This story is breaking and will be updated.

Two giants of Oregon health care are set on a collision course as they both attempt to revive their heart transplant programs.

Providence Health & Services announced on Thursday it intends to have its transplant unit up and running in six months to a year. In the middle of Providence’s press conference, Oregon Health & Sciences University went public with its own plan to restart a transplant unit, after it abruptly shut it down in August.

The high-stakes competition got even higher Thursday when Oregon’s richest couple gave $75 million to Providence. Phil and Penny Knight donated the money to support the Providence Heart Unit and its transplant program, hospital officials said.

Seven years ago, OHSU renamed its cardiac unit the OHSU Knight Cardiovascular Institute after the Knights donated $125 million.

Oregon has been without a heart transplant program since August, when OHSU shut down its transplant operation. Providence says it is already the highest-volume heart care program between San Francisco and Seattle, with 900 to 1,000 surgeries performed each year. It has gotten larger since OHSU’s difficulties, taking on about 350 former OHSU patients.

OHSU issued a press release saying it would restart its heart transplant program, but gave few details about how they would pull it off. Later, officials said they have made two hires for the first time since the program imploded last summer. But to actually perform surgeries, the hospital will likely need more. Heart transplant patients require intense after-surgery care that is so specialized that essentially no nurses or residents can do it.

When OHSU discontinued its transplant program last summer, it threw about 20 patients in desperate need of new hearts into limbo. OHSU halted its program after four cardiologists who specialized in working with post-transplant patients quit.

Providence had moved cautiously and deliberately to fill the gap left by OHSU, staffing up its own heart failure program. But it wasn’t ready to jump into the transplant business. As recently as three weeks ago, Providence doctors said they would prefer to collaborate with OHSU on a transplant program rather than go it alone.

But negotiations between the two sides failed to produce a plan.

A “transformational gift”

Providence then got word of the hefty gift from the Knights, which convinced them to go ahead with its own heart transplant program, the Providence Heart Institute. Dr. Dan Oseran, executive medical director of the institute, called the Knights’ donation a “transformational gift.” Providence aims to have the program up and running within six months to a year.

“We believe our state needs a stable heart transplant program,” Oseran said. “These patients who felt orphaned, we want them to feel they have a home.”

Providence also has the largest advanced heart failure team in Oregon and has quietly hired two transplant doctors. The cardiology department has also hired a nurse from OHSU’s advanced heart failure program and several support staff to deal with the influx of patients.

One of the departed OHSU cardiologists, Dr. Jill Gelow, joined the Providence program.

When asked about the parallel announcement on Thursday, Oseran said he did not think OHSU’s restart would have much impact on Providence.

Oseran added that there is no partnership between the two. “Not right now,” he said. “Today is about Providence.”

This is not the first time the Knights have invested in heart medicine. They gave $125 million to start OHSU’s Knight Cardiovascular Institute in 2012. It was the largest donation OHSU ever received at that point. The institute was co-founded and led by Dr. Sanjiv Kaul, who gave up his leadership role at the institute last year after the heart transplant program was put on hold and all the heart transplant cardiologists working under him left. Kaul now focuses on research at the university.

The Knights previously gave Providence $25 million to use on heart disease treatment as well.

Oregon patient overjoyed

Karanjeet Samra learned he would need a heart transplant within days of OHSU suspending its program last summer. Providence had referred him to OHSU, only to call and be told the hospital was no longer accepting patients.

Samra was nervous about what would happen. He had been sick awhile and had just been told he could die without a new heart. His family forced him to stay home and rest instead of keeping himself busy at the restaurant they run in Southeast Portland so he had plenty of time to worry.

“It was scary and very disappointing,” Samra said.

Last year, he ended back up at Providence as the hospital stepped up to offer advanced heart failure services to the orphans of OHSU’s program. He received a device in May that will keep his heart running temporarily. After six months, Samra got on the waitlist for a heart at the University of Washington and started to make the three-hour train ride to Seattle every few weeks for check-ups.

Now he is overjoyed that there might be a chance he could get a heart – or even just the intensive after-care in Oregon, rather than staying in Seattle for at least three months with relatives, far from his wife and children.

“They are good," he said, "but it’s so far away from home.”

He might get the call for a heart before either OHSU or Providence are back up and running, which he would be fine with. But he is anxious about the procedure and the travel makes it worse.

“If it’s done here in Oregon, it would be a great relief to me and people like me who are getting after-transplant care here,” Samra said.

Not the first time competing

When OHSU’s heart transplant program first started, it competed against Providence’s at the time. Providence eventually bowed out after company officials found that there wasn’t enough of a patient population in Oregon to justify both programs. It appears the state’s only academic university will again face competition – but this time, Providence could have the edge with a larger staff and the fact it’s currently caring for the former OHSU patients.

OHSU President Dr. Danny Jacobs said in an interview Thursday that the Providence announcement took him by surprise. The two hospital systems’ leaders have met regularly to discuss the care of patients that have moved from OHSU to Providence and about a possible collaboration on heart transplant services.

Jacobs said that he doesn’t know why Providence decided to strike out alone or what that means for their intentions to keep working with OHSU.

“You’d have to ask them that,” Jacobs said. “We remain open to continuing conversations with them in the future.”

OHSU had sent out their press release with the headline “OHSU to reactivate heart transplant program” based on an already-scheduled plan to update the public about their work anyway, Jacobs said.

Two junior advanced heart failure cardiologists have signed contracts with OHSU in past weeks, said OHSU Healthcare vice-president and chief medical officer Dr. Renee Edwards. She refused to identify them or give more details, saying that they had just made the commitment and that OHSU would release more information about them soon.

Officials are still trying to recruit cardiologists with more experience to lead the program, which could still take from days to years.

Volume is key

Both Providence and the University of Washington, which has had to absorb Oregon transplant patients, say that Oregon needs a resident heart transplant program, said Providence Dr. Jacob Abraham, executive director of advanced heart failure in a recent press conference

Volume is key to any transplant program’s success. Abraham said there’s no doubt Oregon generates a sufficient number of transplant candidates -- 30 to 50 a year -- to support a program.

About 2,500 to 3,000 heart transplants are conducted annually in the U.S., far less than the approximately 250,000 people a year who need a new heart. The imbalance is created by the shortage of donor hearts.

OHSU has performed more than 700 heart transplants since the program started in 1985.

However, whether that patient load could support two programs is another issue. OHSU officials said they are certain the academic hospital could sustain a competing program -- and that it is OHSU’s duty to have a program.

They might face an additional obstacle if OHSU can’t perform any transplants before August. Heart transplant centers need approval from both the federal Centers for Medicare and Medicaid and the United Network for Organ Sharing before launching.

Providence must perform 10 heart transplants successfully to earn accreditation from the federal Centers for Medicare and Medicaid. That means that the hospital will likely have to eat the costs of those surgeries and after-care. OHSU would have to do the same if it goes a full year without performing a heart transplant. If the hospital hoped to beat the August deadline, those recruits would need to be locked into place soon.

Jacobs said that building a exceptional team of cardiologists is a bigger priority than losing the CMS certification. He said the cost and time of having to do the 10 transplants would not be an obstacle.

“If we can do it before that deadline that’s great but there’s not a rush,” Jacobs said.

Jacobs said that the internal and external reviews of the cardiology program have not been finalized but again promised to share what he called “high-level” findings. He said those will include lessons learned and observations about what hurt the program and could do better.

So far, OHSU has declined most of The Oregonian/OregonLive’s public records requests concerning individual doctors and the program in general.