Sunday, November 23, 2008

Transplant Center Stats - Does One Bad Apple Spoil the Whole Bunch?

A front-page article in the November 21st issue of The Wall Street Journal, "Doing a Volulme Business in Liver Transplants," was thought-provoking and, ultimately, disturbing. According to the article, the non-profit University of Pittsburgh Medical Center (UPMC) hired an innovative and aggressive surgeon, Dr. Amadeo Marcos, to head its under-performing liver transplant program, with the directive to increase the number of liver transplants performed every year. Dr. Marcos doubled the amount of liver transplants conducted at UPMC, but this achievement was in question because "... he resorted to practices that some colleagues found questionable... he used more livers from older donors [and] transplanted some of these into relatively healthy patients for whom the risk-reward calculation was less certain. He used partial livers from living donors, and then understated complications from the controversial procedure."

My husband and I discussed this article and what it could mean to transplant candidates. Prior to my surgery, we did a lot of homework, including reviewing transplant survival rates for liver transplant centers within a four hour drive of our home. We wanted a transplant program that had the following: 1) most importantly, a track record of performing a reasonably large number of transplants annually (to help ensure that the surgeons and staff were highly experienced and that a liver was likely to be available when I needed one); 2) was close enough to our home that pre- and post-transplant doctor appointments wouldn't be too overwhelming; and 3) was part of our health insurance plan.

It never occurred to us that we should be concerned about the accuracy of the transplant data we reviewed. We knew that not every available liver was top-rate (from a young, healthy donor), but our transplant team explained that if there were any issues about the donor liver, we would be told prior to surgery and have the option of rejecting the liver. (Note: We were told that my donor liver was in excellent condition, so we never had a discussion about possibly rejecting it.)

I believe that the situation at UPMC was the exception to the rule, that most transplant centers, doctors and staff put patients, not profits, first. But the article raises a valid question and I don't know how it can be answered. How can you tell if a program is operating under a risky protocol? Do centers publish their donor organ selection criteria? If you believe the organ you're offered isn't acceptable, does it mean that you're a "troublemaker" and won't be treated fairly or objectively?

The article raises many questions and I'm very curious about possible answers. Please leave a comment and share your thoughts, knowledge and other questions - this topic warrants a healthy discussion.

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