Thousands of patients are denied potentially lifesaving transplants while donated organs are being thrown away. Why? Harvard law Professor Glenn Cohen ( @CohenProf ), UMass Transplant Surgeon Dr. Adel Bozorgzadeh , and UMass Medical MD/PhD candidate Natasha Dolgin discuss.
A study out of UMass Memorial Medical Center revealed that a growing number of usable organs are never transplanted. In 2007 the Centers for Medicare & Medicaid Services instituted a policy for conditional participation. Bozorgzadeh says, "This regulation was intended to standardize the quality of care across the board for all transplant centers and benchmark the outcome." Instead, it caused transplant centers to focus on the success of patient outcomes to secure federal funding.
Dolgin explained that the study didn't focus on organs, but on patients. She said patients go through a screening process to ensure they will be able to tolerate a surgery, and "once it's concluded that [patients] would benefit, they're added to the waiting list." The study showed that after the policy went into place, the rate of people being removed for being too sick to transplant rose rapidly.
Cohen says, "This is a trend in a lot of these kind of consumerist attempts to measure things, that you end up seeing gaming by the centers." It becomes complicated when the distribution rules change for different organs. Urgency of sickness and best outcomes are both factors in determining who gets moved off the waiting list. "One of the issues that comes up if you are a doctor is how you communicate what the risks really are to a patient," explains Cohen .
"The importance of this study is to refocus and shine light on this very important subject," says Bozorgzadeh . The study showed that many transplant centers would rather not risk failure. Dolgin added, "Quality initiatives are supposed to be a positive thing... it's about having a balance and having an informed quality policy." The study showed that the policy only looked at post-operative outcomes, it didn't consider the wait list outcomes. Dolgin says, "In other cases, there's a lot of CMS policies beyond the transplant world where it's really pushing practitioners to practice in a certain direction. Consciously or not."
When they passed this regulation, it was intended to improve quality. Cohen says, "It had a good intention, but it's had this perverse outcome. If they don't change it, knowing the perverse outcome, that's when I really lay the blame."
