Study Calls for Modification of CMS Conditions of Participation to Preserve Access to Life-Saving Liver Transplantations under Less than Optimal Conditions

SAN FRANCISCO, Nov. 4, 2011 /PRNewswire/ -- Adherence to strict outcome requirements imposed by the Centers for Medicare and Medicaid Services (CMS) has an adverse effect on liver transplantation centers performing life-saving liver transplantations under less than optimal conditions, according to researchers at Northwestern University. According to researcher Edward Wang, PhD, "While quality improvement initiatives aim to enhance post-transplant outcomes, the inadequately risk-adjusted criteria implemented by CMS might act as a disincentive to perform life-saving liver transplantation in high cardiovascular risk patients and limit the use of valuable donor organs of perceived lower quality."

That statement was made as part of a study that was presented on Sunday, November 6, 10:30 am, at the Liver Meeting®, the annual meeting of the American Association for the Study of Liver Diseases. Researchers retrospectively examined the records of 65,601 adult recipients of deceased-donor liver transplantations performed between 1995 and 2010.

Examination of these records, which were part of the database of the Organ Procurement and Transplant Network (OPTN) of the United Network of Organ Sharing (UNOS), revealed that access to liver transplantation for high-risk patients suffers under the CMS Conditions of Participation (CoP). Specifically, researchers looked at trends in the Donor Risk Index and the recipient Cardiovascular Risk Index before and after implementation of the CoP. What they found was that 71 percent of transplant centers experienced a decline in either or both of the risk indices.

According to Dr. Wang, "Our findings suggest that regulatory oversight by the CMS on liver transplantation programs has led to the unintended consequence of risk-averse behavior by transplant centers. As a result, transplant centers under strict oversight might be reluctant to perform life-saving liver transplantation in high cardiovascular risk patients and/or to accept suboptimal donor organs.  Modification of risk adjustment, which is integral to performance measurement, is necessary to preserve access to liver transplantation among high risk recipients and sustain the optimal use of marginal donors."

The conclusion reached is that risk adjustment must be modified to preserve access to liver transplantation by high cardiovascular risk recipients and the use of marginal donor organs. "We believe that there is a need for mitigating factors that could justify inferior outcomes by transplant centers under specific circumstances. Failure to reach consensus on such a mechanism would result in continued risk-averse behavior by transplant centers undermining innovation and hampering advancement of the field of transplantation and ultimately compromising patient care," said Dr. Wang.

Abstract title:

Donor and Recipient Risk Aversion in Liver Transplantation

AASLD is the leading medical organization for advancing the science and practice of hepatology. Founded by physicians in 1950, AASLD's vision is to prevent and cure liver diseases. This year's Liver Meeting®, held in San Francisco, California, November 4 – 8, will bring together more than 8,000 researchers from 55 countries.

A press room will be available from November 5 at the annual meeting. For copies of abstracts and press releases, or to arrange researcher interviews, contact Gregory Bologna at 703-299-9766.

Press releases and all abstracts are available online at www.aasld.org.

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SOURCE American Association for the Study of Liver Diseases (AASLD)