 |
|
|
Natasha Dolgin |
Liver transplant centers are removing more of the sickest patients from the organ waiting list, deeming them “too sick to transplant,” in the wake of federal performance standards that have only minimally improved one-year survival rates, according to an NPR report on UMass Medical School MD/PhD student Natasha Dolgin’s research.
The analysis of nationwide transplant data was published in April in the Journal of the American College of Surgeons.
“There's no common definition for when someone is too sick to transplant," Dolgin told Kaiser Health News for a June 7 story that ran on NPR.
The study found that between mid-2007 and 2012, 4,300 Americans with life-threatening liver diseases were removed from the transplant waiting list. That’s nearly twice as many as the 2,311 removed in the previous five years (April 2002 and June 2007.) In 2007, the Centers for Medicare and Medicaid Services (CMS) began a new regulatory policy to set expectations for safe, high-quality transplant services in Medicare-participating facilities. If the centers do not meet the required conditions, they could lose Medicare funding and coverage by private insurers, and face closure.
Dolgin and co-authors studied trends in delisting rates and one-year post-transplant mortality, or death rates, for 90,765 adults awaiting a liver from a deceased donor from April 2002 through December 2012 at 102 liver transplant centers. The researchers compared trends during the five years before versus after the new policy implementation.
Dolgin found that the federal policy was not associated with a significant improvement in one-year post-transplant death rates. The one-year patient survival rate rose only slightly, from 86.6 percent before the new policy to 88.5 percent afterward.
“Although the policy was a quality improvement initiative designed to improve transplant patient outcomes, in reality, it failed to show beneficial effects in the liver transplant population,” Dolgin said.
Immediately after the new policy, there was a 16 percent spike in liver transplant candidate delisting because of patients becoming “too sick for transplant.” That rate continued to increase by 3 percent per quarter through the end of the study.
Nearly 14,750 liver transplant candidates are currently on the U.S. transplant waiting list, according to the Organ Procurement and Transplantation Network1.
Read the full story: NPR: Federal Standard May Be Thwarting Some Liver Transplant Patients
