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Organizational structure and processes in pediatric heart transplantation: a survey of practices
Gail Stendahl1, Kathleen Bobay, Stuart Berger
1Children's Hospital of Wisconsin, Milwaukee, WI 53226, USA. gstendahl@chw.org
Insights
Pediatric heart transplant programs show significant practice variations. Larger centers manage more complex patients, but inconsistencies exist in protocols like crossmatches and steroid use, impacting care consistency.
Area of Science:
- Pediatric Cardiology
- Transplant Surgery
- Healthcare Management
Background:
- Pediatric heart transplantation is a complex procedure with evolving practices.
- Significant variability exists among pediatric heart transplant programs, impacting patient care.
- Previous characterization of this variability has been limited.
Purpose of the Study:
- To evaluate the organizational structure and current practices of pediatric heart transplant programs.
- To identify and quantify variations in care protocols across different transplant centers.
- To understand how institutional volume influences practice patterns.
Main Methods:
- Survey of coordinators from 50 pediatric heart transplant institutions (70% response rate).
- Institutions categorized into four groups based on patient volume.
- Analysis of reported practices regarding patient selection, protocols, and program structure.
Main Results:
- Practices varied significantly across centers, with some trends linked to institutional volume.
- Larger centers routinely transplant highly sensitized patients and manage a wider range of recipient acuity.
- Inconsistent use of steroids, varying crossmatch protocols, and diverse prophylaxis strategies were observed.
- Sixty-five percent of centers transition adolescent patients to adult programs.
Conclusions:
- Pediatric heart transplant programs exhibit remarkable variability in routine care strategies.
- Understanding these divergences and uniformities is crucial for developing evidence-based protocols.
- This analysis serves as a foundation for improved cooperation and clarity in pediatric heart transplantation.
Abstract:
Despite emerging literature on pediatric heart transplantation, there continues to be variation in current practices. The degree of variability among heart transplant programs has not been previously characterized. The purpose of this study was to evaluate organizational structure and practices of pediatric heart transplant programs. The UNOS database was queried to identify institutions according to volume. Coordinators from 50 institutions were invited to participate with a 70% response rate. Centers were grouped by volume into four categories. Some institutional practices were dominated by clear volume trends. Ninety-five percent of larger centers routinely transplant patients with known antibody sensitization and report a broader range and acuity of recipients. Ninety-four percent report problems with non-adherence. Sixty-nine percent of centers routinely require prospective crossmatches. There was dramatic variation in the use of steroids across all centers. Sixty-five percent of centers transition adolescents to an adult program. Prophylaxis protocols were also highly inconsistent. This survey provided a comprehensive insight into current practices at pediatric heart transplant programs. The results delineated remarkably variable strategies for routine aspects of care. Analysis of divergence along with uniformity across protocols is a valuable exercise and may serve as a stepping-stone toward ongoing cooperation and clarity for evidence-based practice protocols.
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