Jefferson suspends heart transplant program

Posted: February 21, 2016

Jefferson Health announced Friday that it was taking the unusual step of voluntarily suspending heart transplant procedures for six to nine months while it begins a "significant redesign" of the program.

"Every facet of healthcare delivery in our country is changing, and transplant care is no exception," Anne Docimo, chief medical officer of Jefferson Health, said in a statement.

Asked why expansion would require a suspension, spokeswoman Jacqueline Kozloski said, "we are taking a timeout."

Philadelphia is a major center for organ transplants, with adult heart programs at Temple, Hahnemann (the smallest), and the Hospital of the University of Pennsylvania (the largest). Children's Hospital of Philadelphia also does heart transplants.

Transplant programs occasionally suspend operations temporarily due to the loss of surgeons, as Hahnemann University Hospital did three years ago; because it lacks enough patients to meet federal volume standards, as Temple did in 2011; and while investigating an unexpected rise in death rates, as the University of Pittsburgh did. Kozloski said none of those situations applies to Jefferson.

"I've never heard of a program being suspended for expansion," said a surprised Jim Gleason, a member of the board of the United Network for Organ Sharing (UNOS), the organization that oversees transplants nationally.

Gleason, who lives in Burlington County and had a heart transplant in 1994 at the Hospital of the University of Pennsylvania, said hospitals can keep programs going while rebuilding their facilities. Jefferson's announcement, he said, "doesn't make any sense to me."

Jefferson said it has done 137 heart transplants since 2004. Its first transplant of any organ - a kidney - was in 1974, and its surgeons now do more than 100 heart, kidney, liver, and pancreas transplants a year.

Heart transplants are a small part of that, however - an average of just under 12 per year between 2009 and 2014, according to UNOS. Jefferson did 14 transplants last year through November.

Guidelines from the Centers for Medicare and Medicaid Services say organ transplant centers should do at least 10 transplants a year of each type to be considered a high-volume program. Jefferson's heart program missed that goal in 2014 (nine) and 2012 (six).

In its announcement, the hospital did not state a goal for the number of transplants it hopes to do once the program reopens.

Jefferson's heart transplant program had one death a year between 2009 and 2014, on average, according to billing records from the Pennsylvania Health Care Cost Containment Council (PHC4). Patient survival at Jefferson was considered to be "as expected" between July 2012 and December 2014, according to the Scientific Registry of Transplant Recipients, which rates programs around the country during 30-month periods.

In its statement, Jefferson said that its "voluntary and temporary deactivation of the program will provide the time necessary for Jefferson to recruit additional surgeons and cardiologists, expand clinical support teams and evaluate physical plant and operational needs."

Pressed for more information, Kozloski reiterated in an email that "this decision is entirely Jefferson's," and wrote that "we're taking this pause to completely rethink the full spectrum of advanced heart failure treatment. Transplant is certainly a critical component of that spectrum, but it is just one therapeutic option. As part of this effort, we are looking to build a network of like-minded partners throughout the region; that cannot be achieved overnight, and it's simply too early in the process to know the exact shape and form the program will take in the future."

Rohinton J. Morris was appointed in September as chief of cardiothoracic surgery overseeing operations at both Thomas Jefferson University Hospital, where the transplant program is located, and Abington Hospital, where he had directed cardiothoracic surgery since 2010. Abington recently merged with Jefferson.

"No patient will lose their accumulated time on the wait list," Morris was quoted as saying in the statement. "Great efforts are being taken to ensure all Jefferson transplant recipients receive the ongoing care they require while our program is temporarily offline."

Jefferson said it is working to make sure that patients on its transplant list transition to other programs in the area.

That should not be a problem, said Howard Nathan, president and CEO of the region's Gift of Life Donor Program, the nation's largest. "Hearts are given away according to patient priority, not center priority," he said.

Between 75 and 100 transplants a year are performed by all five programs in the city. There are 123 people on the heart waiting list in the Gift of Life region, which includes Pennsylvania east of State College, South Jersey, and Delaware.

Experts say it is important to have a good volume of patients because transplants require highly complex, coordinated care, and having too few patients or surgeons can trigger a closure.

Hahnemann University Hospital voluntarily inactivated its heart transplant program in June 2013 due to a lack of backup surgical care. John Entwistle 3rd, who had been surgical director at Hahnemann, left to became surgical director of Jefferson's heart transplant program in late 2012.

Temple University Hospital voluntarily deactivated its heart transplant program in July 2011 because of low surgical volume. Both Temple and Hahnemann later restarted their programs.

Staff writers Tom Avril and Dylan Purcell contributed to this article.

215-854-2617 @DonSapatkin

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