Inconsistencies found in transplant records at the UCSD Medical Center have prompted the United National Organ Sharing program to recommend that the hospital be placed on probation.
After examining the medical records of five liver transplant patients, the program’s disciplinary board began to question the practices of the hospital’s transplant ward.
UNOS, a federal regulatory body for transplant programs, audited all California transplant programs in January 2006 in accordance with a standard review process that occurs every three years. The UCSD Medical Center received a chart review audit, during which UNOS discovered several problems including incorrect blood-type documentation for five liver transplant patients. In the five cases, the charts incorrectly indicated that the liver donor and recipient shared the same blood type.
However, according to UCSD Chief Medical Officer Angela Scioscia, the mismatched blood types did not result from a clinical error.
“”While we agree with the finding that the information was not correctly entered in the record, the clinical decision that these patients would receive an organ of any blood type due to the severity of their condition was the correct one,”” Scioscia stated in an internal memo.
The patients were diagnosed with fulminant, or end-stage, liver disease, which requires a liver transplant if the patient were to survive beyond a few hours. At this stage, it is common practice to transplant whatever organ is available regardless of blood type, according to Andrew Aussi, the transplant director at UCSD Medical Center.
The liver transplant patients mentioned in the UNOS review were terminally ill patients who would have died in a few hours if untreated, he said, and the practice of organ transplants in this situation is a “”widely known but less favorable treatment.””
UNOS also found that some data entered by medical center officials did not match patients’ medical records, which could have skewed the representations of transplant candidates’ conditions, since the severity of a patient’s condition dictates his or her prospects for a transplant.
Aussi said that UNOS did not find any specific problems with clinical issues, but did not elaborate on the other issues raised in the review.
“”Most of the issues that were brought up were of clerical issues or resulted from clerical issues,”” he said.
The number of problems found in the program led to probation in July 2006, but the penalty was rescinded after the medical center presented UNOS with a list of changes that it was willing to make. UNOS has now placed the hospital’s transplant program on “”probation in abeyance,”” according to Scioscia’s memo.
The actions carried out by the UNOS review board were “”meant as measures to warn us to strengthen UCSD’s clerical and record-keeping processes,”” said Leslie Franz, UCSD Medical Center’s chief director of health science communications and public affairs.
In addition, the UNOS audit found “”no issues that were outlined that would have negatively impacted patient care,”” Aussi said, which has been the source of much speculation after the findings initially surfaced.
Franz said that the program was “”committed to patient care”” but was also in a constant state of improvement in order to keep up with regulations.
UNOS spokeswoman Annie Moore was unable to comment on individual cases. While the findings would be kept confidential, public disclosure occurs after a member of UNOS is either put on probation – as the center was in July – or is found to “”not be in good standing,”” Moore stated in an e-mail.
For the time being, the medical center’s transplant program will continue to run without additional interference by UNOS, although Aussi said he is not sure if UNOS will reconsider probation.
“”I cannot say that they have completely let go of the idea,”” Aussi said.
However, he said he is confident that the hospital has made the necessary changes to satisfy UNOS policy in the wake of the recent review. He also said that any upcoming review or action by the panel will be based on future performance.
The medical center’s changes include bolstering the numbers of its pre- and post-transplant staff, Aussi said. In order to satisfy UNOS policies, additional coordinators have also been hired to handle data needs that had previously fallen short. Other changes include notifying patients of their wait list status by mail within 10 days regardless of whether the patient was in the hospital or not, as some records had shown that transplant patients were unaware of their status.
UCSD Medical Center will be reviewed again by UNOS early next year.
