seared in their brain,” he said. His team is honest about risk. “Most people do okay. But not everybody does. It’s still a high stakes game. We believe in transparency.”

He’s also direct about the practical side. The program has housing near the hospital in Omaha, financial assistance for travel, and working relationships with South Dakota Medicaid and Indian Health Services. “People are coming from the ranch. They don’t have a lot of resources. We are going to make this process as inviting as possible and we’re going to do it with you.”

If Transplant Is on the Table

Talk to your doctor and ask whether transplant is an option. If it is, ask about a referral to the transplant team through Monument Health. The Nebraska Medicine team comes to Rapid City regularly. You don’t have to figure out a trip to Omaha before you’ve even had a conversation.

“There’s no such thing as a dumb question,” Dr. Langnas said. “Write down your questions, give us a call. We don’t want you laying in bed at night worrying about stuff.”

Sources

Doc Talk with Monument Health, interview with Dr. Alan Langnas, Professor of Surgery and Director of the Nebraska Center for Transplantation, University of Nebraska Medical Center (April 2026).