For nearly five decades, Gwen McNatt, PhD, ARNP, FNP-BC, FAAN, has watched transplantation transform from an emerging specialty with uncertain outcomes into one of the most sophisticated and collaborative fields in health care. Through every era of that evolution, one thing has remained constant: her conviction that transplantation never loses its sense of wonder.
“I still think it’s a miracle,” McNatt said. “In the early days, we were only doing kidneys and the patients that did well did so much better. I quickly learned that dialysis is not fun. Liver failure is even less fun. Being able to see patients get their lives back after transplantation has always fascinated me.”
That perspective has shaped a career spanning more than 40 years, from bedside transplant nursing to executive leadership. This month, McNatt retired as chief administrative officer of the Organ Transplant Center at the University of Iowa Hospitals and Clinics, where she oversaw abdominal transplant programs while continuing to care for patients as a nurse practitioner, a balance she intentionally maintained throughout her leadership career. She still intends to remain involved in the transplantation community, as she is quick to point out.
Her longevity in transplantation is remarkable, but perhaps even more striking is that she has never worked outside the field.
“I graduated from college in 1979,” she said. “I’ve never worked in anything other than transplant.”
Finding a Calling by Chance
Unlike many clinicians who describe an early calling to nursing, McNatt’s path began with practical considerations.
Growing up in Wheaton, Illinois, after her family moved from Colorado, she was encouraged by parents who valued education and gently steered her toward a career with stability. A full scholarship to the University of Iowa’s nursing program ultimately determined her major more than any lifelong dream of becoming a nurse.
“I mostly wanted to go to the University of Iowa,” she recalled. That love of Iowa continues as she and her husband of 42 years are season ticket holders to Iowa Hawkeye football, men’s and women’s basketball, and men’s and women’s wrestling teams. “When it’s still football’s season and basketball and wrestling get started, we can go to a sporting event eight nights in a row.”
That intense black-and-gold loyalty even extends to their wardrobe. “We wore our Hawkeye gear to an AC/DC concert in Madison recently because that’s mostly the casual clothes that we have. And every time there’s a coaching opening at Iowa, my husband always kids around that I should apply for it.”
Her first job after graduation from Iowa placed her on a transplant floor at the University of Illinois, largely because it happened to be the available opening. “I thought I wanted to go into dialysis,” she said. “But I ended up really liking transplant.”
She never looked back.
Those early years came before many of the advances that today’s transplant professionals take for granted. “I remember when there wasn’t cyclosporin, let alone tacrolimus,” she said.
Working during what she describes as the “Wild West” days of transplantation offered a front-row seat to extraordinary medical progress. As survival rates improved and immunosuppressive therapies evolved, she witnessed firsthand how transplantation changed lives, reinforcing her belief that the field offered something unique.
Just as important was the opportunity to build lasting relationships with patients. “I like to know what happens,” she said. “I want to establish longitudinal relationships with patients.”
Unlike specialties where clinicians may see someone only once, transplantation allows providers to accompany recipients and donors through years of recovery, milestones and new beginnings.
That continuity remains one of the profession’s greatest rewards for her.
Leading While Staying Connected
Although McNatt now oversees a complex transplant enterprise that includes nurse coordinators, financial counselors, navigators, quality professionals and multidisciplinary clinical teams, she has never wanted leadership to separate her from patients.
Every week she continues seeing transplant recipients and living kidney donors.
For McNatt, those visits are far more than maintaining clinical credentials. “I like connecting with the patients,” she said.
Her commitment is especially evident in her work with living donors. “I think it’s important to pay attention to them after they’ve donated,” she said. “Usually they don’t have any problems, but if they do, I like to proactively find that out and help find a solution. I think it’s important that they are not forgotten.”
That philosophy reflects an increasingly important conversation across transplantation as programs continue expanding living donor opportunities while ensuring long-term donor care.
McNatt believes living donation represents one of transplantation’s greatest strengths. “It’s a better deal for the patient,” she said. “Living donor kidneys generally do better and last longer.”
At the same time, she emphasizes that both deceased and living donation remain essential parts of a comprehensive transplant system, each serving patients in different ways.
Her administrative responsibilities are equally expansive. She oversees quality systems, regulatory compliance, policies, multidisciplinary coordination and continuous improvement, work that has become increasingly important as transplant programs navigate evolving oversight and reimbursement requirements.
Building Better Conversations
One reason McNatt values her involvement with the Organ Donation and Transplantation Alliance (The Alliance) is its ability to bring together professionals who might not otherwise have opportunities to learn from one another.
Her engagement began simply enough.
After being invited to present an Alliance webinar, she was asked to help plan future educational programming. That evolved into participation on the Transplant Leadership Council, The Alliance Conversation Series Faculty, and more recently, The Alliance’s Payer Collaborative Steering Committee. The collaborative was formed as reimbursement discussions between Medicare and commercial insurers became increasingly complex.
Rather than allowing policy changes to deepen misunderstandings, participants saw an opportunity to create dialogue.
“We create educational programs to get the payers and the transplant centers on the same page,” McNatt said. For McNatt, those conversations reflect one of transplantation’s defining characteristics: progress depends on collaboration across organizations, disciplines and perspectives.
No single institution solves the field’s challenges alone.
Whether discussing finance, quality, operations or regulation, meaningful improvement comes when professionals are willing to share experiences and learn from one another.
That collaborative spirit mirrors the broader role The Alliance plays in creating spaces where leaders can exchange practical knowledge and work collectively toward stronger systems of care.
Looking Ahead
After more than four decades in transplantation, McNatt has accumulated honors that include fellowship in the American Academy of Nursing and the UNOS Heckenkemper Leader in Transplant Administration and Quality Award. Yet she speaks less about recognition than about the privilege of witnessing transplantation’s evolution.
She has seen therapies improve, regulations expand, multidisciplinary teams grow, and patients live longer, healthier lives.
Through every change, one lesson has remained clear.
Success in transplantation is never the work of a single person.
It depends on clinicians, administrators, donor hospitals, transplant centers, payers, regulators and professional organizations learning from one another and continually refining how care is delivered.
For McNatt, that commitment to shared learning is what will carry the field forward. After nearly half a century, the miracle that first captured her imagination still inspires the work she does today.
