A donor's death was the final blow for a struggling kidney transplant program.

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http://lubbockonline.com/health/2011-06-11/patient-overload-death-doomed-umc-kidney-transplant-program

Patient overload, death doomed UMC kidney transplant program
A donor's death was the final blow for a struggling kidney transplant program.
By BY KELLIE BRAMLET 
AVALANCHE-JOURNAL
 

A donor's death was the final blow for a struggling kidney transplant program depended upon by patients across the South Plains, newly released records show.

Documents obtained by The Avalanche-Journal under the Freedom of Information Act from the Department of Health and Human Services Centers for Medicare and Medicaid Services provide explanations never given to University Medical Center transplant patients, now searching across the Southwest for a new, highly specialized surgeon to perform the life-saving operation.

High demand overwhelmed the small program, and, the records show, consequences were deadly.

The donor's death motivated hospital officials to suspend the program Jan. 21, and letters were sent notifying patients Jan. 27. An Independent Peer Review Team, composed of transplant and nephrology experts from across the country, visited the hospital to inspect the program, in light of poor mortality rates.

The results of that study: a long list of changes, including hiring an additional transplant surgeon.

In the end, the findings provided too many demands to turn the program around.

"We had concerns about the ability (of) a program our size to meet those standards," said Greg Bruce, UMC vice president, who is not a practicing physician. "We decided it was in the best interest of our patients that we serve and the hospital that we discontinue the program."

On April 15, Bruce confirmed rumors the transplant program, the only one in the West Texas region, would close effective May 13.

 

Increased patient load

Many of the program's troubles began in 2009, when Covenant Health System closed its kidney transplant program.

About 90 percent of Covenant's 99 patients were referred to UMC. The number of transplant patients increased from 21 in 2008 to 50 in 2009, according to a report.

The program's quality suffered under the increased patient load.

A report shows the highest number of grafts, meaning the transplanted organs, and patient losses occurred in the second half of 2009, around the same time Covenant's program closed.

But UMC staff strove to improve.

The hospital hired two transplant coordinators and worked closely with the United Network for Organ Sharing to improve outcomes and patient safety.

In January 2010, the Membership and Professional Standards Committee, a division of the organ sharing network, determined UMC's program had improved and did not need further reporting.

"The actual patient and graft survival rates have improved for transplants performed in more recent years," a letter read.

 

Still struggling

But survival rates remained unsatisfactory.

Four of six transplant patients died from infections within a 12-month period, but doctors could not identify a specific cause of infections.

An additional two patients suffered transplant failures related to technical issues.

As a result, Dr. David Van Buren, a transplant surgeon, agreed to perform all transplants when available "due to his vast experience," a report dated Jan. 25 of this year, said.

According to reports dated Dec. 9, 2010, the hospital agreed to stricter criteria for transplant patients, after a patient died of a "non-transplant-related cause" because he wouldn't accept blood.

Another patient's death because of a "rare and sudden" depletion of sodium in the blood serum prompted a protocol change in monitoring patients' fluids and electrolyte status.

UMC agreed to make more changes after the Peer Review Team inspected the hospital, reports show.

Hospital and Texas Tech Health Sciences Center recruiters began looking for an additional transplant surgeon. But the search proved a difficult one and ultimately factored into the decision to close, Bruce said.

"We didn't know our ability to find a second transplant surgeon in a very timely fashion," he said. "There's not a whole lot of those folks out there. It was going to be a very difficult recruitment."

Directors also agreed to no longer use Rapamune, a medication used to prevent the rejection of a donated kidney and to suppress the immune system.

Rapamune is also known to increase the risk of infections and cause cancer.

Bruce said he did not know if the drug was responsible for the infections UMC pateints suffered.

The directors planned to reduce the duties of Dr. Melvin Laski, the program's nephrologist, so he could focus solely on the program.

Laski has declined requests for interviews.

And the program's directors revised post-transplant follow-up care.

But no matter the changes, nothing would alleviate the increased patient load.

"That's a challenge that was not going to be changed," Bruce said. "The size of the program was always going to be a concern for us."

 

Patients respond

The information the documents reveal is not news to many patients. Rumors had circulated around the small and tightly knit group of patients who had already undergone transplants.

Many of them had positive experiences with the center. Not even failing statistics and the death of a donor changed their minds.

"I've developed a relationship with my doctor," said Jana Gardner, who had a transplant two years ago after her kidneys failed because of polycystic kidney disease.

Gardner, 42, may need another transplant someday. She would prefer it be performed by the surgeon who completed her first.

Other patients echo the same feeling.

"Our No. 1 choice is to have the doctor who did the transplant to follow us," said Karla Hope, who underwent a transplant of both kidneys in 2009.

UMC officials hope to establish a partnership with another hospital to perform the transplants, allowing UMC to focus on the pre- and post-operative work.

Patients would have to travel, but they would be provided with a clear path. The amount of travel would depend on the partner hospital's location, which could be as far away as Dallas or Houston.

Bruce said he hoped the partnership would have been established already, but he said he's optimistic he'll make the announcement soon.

But many patients said they aren't satisfied with the solution.

"There are still going to be those that can't travel," Gardner said. "It still doesn't change my opinion that we need a kidney transplant center in this area."

 

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