Organs Refused While Patients Die
Over the last two years, more than 30 people died awaiting liver transplants at UCI Medical Center in Orange as the hospital turned down scores of organs that might have saved them, according to a federal report.
More than 100 UCI patients still are waiting for transplants, and 28 have joined the roster this year alone -- despite a staffing shortage that dampens their prospects for a transplant.
Although patients may not know it, the UC Irvine medical center has not had a full-time liver transplant surgeon since July 2004.
The center has performed just five liver transplants this year and has consistently fallen below the minimum number required by the federal government to maintain funding, according to the report from the U.S. Centers for Medicare and Medicaid Services.
The low number of surgeries was not for lack of offers. Between August 2004 and July 2005, the hospital received 122 liver offers, most of them from the regional organ procurement agency, which coordinates donations and offers in Southern California. But only 12 were transplanted, including two that went to the same patient because the first one failed, according to the Aug. 5 federal report, obtained by The Times under the Freedom of Information Act.
Even when patients did get transplants, the report says, they did not fare as well as they should have. Only 68.6% of patients who received liver transplants at UCI from January 2002 to June 2004 survived at least a year -- well below the 77% survival rate required for federal certification.
Research has shown that surgical success rates at hospitals are linked to the number of procedures performed.
The report suggests that UCI’s problems existed for years. The review was prompted by a complaint from a former UCI patient who had languished on the list from 1998 to 2002. The woman, who ultimately received a transplant at another hospital, discovered only through a lawsuit that UCI had turned down more than 90 organs offered for her.
In refusing organs over the last year, the center often cited their poor quality.
But most of the livers turned down by UCI this year were subsequently accepted by other hospitals and transplanted into their patients, said Thomas Mone, chief executive officer of OneLegacy, the organ procurement group in Southern California.
On its website, the UCI program projects professionalism and stability.
The site includes a brief biography of its chief of transplantation, Dr. Marquis Hart. It makes no mention that Hart spends most of his time as a transplant surgeon at UC San Diego. UCI’s other liver transplant surgeon, Dr. Ajai Khanna, also is on staff at UC San Diego, 90 miles away. Federal standards require that a surgeon be constantly available.
When federal inspectors visited UCI on July 19 and 20, a liver transplant surgeon “was nowhere in the immediate vicinity of the hospital,” according to the report.
On the 19th, staff at the hospital told inspectors, the on-call surgeon was operating on patients all day at another hospital -- apparently UC San Diego. The following day, the same “covering” physician was out of state and unavailable.
All the while, one of the hospital’s patients was “on the highest priority list for transplantation should a liver be available,” the report says.
A UCI official on Wednesday did not address the specific allegations in the federal report, saying only that the medical center was making improvements to its liver program. Dr. David Imagawa, who since July has overseen the liver transplant program, said the hospital had recruited a full-time transplant surgeon who would start early next year. Until then, part-timers will continue providing coverage.
“We agree that there were some problems, and we’re moving forward to change them,” said Imagawa, who founded UCI’s liver transplant program in 1994, left in 2002 and only recently returned.
The medical center has been shaken by two other major healthcare scandals in recent years.
In an internationally publicized case, fertility doctors in the mid-1990s stole the eggs of patients, implanting them in infertile women who in some instances gave birth. The university paid out nearly $20 million to settle legal claims.
And in 1999, UC Irvine fired Christopher Brown, the director of its donated cadaver program, amid suspicion that he had improperly sold spines to an Arizona research program. The buyers paid $5,000 to a company owned by a business associate of Brown. Brown was not prosecuted.
In the case of the liver program, patients apparently had no idea that UCI was passing up livers on their behalf.
When a potential donor is near death, the regional organ procurement agency looks for the sickest patient at the hospitals within its region and moves down the list until a hospital accepts the organ. Patients generally are told only of the offers that are accepted.
Elodie Irvine, 51, whose case gave rise to the federal inspection, went on the waiting list in 1998 with polycystic kidney and liver disease, a condition in which her organs developed large cysts. Her liver eventually swelled to five times its normal size.
In 1999, Imagawa wrote to the national organ oversight agency pleading Irvine’s case.
“We believe that due to the mass of her liver if she is not transplanted ... within the next year, she will become too malnourished to survive this operation.”
She moved up the list. By 2002, UCI had turned down 38 livers and 57 kidneys offered on her behalf, according to a log from the national organ network that she obtained during her subsequent lawsuit against UCI.
The liver offers stopped coming in February 2002, after the hospital failed to submit critical information on Irvine’s condition to the national group overseeing organ transplants, which caused her to drop to the bottom of the list for a transplant.
Doctors “kept saying, ‘You’re on top. You’re on top.’ They led me to believe that there were no offers.... They left me to die.”
Irvine did not die, though. One of her doctors outside UCI encouraged her to transfer to Cedars-Sinai Medical Center, telling her she had a better chance of getting a transplant there. Indeed, within two months of transferring, she received her transplant, in December 2002.
Irvine settled her case earlier this year, a decision she regrets because she believes she received bad legal advice. Her attorney said her settlement was fair.
Federal officials, in their report, faulted UCI’s handling of her case.
Imagawa acknowledged that the hospital had made some errors but said the organs offered on her behalf were of poor quality and “not suitable for someone without life-threatening emergency.”
In a separate case cited by regulators, miscommunication between the liver program and the cardiac unit delayed a patient’s placement on the transplant waiting list for at least eight months this year.
There was no indication that the patient had ever been told about the reason for the delay, the federal report said.
The people who oversee liver transplantation have long known about what was going on at UCI. Mone of OneLegacy said Wednesday that his staff noticed that UCI turned down an increasingly large number of organs after Imagawa stopped performing transplants in late 2001.
Mone said his agency did not have authority to take action against the program and that all he could do was report the numbers to the national overseer of transplantation, the United Network for Organ Sharing.
The network, which controls a massive database of transplant information, renewed its accreditation of UCI’s liver program in December despite the fact that it failed to meet federal requirements in a number of areas.
UC Irvine failed, for instance, to meet the federal requirement of 12 liver transplants in each of the past three years. In 2002-04, only eight transplants were performed each year.
