Transplant Chief's New York Hospital Fined

By Christopher Snowbeck

Pittsburgh Post-Gazette

April 24, 2004

The New York Health Department issued a $20,000 fine yesterday to a Rochester, N.Y., hospital for problems in its liver transplant unit, some of which occurred during the tenure of the current transplant chief at the University of Pittsburgh Medical Center.

Investigators found quality problems with the care of eight out of 29 liver transplant patients who received care at Strong Memorial Hospital between 2000 and 2003, said Rob Kenny, spokesman for the New York Health Department.

Dr. Amadeo Marcos became clinical director of transplantation at UPMC in August 2002 after serving two years as director of the solid organ transplant program at the University of Rochester. The University of Rochester owns Strong Memorial.

Neither Marcos nor any UPMC official would comment yesterday about the investigation and a spokeswoman at Strong refused to say whether Marcos was involved with any of the cases highlighted in the investigation.

One of the liver transplants cited by New York investigators was performed during 2001. Also, they found several problems with the hospital's use of livers from "expanded-criteria donors."

At UPMC, Marcos' use of these organs -- which typically come from older donors or donors with health problems that might have disqualified them in the past -- enabled the hospital in 2002 to reverse a 12-year decline in the volume of liver transplants here.

The practice has proven controversial.

A dispute between the VA Pittsburgh Healthcare System and UPMC about allocating organs from these donors last year culminated in the VA severing its ties to the UPMC program. The rift continued last week, when officials from the VA and Allegheny General Hospital wrote federal officials to protest a UPMC plan to create an independent call center to handle calls from organ procurement agencies outside of the region.

In a press release, the Rochester hospital said the surgeon who replaced Marcos had "improved significantly" the quality assurance processes of its transplant program.

Kenny, the Health Department spokesman, did not know the name of the surgeons at Strong Memorial involved in the cases cited by the department's investigators. He said the department received an anonymous complaint about the liver transplant unit at Strong Memorial in October 2003.

Among other things, the six-month investigation found that a 2001 transplant patient received a liver with an incompatible blood type and subsequently required two additional transplant procedures after suffering serious post-operative complications.

A liver transplant between people with incompatible blood types is not prohibited by liver allocation policies, according to a spokeswoman with the United Network for Organ Sharing. But New York officials made it a point to say there was no documented evidence that the recipient's condition was life-threatening, which might have justified the use of the incompatible liver.

Another patient underwent a second liver transplant procedure after experiencing complications following a transplant involving an extended-criteria liver. In that case, the hospital failed to document the rationale justifying the initial high-risk procedure on the patient, who hadn't been in any immediate danger of dying without a transplant, investigators said.

Other problems ranged from failing to document that patients were fully informed about receiving extended-criteria livers to a lack of written policies and procedures.

Because of the findings, Dr. Antonia C. Novello, the Health Department commissioner, said she would create a liver transplant workgroup to study issues related to the use of extended-criteria livers.

United Network for Organ Sharing officials said they were aware of the New York investigation, but would have no specific comment. The agency said in a statement, however, that it had "recently finalized reviews of every liver transplant program in the country and dealt with every violation thoroughly and expeditiously in order to ensure patient safety and trust in the transplant network."

(Christopher Snowbeck can be reached at csnowbeck@post-gazette.com or 412 263-2625.)

Copyright © 1997-2004 PG Publishing.

This article posted May 9, 2004.