Transplant Administrator Often Fails To Address Problems

The United Network for Organ Sharing, which administers the U.S. organ transplant system, "often fails to detect or decisively fix problems at derelict hospitals -- even when patients are dying at excessive rates" -- and "routinely keeps findings of its investigations secret, leaving patients and their families unaware of the potential risks," according to a Los Angeles Times investigation.

For the investigation, the Times reviewed confidential UNOS documents and interviewed dozens of past and present organization board members, transplant physicians, patients and others. According to the Times, UNOS has never recommended that the federal government close an active transplant program and in some cases takes years to take action against programs that have high mortality rates.

In addition, UNOS "often backs down after being challenged -- or even defied" -- by transplant programs, and organization officials in a number of cases have "missed obvious red flags," the Times reports. The UNOS board within the past year has voted to publicize the names of transplant programs on probation and accelerate some investigations, but organization officials maintain that "resolving matters amicably serves patients better in the long run than issuing black marks," according to the Times.

However, some critics maintain that such "collegiality" is a problem because the UNOS "isn't just a regulator; it is a membership organization, run mostly by transplant professionals," the Times reports.

Judith Braslow, who administered the federal division of transplantation from 1990 to 1998, said, "In their capacity as the government contractor, they have responsibility to keep the public informed. In their capacity as a membership organization, they have responsibility and loyalty to their members. Those two roles are really in conflict in terms of the policy function."

Michael Acker, head of cardiac transplantation at the Hospital of the University of Pennsylvania, said, "If there's a sense that one place isn't playing by the rules, and you play by the rules, then your poor patients aren't going to get a fair shake."

However, Gabriel Danovitch, an UNOS board member and medical director of the kidney and pancreas transplant program at UCLA Medical Center, said, "UNOS is not the FBI. It's not a police force."

UNOS President Sue McDiarmid added, "If you come down too fast and hurriedly and potentially wrongly, you can do a good deal of harm to patients on the waiting list" (Ornstein/Weber, Los Angeles Times, 10/22).