Tuesday, March 19, 2013

Should This Kidney Txp Program Close?

Closure of the Miami Valley Hospital Kidney Transplant Program in Dayton, Ohio will alter the face of transplantation in the region - but will it be for the better or not? Whose opinion matters? This is a 43 year old program that has performed more than 900 kidney transplants according to the  Dayton Daily News , and patients have received deceased donor transplants faster there than at surrounding programs, or in the rest of the country. see program specific data reports To insiders, this may reflect better access to good quality organs, in which case the local patients would be disadvantaged with closure of the program. Or, it may mean that transplant surgeons were more aggressive in the types of organs they were willing to use for transplantation. If those organs worked well, the decisions were terrific. If not, then maybe not such good decision making. However, good outcomes also require good follow-up patient care, which takes a transplant "village". And this may not have been readily available at a fairly small center.

Administration officials indicated that finances are driving the decision to close the program, a very plausible explanation since hospitals generate much more income from liver transplantation - not in this institution's repertoire dayton daily news 3/19/13 . That is undoubtedly part, not all of the story. Local patients will now have to seek care at more remote transplant centers but will undoubtedly return to their own providers for follow-up. This is the trend in modern transplantation. Transplant at one center with the majority of subsequent care delivered elsewhere. It may be supervised to a greater or lesser degree by phone by coordinators from the primary transplant center. But a not so well known truth is that many patients will never return back to that transplant center, opting instead to receive what proves to be essentially the same quality follow-up care that may have been responsible at least in part for the closure of their own local center.

Which patients are least likely to return for follow-up at the primary center? The least healthcare literate, oldest and least affluent of course. So, closure of a small, local center favors the typical patients in subtle ways that also contribute to their better outcomes with transplantation. Go figure.

1 comment:

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