http://www.post-gazette.com/pg/11169/1154623-53-0.stm?cmpid=localstate.xmlUPMC kidney transplant program remains on hold indefinitely
By Sean D. Hamill
UPMC's living kidney and liver programs will remain closed indefinitely while the organization overseeing the nation's organ transplant centers decides what action to take.
The United Network for Organ Sharing completed its on-site investigation at UPMC last month after a botched kidney transplant. The visit "went well and we received positive feedback," a UPMC spokeswoman said Friday.
UPMC had hoped that the brief visit would lead to quick action -- and restart of the transplant programs, which shut down in early May -- by a committee after it held a meeting June 8.
But the Membership and Professional Standards Committee did not take action during that meeting, which was done via a conference call with members.
Now UPMC is forced to wait at least until the full UNOS board meets June 28 in Richmond, Va., or the committee meets again in person in Chicago July 12-14, or even later, to see if it can restart its programs.
UPMC spokeswoman Jennifer Yates had no comment on the longer-than-expected wait, except to say: "We just want to respect the process."
A separate federal investigation into the kidney case, by the Centers for Medicaid and Medicare Services (CMS), concluded June 9 -- although restarting the transplant programs was not tied to the outcome of that inquiry as it is with the UNOS investigation.
Even in a worst-case scenario, a CMS investigation wouldn't necessarily shut a program down.
CMS typically recommends corrections and gives time for a transplant center to make corrections. If action is not taken, CMS could pull Medicare funding from a hospital -- which typically makes up 50 percent or more of kidney surgeries. Losing that funding could automatically shutter some programs, but not all.
But UNOS, a nonprofit that contracts with the federal government to run the Organ Procurement Transplant Network, does have the power to permanently shut a transplant program down by pulling its certification.
Its investigation began sometime in mid-May when several UNOS staffers visited Pittsburgh to gather information that was then given to the membership committee for a peer review process. Nearly all of the 40 members of the committee are either transplant surgeons or transplant administrators.
If the investigation finds the problem is less serious and easily correctable, the membership committee could decide on its own to issue a notice of uncontested violation, letter of warning or a letter of reprimand -- none of which would close the program.
But if the membership committee's review finds the problem is serious enough, the full UNOS board would decide if a transplant center is to be put on probation or be found to be a member not in good standing. The board also could recommend to the secretary of Health and Human Services that the program be suspended or to terminate its certification.
Ever since UPMC told federal officials on May 6 that it discovered that a kidney from a living donor who tested positive for hepatitis C had been mistakenly transplanted into a recipient who was not positive for the virus, UPMC officials had said they hoped to restart the program in about a month.
But former UNOS board members say that because UPMC's case is such a surprising incident, the full UNOS board would probably want to review any findings -- even if deemed less serious -- before the committee allowed UPMC to restart.
"This is an important enough case that it won't be left with the committee alone, particularly now that it's so public" said William Harmon, director of the kidney transplant program at Children's Hospital of Boston and a former UNOS board member. "The full board will want to weigh in."
That wasn't always the case.
Donna Luebke, a registered nurse and transplant patient advocate in Cleveland and former UNOS board member, said the board began having more input into even lower-level investigations when she was there because there were too many revelations of transplant problems coming out in media stories that the board never heard about.
"It was my concern on the board that we were constantly being blindsided; we wouldn't know about cases until they appeared in the papers," she said.
Ms. Luebke has been following the UPMC case as it has progressed and was bothered by the fact that UPMC had not only demoted a surgeon for apparently missing the positive hepatitis C result, but also suspended a nurse in the case.
"Surgeons always say they're the final person responsible for a case. And I say fine. But if an adverse event comes out, then you're responsible for any adverse events, too," she said. "So, to blame the nurse? I don't think so. You blame the surgeon."
Sean D. Hamill: shamill@post-gazette.com or 412-263-2579.
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