Why lung transplant patients rejected by other hospitals seek UPMC

Mallory Smith's journey to receive a needed double lung transplant was all but smooth.

The 25-year-old Los Angeles native, who has cystic fibrosis, was reportedly turned down by various healthcare organizations nationwide, including nearby UCLA and Stanford (Calif.) Health Care. Both UCLA and Stanford Health Care say they don't comment on individual cases due to patient privacy. But CBS Pittsburgh attributed the reasoning behind hospitals' rejections to a rare bacteria in Ms. Smith's lungs.

Eventually, Ms. Smith was accepted for a transplant by UPMC in Pittsburgh. UPMC spokesperson Lawerence Synett says the hospital knew Ms. Smith, an Anthem member, would be out-of-network for the transplant. This could have potentially prevented Ms. Smith's transplant due to financial reasons. Fortunately, though, Pittsburgh-based Highmark was able to negotiate a single case agreement with UPMC, and Ms.Smith's surgery took place Sept. 11.

Program roots

Ms. Smith is among many patients to receive a lung transplant at UPMC. UPMC's lung transplant program was established in the 1980s and is one of the oldest programs of its kind in the nation. Overall, UPMC has performed more than 2,000 lung transplants since the program's establishment, with a high volume of lung transplants over the last decade.

Currently, more than 30 percent of the hospital's lung transplant patients are turned down by other hospitals nationwide first.


Patients with advanced stage lung disease, such as cystic fibrosis, emphysema or pulmonary fibrosis, seeking a transplant typically initiate a referral to a location close in proximity, according to Jonathan D'Cunha, MD, PhD, chief of lung transplantation at UPMC.

But he says there may be an aspect of their care a local hospital is not comfortable managing, and patients are then referred to locations such as UPMC.

For instance, other hospitals may not be able to manage patients with scleroderma, a condition that involves problems moving food through the esophagus. Dr. D'Cunha says there may also be problems with donor-recipient matching due to antigens in the patient's blood, or there may be anatomical challenges with the patient, which a particular hospital isn't prepared to deal with.

"So then they refer those patients to us because of our expertise of managing patients who have a riskier profile when it comes to their lung disease and getting a transplant done successfully," he explains.

From May 2005 — when the Lung Allocation Score system began — through December 2016, UPMC said it had nearly 400 patients considered the "sickest of the sick." According to data, 92 out of 100 UPMC lung transplant patients were alive 90 days after the surgery, and 80 were alive one year after transplant. Forty-five were alive five years after the transplant. Overall outcomes are above national data, Dr. D'Cunha says.

He attributed UPMC's good outcomes to a thorough system that identifies complications after surgery quickly and involves experts in the field.


Once a referral comes to UPMC, the patient arrives at the hospital and undergoes a week-long evaluation process, which involves the patient undergoing various tests and meeting everyone in UPMC's lung transplant program, including Dr. D'Cunha, a medical pulmonologist, dieticians and social services.

"We put together a picture of their candidacy related to all aspects of their medical care, not just lung disease," Dr. D'Cunha says. "The next week we meet as a group ... to determine if they're really a candidate for a transplant."

If the person is an acceptable candidate for UPMC's program, they go through final phases of authorization with an insurance company, which then goes on to approval for listing for transplantation.

"We are so thorough in the way we evaluate patients because donor lungs are so scarce that we really take our time and make sure that we have all our ducks in a row before we list the patient," says Dr. D'Cunha. "That includes having a primary caregiver to help the patient out after they get their transplant, backup caregivers, transportation … these things are in place such that there really are minimal surprises when they get their lungs."

UPMC lung transplant patients typically stay in the Pittsburgh area for about three months after their surgery so UPMC can closely monitor the patient's care.

While UPMC performs many lung transplants and monitors these patients afterward, other hospitals still play a large role, Dr. D’Cunha notes. He says they take care of patients they are able to treat and make every effort to help those with special circumstances until they need a referral to somewhere like UPMC.

"We view them as very important because they also take care of [patients referred to UPMC and those who don't get referred to UPMC], and they do a great job at it. We do this because if we don't help these patients who can't go to one of the other centers, who else will? That's our role, and we take great pride at looking at everything we do on a daily basis and making sure we're doing the best we can for all the patients in our program."


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