The University of California Irvine (UCI) Medical Center and St. Vincent Medical Center in Los Angeles transplant programs are once again in the public spotlight following press reports of poor patient survival rates, high organ turndown rates and inadequate staffing.

Here are some of the charges being levied at the two Southern California institutions:

*The Los Angles Times, on Dec. 17, 2005, reported that kidney patients at St. Vincent had an exceptionally high death rate, according to information compiled by the United Network for Organ Sharing (UNOS).

*The Orange County Register, on Jan. 11, 2006, reported that the UCI Medical Center’s Bone Marrow Program had only met California state standards once since the program was founded in 1995. According to the report, the state requires a BMT program to perform at least 10 autologous and 10 allogeneic bone marrow transplants a year.

*The Los Angeles Times, on Jan. 24, reported that the UCI Medical Center had turned down kidneys offered to the institution “at an exceptional rate over the last five years.” An analysis of UNOS turndown data found that between July 2000 and June 2005 UCI accepted only 8.7% of kidneys offered for its patients. The UNOS data revealed that the annual kidney acceptance rate in the country during that time was 25.9% to 31.2%, the Times said.

The newspaper reports, especially the LA Times, have resonated nationwide and the transplant community is scrambling to address what appears to be inadequate oversight of US transplant program allocation procedures and outcomes.

To its credit the Organ Procurement and Transplantation Network (OPTN)/UNOS Board of Directors moved quickly and aggressively at its November meeting to address the issues after UCI closed its liver transplant program after the Times reported 35 patients had died over the past two years while on the liver transplant waitlist. (Transplant News, Nov. 30, 2005).

“The Board was very clear in its recognition that it is a ‘new day’ when it comes to member responsibility for policy compliance and the provision of high quality patient care in organ transplantation,” Francis Delmonico, MD, OPTN/UNOS board president, said in a summation memo to the board. “This was true not only in deceased donor organ allocation and transplantation but in the provision for living donor transplantation.”

Tom Mone, president and CEO of OneLegacy, the organ procurement organization covering the Los Angeles area, told Transplant News that the scandals have not gotten “a lot of traction” with the local public and did not affect the public’s willingness to donate.

“Last year was hugely successful and that didn’t change one way or the other when the Times articles hit,” Mone said. “We’re 10% ahead of last year and it might have even helped. The average families don’t appear to have paid much attention.”

However, Mone believes it is his responsibility and that of the transplant community to take a strong public stance on the findings.

“Someone needs to speak up for the public trust,” Mone explained. “The aberrations at St. Vincent were extreme and UCI’s problem is that it’s a small center with staffing problems and isn’t emblematic of the entire system. We need to explain that their problems do not undermine the gift of organ donation.”

UNOS declined a request to comment on the Los Angeles situation.

However, Transplant News did obtain a copy of a set “talking points” which were widely distributed to the transplant community in the past few days. The talking points follow this article.

Here is a brief overview of each of the press reports

St. Vincent Medical Center kidney recipient death rate

The Times reported on Dec. 17 that 36 patients who received a kidney transplant from Jan. 2002 to 2004 had died within a year of surgery. According to UNOS, that is 15 more than expected based largely on the quality of donated organs and the condition of recipients, the paper said. St. Vincent is one of only four programs nationwide whose death rate was consistently higher than expected for patients dating back to 1999.

St. Vincent was the ninth busiest kidney transplant program in the US last year with 216 transplants performed. There are more than 1,100 patients on its waiting list for a kidney.

The transplant administrator for the program Deborah Maurer and co-medical director Robert Mendez, MD, told the Times the hospital’s statistics had suffered because the program had been deliberately aggressive, treating sicker, older patients who have fewer options for care. They also said the program serves the less educated and non-English speaking who may have difficulty following doctors’ orders in the months following their transplant.

Health insurers have pulled out. Aetna stopped sending patients to St. Vincent in Dec. 2004. Humana followed suit in July 2005. United HealthCare and PacifiCare Health Systems suspended coverage for kidney and liver transplants this year after the liver scandal was reported.