In early 2014, when Travis Hogan’s malformed heart was failing, his longtime doctors at Texas Children’s Hospital referred him to Baylor St. Luke’s Medical Center, long recognized as one of the best in the country for complicated heart transplants.

Hogan, then 29 and living at his family’s home in Pasadena, Texas, didn’t know it, but the iconic program was undergoing a series of dramatic changes.

Two years earlier, the transplant program slipped into turmoil when several top physicians left for a competitor. In the years that followed, patients at St. Luke’s waited significantly longer than the regional or national average for new hearts.

In 2015, as Hogan’s health declined after more than a year on the list, he was dealt two additional blows. First, hospital staff took him off the active transplant waiting list in November 2015, citing his worsening liver as cause for concern, which his mother, Georgeann Hogan, said she did not know until told by a reporter this week.

Then, around that same time, hospital staff explained that Dr. O.H. “Bud” Frazier, the 75-year-old surgeon who initially agreed to treat her son, was no longer operating. Frazier had been planning to implant a ventricular assist device to aid Hogan’s failing heart and allow his liver to recover until he could receive a transplant, Georgeann Hogan said.

She said nobody told her family why Frazier had stopped operating; Frazier told reporters in an interview in April that he was getting old and was ready to stop.

The change stunned Hogan’s family.

They did not realize that earlier in the year, several patients died shortly after receiving transplants at St. Luke’s, leading the hospital to scrutinize the heart program and adopt a more conservative approach.

It also hired a new lead surgeon, Dr. Jeffrey Morgan, who arrived in early 2016. Hospital staff told the Hogans that Morgan would pick up where Frazier left off with his plans for a ventricular assist device, Georgeann Hogan said.

But after Travis Hogan was admitted to the hospital in February 2016, St. Luke’s Heart Transplant Medical Review Board decided he “would not likely survive a combined heart and liver transplant,” the hospital said in a statement. Morgan sent word via Hogan’s cardiologist that he would not be operating, Hogan’s family said, not even to implant the heart assist device.

“That was devastating,” said Hogan’s sister, Regina Tran.

In past decades, patients born with a heart defect such as Hogan’s came from around the country to be treated at St. Luke’s, which was known for its willingness to take the most difficult cases. But in 2016, according to publicly available data, the hospital did not add a single patient with a congenital heart defect to its transplant waiting list; meanwhile, other high-risk patients, such as Hogan, were removed from the list.

Dr. Andrew Civitello, the transplant program’s top cardiologist, remembered a handful of difficult conversations with critically ill patients that year, though he did not refer specifically to Hogan: “‘We wanted and still want to transplant you,’” he said, recalling how the conversations played out, “’but given the current environment, we unfortunately can’t take the risks.’”

Hogan’s family scrambled to find an alternative. Another St. Luke’s physician urged the family to transfer to nearby Houston Methodist hospital, his mother said.

The process took weeks as the family fought to get the insurance company to approve the transfer. At Methodist, doctors implanted a balloon pump to help Hogan’s heart pump blood while he awaited a transplant.

One did not come in time. Hogan died a few weeks later, on May 26, 2016, at the age of 31.

In a written statement, St. Luke’s said Hogan spent 486 days on the active heart transplant list before he was made inactive and later removed, and that the median wait time for a heart transplant in its region for a patient with Hogan’s blood type was 537 days. “Mr. Hogan’s choice to be treated at [St. Luke’s] did not adversely influence his likelihood of obtaining a heart transplant,” the hospital said.

Tran acknowledges that her brother was very sick. But she sometimes wonders whether he might still be alive if he hadn’t spent two years waiting for a heart at St. Luke’s.

“We went there because we were told St. Luke’s was the place to go for help with the most difficult heart conditions,” Tran said. “But when it finally came time for my brother to receive a new heart, they turned us away.”