Quality of care and oversight

Happy New Year and welcome to Transplant Headquarters! For the first post of 2007, I wanted to highlight some of the biggest news stories in transplantation from 2006.

In June, the Los Angeles Times reported that 20% of US transplant programs receiving federal funding didn't meet CMS (Medicare) standards for volume, outcome, or both, and calculated that these programs accounted for 21 more deaths among transplant patients than statistically expected. Since CMS only sets standards for some of the organs transplanted (heart, lung, and liver), and not all transplant centers are CMS-certified, the actual number of "substandard centers" may be underestimated.

The LA Times also published a list of the substandard programs. More than the 20% figure in the first article, this list is even more surprising given some of the institutions on the list: Mass General, Johns Hopkins, Yale, University of Miami/Jackson Memorial, Mount Sinai, Medical College of Virginia, and other similarly prominent hospitals and transplant centers.

In October, the LA Times turned its attention to UNOS, the private organization under contract from the US government to run the national organ allocation system. This article focused not only on centers not meeting quality of care standards, but also the UNOS response (or lack of response) to programs that had violated UNOS policies in the recent past. This article prompted a response from UNOS, explaining its approach and defending its performance to date.

These pieces include all the buzzwords you could ask for:

• "glaring and repeated lapses"
• "continued artificial bolstering of programs that shouldn't exist"
• "mortality increased sharply and exponentially"
• "derelict hospitals"
• "sense of outrage"
• "fox guarding the chicken house"
• "stuck to its slow and silent ways"

from the LA Times, and from the UNOS side:

• "best interest of patients"
• "patients' access to transplant"
• "public trust is essential"

On one hand, the fact that this story can be reported at all is a testament to the strong regulation of transplantation in the United States, where every "transplant event" (every patient listed, every deceased and living organ donation, and every transplant operation) is recorded. On the other hand, it seems like this information isn't being used to the fullest benefit possible. As for how much "policing" should be done by the government or UNOS, and how much professional autonomy should be allowed for transplant programs, I don't know. What I do know is that, as a transplant patient, I'm glad this information is out there.