No Such Thing as Too Many Transplants?

April 15, 2008

If you’re a heart transplant patient, you want to go to a hospital that does tons of transplants. But having so many programs in one city means no single center performs that many procedures.

The Wall Street Journal health blogger, Jacob Goldstein, brought about a good point recently in his post. In it, Goldstein cites Chicago, tied with Philadelphia for the metro area with the most adult heart transplant centers.

Says the Chicago Tribune, if you’re a heart transplant patient, you want to go to a hospital that does tons of transplants. But having so many programs in one city means no single center performs that many procedures. Each of the biggest programs in the Chicago performs only one heart transplant every two weeks or so, fewer than those in other areas that don’t have so many transplant centers.

But critics say the explosion of these medical services are unnecessary and enormously expensive. Yet without the procedure, most acutely ill heart-failure patients will die in a year or two; with new hearts, more than 90 percent of patients in Chicago are alive at one year and 60 percent or more will live 10 years or longer, experts report.

Further dispelling the argument, the largest programs in the Chicago area—at Loyola University Medical Center, Northwestern Memorial Hospital and the University of Chicago Medical Center—each perform about one heart transplant every two weeks, far fewer than those at leading medical centers in New York, Los Angeles, Cleveland, Houston and elsewhere.

Rush University Medical Center, meanwhile, performed only three heart transplants last year, far fewer than the 10 required by the government to maintain Medicare certification. They have not met the minimum annual threshold of 10 per year required to maintain Medicare certification because they say they are expanding upon their transplant center staff and plans to meet Medicare requirements by the end of the year. Medical outcomes for Rush patients have been top-notch, but Medicare officials confirmed they're evaluating all hospitals that are failing to meet standards. Heart transplants are among the most complex procedures in medicine, and it's not easy for transplant teams to be at the top of their game if only conducting a handful monthly.

Rush has the fifth Chicago facility; Advocate Christ Medical Center opened last year and will likely subsidize transplants through the end of 2009, when the hospital anticipates receiving Medicare certification.

Many cardiologists aren’t referring patients whose lives could be extended by heart transplants, says Goldstein. Other docs are skeptical.