About 20% Of Federally Funded Transplant Programs Do Not Meet CMS Standards, Los Angeles Times Reports

Main Category: Transplants / Organ Donations
Article Date: 03 Jul 2006 - 12:00 PDT

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About 20% of federally funded transplant programs do not meet minimum CMS standards, according to a Los Angeles Times investigation. CMS funds most U.S. transplant programs and requires medical centers to perform a minimum number of procedures and maintain a minimum survival rate to receive certification. The Times examined the number of procedures performed by medical centers as part of the 236 federally funded heart, liver and lung transplant programs from 2002 to 2004, as well as survival rates, based on information available to the public on the Web sites of the United Network for Organ Sharing and the Scientific Registry of Transplant Recipients. According to the Times, 48 of the transplant programs continue to operate "despite sometimes glaring and repeated lapses." Nine lung transplant programs and 36 heart transplant programs did not meet CMS standards. Those 48 transplant programs accounted for 71 more deaths within one year of transplants than expected under normal conditions, based on a government analysis of survival rates. CMS has the authority to revoke the certification of transplant programs that fail to meet agency standards but "rarely does," the Times reports. CMS has revoked the certification of 11 transplant programs since 2000, but, in "nearly all of those cases, it moved only after the programs had voluntarily ceased operations," according to the Times. However, after CMS received detailed questions from the Times, agency officials in March sent letters to all of the transplant programs that requested information about staffing and performance. An anonymous CMS official said that the agency to date has identified 25 transplant programs "seriously out of compliance."

Reaction
Mark Barr, president of the International Society for Heart and Lung Transplantation and a surgeon at the University of Southern California, said, "The bottom line message is that there are too many programs in the United States that need to be shut down." Barry Straube, chief medical officer for CMS, said, "In areas where there is a concern, whether it's because they are not meeting certain volume standards or outcome standards, at a minimum, that is going to trigger a review of that specific program." He added that CMS might reduce the number of the minimum number of procedures that transplant centers must perform. However, Michael Acker, a heart transplant surgeon and chief of cardiac surgery at the Hospital of the University of Pennsylvania, said that heart transplant programs should have to perform more, not fewer, procedures. Acker said, "It's not just doing the transplant. ... There are so many reasons for why you need a vigorous team." Officials from transplant programs that do not perform the minimum number of procedures said patients in many cases would have to travel long distances in the event they had their certification revoked. Officials from transplant programs that did not maintain minimal survival rates "uniformly say they should be given more time to ... fix problems that led to unexpected patient deaths," the Times reports (Weber/Ornstein, Los Angeles Times, 6/29).

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