WASHINGTON -- People needing an organ transplant have new tool at their disposal -- a 1,400-page evaluation of transplant success rates at 252 U.S. hospitals.
The ratings were mixed for two Baltimore hospitals that perform organ transplants -- Johns Hopkins Hospital and the University of Maryland Medical Center.
The report, mandated by Congress in a 1990 law, is the first comprehensive breakdown of transplant-program success rates.
"To me, back in 1983, this would have been a godsend," said Dr. Dennis Rager, a liver-transplant recipient who was involved in compiling the report. Dr. Rager spoke at a media briefing Tuesday by members of the U.S. Department of Health and Human Services and the United Network for Organ Sharing.
But despite the potential uses of the four-volume report, media conference participants warned that the data is incomplete, and many other factors should be considered when choosing a hospital.
The report covers heart, lung, heart-lung, liver, kidney and pancreas operations performed between October 1987 and December 1989.
Nationally, 92.9 percent of people who received a kidney during that time period were alive one year later. Kidneys are by far the most frequently transplanted organ.
After a year, 82.1 percent of heart recipients were alive as were 74.9 percent of liver recipients, 88.7 percent of pancreas recipients, 53.9 percent of lung recipients and 53.3 percent of heart-lung recipients.
Both the University of Maryland and Johns Hopkins hospitals came very close to the national average on success of kidney transplants.
The University of Maryland performed only two heart transplants in the 26-month monitoring period and one of the recipients died within 12 months after surgery.
Dr. Stephen Bartlett, chief of transplants at the University of Maryland, said his hospital's transplant program has been completely rebuilt since the data for the study were collected. The department has expanded from one doctor to two and "our && survival rate has been outstanding," he said. "But it will be a couple of years before that data is released."
At Johns Hopkins, 10 out of 35 heart recipients died within a year -- significantly higher than the national average.
Dr. William Baumgartner, director of the heart transplant program, said Hopkins patients tend to be in more serious
condition than patients in many other hospitals.
If such "risk" is factored in, Hopkins compares favorably with the national average, he said.
When the entire period of Hopkins' heart program is analyzed, from 1983 to the present, the one-year survival rate is about 88 percent, compared with the national figure of 82.1 percent, he said.
The University of Maryland did not perform liver transplants during the monitoring period, although it now does.
For liver patients, Johns Hopkins' 60 percent survival rate after one year was below the national average of 74.9 percent, but the director of liver transplantation said that is because some of the sickest liver patients in the world come to Hopkins.
"The data significantly underestimates the rate of survival presently expected for patients awaiting a liver transplant at Hopkins and does not accurately reflect either the expertise or commitment to excellence found at our institution," said Dr. Andrew Klein in comments accompanying the report.
The numbers have improved in recent years, Dr. Klein said in an interview. Currently the survival rate for liver transplants averages 83 percent and that is for three years after surgery, he said.
The improvement for all types of transplants at Hopkins is partly because of a firmer stance on which patients may receive organs, Dr. Baumgartner said. Patients' conditions often deteriorate while they are waiting for organs and doctors previously were reluctant to tell people they are no longer candidates.
"In the past, in a compassionate way, we sometimes [operated on] those patients, and they don't do that well. But we've learned not to do that in some cases," Dr. Baumgartner said.
TO GET THE REPORT
The complete report is available for $125 and books for individual organs cost about $30. To receive copies, call the National Technical Information Services at (703) 487-4650 or write NTIS at the U.S. Department of Commerce, Port Royal Road, Springfield, Va., 22161.
Phone numbers and addresses of transplant centers and organ procurement offices are available from the United Network for Organ Sharing at (804) 330-8500. For a copy of the report's executive summary and user's guide, call (800) 24-DONOR.