Officials overseeing the nation’s transplant centers have put UPMC on probation for repeatedly accepting a lung for one person, then giving it to another of its patients without consideration of the larger pool of would-be recipients, including those who may have been from other institutions and ranked higher on the waiting list.
UPMC attributed the error to a misunderstanding of transplant protocols.
However, the directors of the United Network for Organ Sharing and the Organ Procurement and Transplantation Network voted Monday to put UPMC on probation after officials determined that the institution “requires close monitoring as it continues its quality improvement process.”
The vote followed a review of the UPMC case by the UNOS/OPTN Membership and Professional Standards Committee. UPMC waived its right to a hearing.
UNOS spokeswoman Anne Paschke declined to give details of the corrective action plan UPMC has implemented, and UPMC spokeswoman Wendy Zellner said she didn’t have details. Ms. Zellner said the lung program will continue to operate during the yearlong probationary period.
UNOS describes probation as a “public designation” indicating that a “member institution is undergoing extensive corrective action for compliance with OPTN requirements, or for a situation that, if left uncorrected, could pose a risk to the health and safety of transplant patients, living donors or other members of the public.”
“Probation does not directly affect the ability of an OPTN member institution to continue to provide services,” according to a UNOS document. “A transplant hospital or laboratory may continue to provide transplant services; an organ procurement organization may continue to recover organs from deceased donors.”
However, in addition to implementing a corrective action plan, a transplant center on probation must notify patients of its status and undergo stepped-up monitoring. “We’re notifying patients,” Ms. Zellner said.
Ms. Paschke declined to say how the UPMC lung program irregularities came to light but noted that UNOS periodically audits transplant center data. Ms. Zellner said she didn’t know how UNOS was alerted.
“In an unusually high number of instances in 2013 and 2014, the lung transplant program at UPMC accepted lung offers for one transplant candidate, then eventually transplanted another candidate at the program without providing an opportunity for consideration of other candidates identified on the match run,” UNOS said in a statement.
UNOS defines a match run as a “ranked list of patients” deemed suitable for a recovered organ. Severity of illness factors into the ranking process, and Ms. Paschke said a match run can include patients from multiple institutions.
When an organ can’t go to the patient for whom it’s originally intended — perhaps because that person has become unstable — UNOS wants the organ to go to the next suitable person on the match run. Ranking is necessary because lungs and other organs are in short supply.
In a statement, Jonathan D’Cunha, surgical director of the UPMC lung transplant program, said: “As health care providers dedicated to saving lives, we would never intentionally deviate from UNOS guidelines for organ acceptance.”
In each case questioned by UNOS, he said, the transplant program had received permission from an organ procurement organization “to have a ‘backup patient’ available to receive the organ, if necessary. Our intention is to help patients who are often here as their last hope and to ensure that no precious organs are wasted.”
Upon learning that UNOS disapproved of the practice, Dr. D’Cunha said, UPMC immediately halted it. “We have been fully compliant since that time and transparent during this entire process.”
The nation has 58 procurement organizations, which connect donated organs with transplant centers and recipients. Ms. Zellner said she didn’t know which organ procurement organizations authorized the allocation of organs to “backup patients,” but said the O’Hara-based Center for Organ Recovery and Education was not among them.
Ms. Zellner said she did not know whether UPMC’s other transplant programs ever allocated organs to backup patients.
Nationwide, 1,587 people are waiting for lung transplants, and 44 are waiting for a heart-lung combination. UPMC performed 86 lung transplants last year and 100 in 2013, according to UNOS data.
This is the second time UPMC has been placed on probation for a transplant problem.
In 2011, it was placed on probation, UNOS said, after disease was transferred from a living kidney donor to a recipient. That probation is over.
In all, UNOS said, eight transplant centers nationwide have been placed on probation since 2006. Probation can be lifted once centers demonstrate to UNOS that they have made necessary changes or improvements.
Joe Smydo: jsmdyo@post-gazette.com or 412-263-1548.
First Published: June 3, 2015, 4:00 a.m.
