Report Puts US Transplant Centers On Critical List
MayorBob.
Posted to SciTech on Fri Jun 30, 2006 at 06:51:10 PM EST. RSS.
Whenever the topic of transplant surgery comes up, the primary complaint seems to focus on the shortage of organs to transplant and the difficulty of getting on a list so you'll have a shot at a transplant before your systems finally fails. Little concern has been expressed about the quality of the transplant once you win the lottery and end up on the operating table awaiting your new heart, lung, liver, etc. Perhaps it's time to give that area a bit more of the limelight. Because, according to a Los Angeles Times' investigation, almost 20 percent of medical centers currently performing transplant surgeries shouldn't be .
There are 236 centers performing transplant surgeries in the US today. The federal government's Center for Medicare and Medicaid Services (CMMS) is tasked with maintaining sets of standards regarding performance of transplant centers. CMMS requires centers to perform a minimum number of surgeries per year and also achieve a specific survival rate to continue to receive funding. These minimum standards vary by type of organ being transplanted with the exception of kidneys, which have no minimum standards attached. The CMMS system requires each center to turn itself in when it fails to meet standards, but even when they do, CMMS rarely acts to cut off funding. In fact funding has only been cut off for 11 centers since 2001, and all had voluntarily stopped performing transplant surgeries prior to funds being cut off.
According to the Times' research there are 48 heart, liver and lung centers failing to meet standards for minimum number of operations performed per year, survival rate for the specific type of organ transplant, or failed to meet both. All 48 are still funded by CMMS and are performing transplant operations. The source for the Times report can be found on databases maintained by the Organ Procurement and Transportation Network and the Scientific Registry of Transplant Recipients. Dr. Barry Straube, chief medical officer at CMMS, says that his agency does take a look at transplant centers not performing up to standards. However, he views the survival rates as a more critical matter than the volume of operations performed:
"I personally can't get hung up on the volume issue. A center might do four transplants a year with 100% survival. We should shut those down?"In this estimation, Straube can draw on the wisdom of a former chief administrator at CMMS who suggested the agency should try to designate "centers of excellence" for transplant surgeries without necessarily concerning itself over volume. Dr. Michael Acker, chief of cardiac surgery at the Hospital of the University of Pennsylvania, has a differing view. According to Dr. Acker, heart centers should be performing at least 20 operations a month "to be versed enough to maintain quality." He says:
"It's not just doing the transplant. It's doing everything else. It's the follow-up care. It's how to deal with immunosuppression. It's how to deal with [patients] when they get infected. There are so many reasons for why you need a vigorous team."
