Hofatma Hospital July 19, 2014

YOU DECIDE
Memorandum for Record:
The purpose of this memorandum is to inform you that the recipient of the heart transplant has been chosen. I will describe to you the process of this decision and evaluation and how the decision was made. Although the time in which to make such a drastic and life changing decision was brief, the decision was made with moral, professional and ethical choices. There were three qualifying candidates who were in need of the transplant: The first is a 55 year old male named Jerry, who is a husband and father of 3 children, aged 14, 16, and 19, a Middle Level Manager at a carpet distributing business and 5 years short of his retirement. His heart is damaged due to the use of steroids in his early 20’s when he was involved with bodybuilding before the dangers of steroid use were fully known. If Jerry gets the heart, his chances of living another 10-15 years are very high. The second is a 12 year old girl named Lisa. She is the only child in the family, and they cannot bear more children. She reads voraciously and yet likes playing with her Barbie Dolls. Lisa has suffered health issues all her life due to various viral infections and a lupus-like immune deficiency. Her heart was damaged during a nasty bout with pneumonia last year and actually stopped for a brief period. Even with a transplant, her chances of surviving into her 20’s are not good. Finally we have a 38 year old male named Ozzy who is homeless and a former crack cocaine abuser. His heart condition is due to continued abuse and overdosing of crack cocaine and without a transplant he will not live out the month. Ozzy has no family and has lived homeless and in shelters for at least 10 years. He was brought to the Hospital through the work of a local charity that assists such men with no assets or insurance....
Organ donation is a valuable and honorable service that a dying person and/or families of the recently deceased can contribute to society. When an organ becomes available, it is very important to find the best suited candidate quickly; this is why there are tissue samples taken and tests run to find the most biologically-suitable match. Sometimes, there are cases when there is more than one person suitable. When these cases arise, the decision-making process becomes more difficult. As the Lead Surgeon Hofatma Hospital, it is my job to decide which candidate is best suited to receive an organ donation. In the case of this donated heart, we have three candidates that meet the biological suitability requirements. While each may have a compelling personal story, there is, unfortunately, only one person that can ultimately receive the heart. My decision has been made based on the following criteria:

A facility must provide not only the transplant team itself, but must provide administrative and operational resources that direct and support the team. We believe it is appropriate to measure a number of factors beyond the qualifications of the transplant team to determine the facility’s overall commitment to a successful transplant program. For example, patient selection policies, patient management protocols, and the facility’s commitment to operational practices, such as quality improvement, all are significant contributors to the success of a transplant program. We do not believe that the experience of an individual or group of individuals is a satisfactory substitute for that institutional commitment. Nor have we found any scientific evidence that supports this position. We continue to believe that the acquisition of an experienced team by another facility should not permit that other facility to claim the first facility’s hard-won success.
In response to the concerns raised by the hospitals employing transplant teams transferring from experienced hospitals, we solicited scientific evidence from the community through our Internet site. Specifically, the questions we raised included the following:
1. Is there scientific evidence or data that support that safety, effectiveness, and medical appropriateness can be determined through evaluation of the experience of the transplant team rather than through evaluation of the facility?
2. Are there any members of the transplant team (transplant physician, transplant surgeon, immunologist, infectious disease specialist, pulmonologist, pathologist, radiologist, nursing, social services, blood banking) who could be replaced by any currently employed license holder in that discipline without affecting significantly the result of the transplant procedure? What evidence is there to support this conclusion?
3. When a transplant team transfers facilities, what assurances are there that the team retains the patient selection and patient management protocols that contributed to the outcomes achieved in the previous facility? What evidence is there to support this conclusion?
4. What evidence is there that a facility that has lost a transplant team will achieve the same or similar outcomes with a replacement team?