Problems Found in Kaiser Permanente Transplant Program

Kaiser Permanente "endangered patients" awaiting kidney transplants by "forcing them into a fledgling program unprepared to handle the caseload," according to a Los Angeles Times investigation.

In 2004, Kaiser told more than 1,500 patients on kidney transplant waiting lists in Northern California that it would no longer pay for treatment at outside hospitals. Adult patients were transferred to a new Kaiser transplant center.

During its first full year of operation in 2005, Kaiser performed 56 transplants, but "twice that many people on the waiting list died," according to the Times' analysis.

The Times found that Kaiser accepted 16.7% of kidney offers through June 2005, compared with 29.5% at California Pacific Medical Centers and 24.1% at University of California-San Francisco Medical Center during the same period. In addition, Kaiser "almost never" accepted organs from a pool of "risky donors," which supplied 15% of kidneys in the San Francisco Bay Area last year, the Times reports.

Kaiser's chief transplant surgeon Arturo Martinez said only one patient had consented to receive an organ from that pool. However, officials at UC-Davis and UCSF said many Kaiser patients had consented to receive organs from the higher-risk pool before they were transferred to the Kaiser facility.

The Times found that Kaiser took "months" to transfer records for "hundreds" of patients at UC-Davis and UCSF that accounted for time already spent on waiting lists.

In the San Francisco area, kidneys usually are distributed based on the amount of time a patient spends on a master waiting list. Kaiser's "delays and paperwork snafus" resulted in patients being placed at the bottom of the list, the Times reports.

According to Stephen Tomlanovich, medical director of the UCSF Medical Center renal transplant program, there are about 220 Kaiser patients on the UCSF list whose wait times have not been properly transferred to Kaiser.

Current and former employees of the program said surgeons and kidney specialists disagreed over who should receive transplants. Ten permanent employees of the program out of a staff of 22 have quit or were fired since the center opened.

Sharon Inokuchi -- the medical director of the transplant center, who has been relieved of her administrative duties -- is the only remaining kidney specialist at the program. Transplant surgeons at other hospitals say programs as large as Kaiser's would need at least four or five specialists to operate properly.

Bruce Blumberg, chief physician at Kaiser's San Francisco Medical Center, said job offers have been extended to two kidney specialists and the program is seeking to hire additional nephrologists.

Blumberg said patient care has not been affected by staff problems. He added that no patients have died after transplants at the center and that surgeons hope to increase the number of transplants performed to 90 this year. About 2,000 patients are on the kidney waiting list, according to Blumberg.

Officials at the United Network for Organ Sharing, the organization that oversees the nation's transplant system, said they were unaware of the problems until the Times contacted them (Ornstein/Weber, Los Angeles Times, 5/3).