Liver Transplant Deaths at Thomas Jefferson Raise Questions

At Thomas Jefferson University Hospital in Philadelphia, 8 of 52 liver-transplant patients died in the operating room and a ninth died within hours of surgery between October 2001 and May 2003 -- a death rate of about 17 percent, according to a report in the Philadelphia Inquirer.

Nationally, over the past three years, fewer than 2 percent of liver-transplant patients died during surgery or within the next 24 hours, according to a special analysis performed by the Scientific Registry of Transplant Recipients.

Jefferson officials said two separate multidisciplinary hospital review committees and the Pennsylvania Department of Health closely examined the operating room deaths of liver-transplant patients and did not find any deficiencies in patient care or outcomes.

"We turned each case inside out to see if there is some way that some cases could be changed or improved and we did not see any patterns or issues in these cases," said Dr. Jonathan Gottlieb, the hospital's senior vice president for clinical affairs.

The U.S. Health Resources and Services Administration, which oversees the nation's transplant network, said that Thomas Jefferson's liver program has never been identified as a "low performer" by the United Network for Organ Sharing nor has it been the subject of a complaint, investigation or sanction.

While other surgeons were reluctant to talk about Jefferson's record, the Inquirer said most that it talked to said one or two deaths in a program might be chalked up to bad luck. Five or six deaths in a program that does about 35 transplants yearly could also be coincidence, some said, but would be cause for far more concern.

"I don't think there's going to be a surgeon who's going to tell you that's a normal experience," said Cosme Manzarbeitia, director of the liver-transplant program at Albert Einstein Medical Center, where 101 patients received liver transplants during the past two years. None died during surgery, but two died the following day.

At the four liver-transplant programs in the Philadelphia area excluding Thomas Jefferson, only three of more than 300 patients -- less than one percent -- died during or immediately after surgery in 2001 and 2002, according to available data.

At the Hospital of the University of Pennsylvania, which performed 120 liver transplants in 2002, Dr. Abraham Shaked said there had been no deaths during surgery in the last two years. He said at the University of Pennsylvania, three deaths would trigger an internal investigation, and with a fourth the hospital would bring in outside experts.

Other Sources: Philadelphia Inquirer, SRTR