Friday, October 13, 2006

More on Transplants

See my posting below on the waste involved in having more transplant programs in New England that are necessary. Now see this article on the creation of yet another liver program, this one at Dartmouth Hitchcock Medical Center. The article notes: "When DHMC first begins performing liver transplants, only private-payer insurance carriers will be covered for the procedure, Berk said. The hope, however, is that publicly funded insurance programs will approve it shortly thereafter and begin referring patients. "

I have nothing against DHMC or the very fine doctors there, but why should society support this program when there is already surplus liver transplant capacity in New England? Another quote: "Of the 4 million people in (New Hampshire, Vermont and Maine), about 40 are succumbing to liver problems every year," Berk said."

The article notes that some potential recipients lack transportation to get to another center in New England. Can this really be true? It is not that far, and people travel throughout the region all the time. If transportation costs are the issue, let's raise money to pay for it rather than hundreds of thousands of dollars for a new liver transplant program that will not do enough procedures to justify its existence.


Anonymous said...

Amen! Dr. Berk seems to be rationalizing his desire to perform transplants near home. But who would want to have a transplant in an institution that performs very few of these each year?

Your comment on the distance was so right. Has Dr. Berk never heard of Angel Flight or other organizations that devote themselves to helping such patients? It seems a flimsy argument to me.

Note the comment in the article by Kristen Senz, third paragraph from the bottom, which states that "'Liver transplant, whether from a living or nearly dead patient, has a high success rate, Berk said.'" One would hope that this is a typo, but if not, how macabre and frightening to lay people to think that a "nearly dead" patient's organs would be taken for transplant! No wonder it's so difficult to get donations!

Anonymous said...

Not all of the physicians at DHMC share such enthusiasm for this endeavor. Indeed, it seems that not only are the biggest champions of the liver transplant program those who least comprehend its impact upon scarce resource allocation (in a small tertiary care hospital functioning near capacity), but our financial leadership remains oblivious to the huge development costs of such a competetive and risky venture.
We do have many fine doctors here...but we cannot do all things for all patients, especially if infrequently. No one has yet addressed the issues of volume, quality or transparency.

Anonymous said...

DHMC employee

If only the leadership at DHMC would walk down the street and speak with their colleagues at the Center for Evaluative Clinical Sciences they would come quickly to the conclusion that building another transplant program in New England is a severely wasteful activity. But unfortunately like some things at DHMC, the liver transplant program is the idea of a highly motivated surgeon. It is not a program with a viable business plan but one that has "serve our community" as the primary reasoning.

I thought DHMC was a bastion of evidence based medicine. Perhaps the leadership might consider practicing evidence based management on this topic.

Labor Nurse, CNM said...

Hmmm... maybe this is why the Darmouth health system is dumping a lot of its midwives.... the money saved there can help support this program! I say this tongue in cheek, of course, but I have to say this decision makes as much sense as the midwife decision.