Title : How are American transplant centers regulated? How does this influence treatment decisions?
link : How are American transplant centers regulated? How does this influence treatment decisions?
How are American transplant centers regulated? How does this influence treatment decisions?
Here's a NYT oped about the fact that transplant centers are regulated based on their one-year graft survival statistics--i.e. on how often the transplant (and the patient) lasts 12 months:
When Is a Transplant Worth It?
A year in a hospital bed is a “success” while dying after 11 months is failure.
By Daniela J. Lamas
Dr. Lamas is a pulmonary and critical care physician.
"The single-minded focus on staying alive for a year begins at the time of a transplant program’s initial certification by the Centers for Medicare and Medicaid Services. If the program’s one-year mortality rate is higher than expected, possibly because surgeons are giving transplants to people who are too sick, that program could be put on probation or lose its certification. That metric is equally important to the United Network for Organ Sharing, which allocates donor organs. A patient looking for information might happen upon the Yelp-style transplant center rankings developed by the Scientific Registry of Transplant Recipients — also based on one-year mortality, particularly for lung transplant programs.
...
"The focus on one-year mortality isn’t necessarily what patients want, and it can have unintended consequences. Dr. Richard Formica, a kidney transplant specialist at Yale-New Haven Hospital, noted that with mortality as the metric of success, surgeons might be apt to discard riskier transplant organs because they worry about their numbers. The concern about program numbers — and the potential repercussions for other patients if a center loses its certification — also might influence the choice of who gets a transplant in the first place. “Do we deny patients who have an increased risk of mortality in the first year?” Dr. Formica asked. “Yes, we do.”
When Is a Transplant Worth It?
A year in a hospital bed is a “success” while dying after 11 months is failure.
By Daniela J. Lamas
Dr. Lamas is a pulmonary and critical care physician.
"The single-minded focus on staying alive for a year begins at the time of a transplant program’s initial certification by the Centers for Medicare and Medicaid Services. If the program’s one-year mortality rate is higher than expected, possibly because surgeons are giving transplants to people who are too sick, that program could be put on probation or lose its certification. That metric is equally important to the United Network for Organ Sharing, which allocates donor organs. A patient looking for information might happen upon the Yelp-style transplant center rankings developed by the Scientific Registry of Transplant Recipients — also based on one-year mortality, particularly for lung transplant programs.
...
"The focus on one-year mortality isn’t necessarily what patients want, and it can have unintended consequences. Dr. Richard Formica, a kidney transplant specialist at Yale-New Haven Hospital, noted that with mortality as the metric of success, surgeons might be apt to discard riskier transplant organs because they worry about their numbers. The concern about program numbers — and the potential repercussions for other patients if a center loses its certification — also might influence the choice of who gets a transplant in the first place. “Do we deny patients who have an increased risk of mortality in the first year?” Dr. Formica asked. “Yes, we do.”
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