The organization that oversees the nation's organ transplants frequently fails to find or fix problems at hospitals under its supervision, according to a newspaper investigation published Sunday.
The United Network for Organ Sharing has even failed to act when patients were dying at abnormal rates, and often has kept its findings secret when it does investigate problems, the Los Angeles Times reported.
The federal government contracts with the nonprofit UNOS to oversee the entire transplant process, from the harvesting to the placement of organs. The organization can censure hospitals and recommend their closure.
But UNOS has never recommended closing an active transplant program, and it has been reluctant to take action of any kind against troubled hospitals, the Times concluded after reviewing documents and interviewing current and former board members.
"It seems like UNOS is often a day late and a dollar short," said Dr. Mark Fox, former chairman of UNOS's ethics committee. "Most people are kind of shaking their heads and saying, 'Who's minding the store?'"
The agency's executive director, Walter Graham, acknowledged that the "sense of outrage has grown in the transplant community" and said changes were being made.
UNOS sometimes took years to follow up on reports of excessive deaths, according to the newspaper's investigation.
At Sunrise Medical Center in Las Vegas, UNOS was aware in 2002 that patients were dying at unacceptably high rates but did not investigate for four years.
Problems with two California transplant centers escaped the organization's notice despite warning signs, including statistics available on its own Web site.
One of those was a new kidney program in San Francisco run by Kaiser Permanente in which twice as many patients died waiting for transplants as received them. Those statistics were available in 2005, but UNOS did not begin an investigation until news stories exposed the problems in May, the same month that Kaiser closed the program.
In the other case, the University of California-Irvine shut down its liver program last November following federal reports that more than 30 patients died on its waiting list in 2004 and 2005, even as the hospital turned down organs that might have saved some of them because the university had no full-time liver transplant surgeon.
In response to the criticism, the UNOS board recently voted for reforms, such as publicizing the names of transplant centers on probation. But officials from the organization said resolving matters peacefully works better than issuing demerits.
Since 2000, UNOS has considered its most serious public sanction — revoking a transplant center's "good standing" — 15 times, but has followed through only once.
