29 Organ Transplant Programs To Be Reviewed For Low Survival Rates

The government plans to review 29 organ transplant programs that have consistently shown lower-than-expected survival rates.

In all, 43 programs that transplant hearts, livers or kidneys had low survival rates over a six-year period, although some have shown improvement in recent years and a few have closed, the Department of Health and Human Services said Tuesday.

But nine liver, nine heart and 11 kidney transplant programs consistently performed at lower-than-expected rates between 1988 and 1994.

HHS Secretary Donna Shalala said these results concern her and asked the United Network for Organ Sharing, which runs the nation’s transplant program and evaluated the facilities, to report within 30 days on its plans for reviewing the 29 programs.

She also asked whether the 29 programs have been reviewed before and if not, why not, and what these centers have in common.

“Please describe how you intend to assist these programs perform up to their expected rate,” she wrote in a letter to the director of UNOS.

Still, officials warned that survival rates is only one piece of information patients should consider when choosing an organ transplant center. And they cautioned that some excellent programs may show up on the list.

“This is another tool available to patients that we hope will be helpful,” said Mary Ann Wirtz, a spokeswoman for the organ network.

The American Liver Foundation agreed, saying survival rates are one factor patients should use in choosing a transplant center. Spokeswoman Pat Davis noted that many patients can’t afford to travel across country to the best center and may want to be closer to home.

And some centers may be new to transplants and have less experience, she added. “You would have to weight that if you did have the option to go someplace else,” she said.

The report, produced every three years, offers a wealth of information about every transplant program in the country. Overall, it showed patient survival rates improving for every type of transplant.

These overall numbers were released last week, but HHS did not release the list of centers performing below expected until Tuesday.

Several programs perform just a handful of transplants each year, and some contend that patients are better off with more experienced surgeons. For instance, eight of the 13 heart programs that were operating in 1992-94 and had low rates performed fewer than 15 transplants over the two-year period.

But it was impossible to tell how many of them would be considered small programs because United Network could not say how many transplants the typical program performed.

Officials noted that small programs tend to have more variation in their survival rates - both high and low - because just a few patients can swing the results dramatically.

The list includes a few very large programs, like the University of Alabama, which performed 1,652 idney transplants in 1988-94. Its survival rate was just barely below expected, and government officials said it illustrated why patients should not take this list as gospel.

“You’d never say the University of Alabama is anything but a quality center,” said Charlotte Mehuron, an HHS spokeswoman.