Jackson has not said why it suspended adult heart transplants. Here’s some insight

While Jackson Health System has not said why it abruptly suspended its adult heart transplant program on Monday, staffing issues, concerns about patient outcomes and substantially changing how it operates could all be factors, according to a transplant expert and the bylaws of the group that operates the U.S. transplant system.

“That’s a hard decision, if you really think about it, to say, ‘I’m gonna voluntarily slow this down,’ that shows their commitment to patient care,” said Dr. Parag Patel, division chair of the Advanced Heart Failure & Cardiac Transplant at Mayo Clinic in Jacksonville, one of three heart transplant programs that Mayo operates nationwide, including in Arizona and Minnesota.

On Tuesday evening, Jackson Health confirmed to the Herald in an email it had “voluntarily placed its adult heart transplant program on temporary inactive status” while it undergoes “an in-depth review of our care.”

Jackson Health and UHealth, the University of Miami health system, jointly operate the Miami Transplant Institute, which opened in 1970 and is considered one of the top transplant centers in the country.

Jackson did not specify when the institute would reopen; it said it was working to transfer patients to other transplant centers. Jackson has not commented beyond its statement to the Herald, and the University of Miami declined to comment.

Patel, speaking in general about transplant centers, said a voluntary closure of a transplant program could be because they don’t have enough key staff to perform transplants or manage the patients. The hospital could have also noticed “suboptimal quality,” in its patient care, whether it was in survival rates (before or after a transplant) or complications from the transplants, he said.

In this situation, he added, the hospital might choose to voluntarily halt transplants and undergo an internal review to optimize patient care. Jackson said it will conduct an “in-depth review.”

“At the end of the day, while it’s a hard decision, and it’s making very difficult challenges for their currently transplanted patients, what they’re doing — they’re saying ‘Hey, we see a slight issue ... we are going to right set it before we commit to our patients to the care they deserve,” said Patel.

Jackson alluded to patients in its statement.

“We will reinstate the program after a thorough assessment and a clear plan to recruit additional world-class clinicians in the same way we have built globally admired transplant programs for other organs,” Jackson said. “Our pediatric heart transplant program is not affected by this decision, nor is our program to provide mechanical heart devices. The quality of care and personal experience of our patients, families, donors, and clinicians are our guiding principles for this partnership between Jackson Health System and UHealth-University of Miami Health System.”

Jackson/UM partnership

Jackson’s Public Health Trust, which owns the hospital and other medical facilities in Miami-Dade County, holds all the authority under its joint operating agreement with UM’s medical school. UM’s medical school provides more than 90 percent of the physicians working at Jackson Memorial Hospital, which is home to the Miami Transplant Institute.

Jackson’s Public Health Trust pays $71 million to UM’s medical school for its general services, including $21 million for the Miami Transplant Institute, according to the annual operating agreement.

The Miami Transplant Institute’s executive director, Dr. Rodrigo Vianna, and his staff of nearly 65 UM medical school surgeons operate under the annual contract with the Public Health Trust. The Trust is responsible for all operational and regulatory issues at the Miami Transplant Institute, including the pending federal review of the institute’s heart transplant program.

Florida’s ranking among heart transplants

Florida ranks fourth in the United States with 263 heart transplants in 2022, which includes both children and adults, according to data from the United Network for Organ Sharing, or UNOS. Currently, there are 219 people in Florida on a waiting list for a heart, according to the Organ Procurement & Transplantation Network.

UNOS, a Richmond-based nonprofit that Congress established it 1984, manages the U.S. organ transplant system under an annual contract with the federal government. On Wednesday, however, U.S. health officials announced plans to overhaul the system, as more than 100,000 people in the United States are on waiting lists for organs, primarily kidneys.

UNOS bylaws stipulate why a transplant center might voluntarily request to have one of its programs go into short or long-term inactivity. This includes, but is not limited to:

Inability to meet functional activity requirements.

Inability to serve potential candidates, candidates, recipients, potential living donors, or living donors for a period of 15 or more consecutive days.

Temporarily lacking required physician or surgeon coverage.

A substantial change in operations that requires an interruption in transplantation.

What happens to the patients on the wait list?

Jackson, in its statement, said the Miami Transplant Institute is working to transfer its existing adult heart transplant patients to other hospitals.

In 2022, the Institute performed 17 heart transplants, 12 of which were in adults, according to data from the Organ Procurement & Transplantation Network. The institute has done 785 heart transplants in adults and children from 1988, when the network first began tracking transplants, through Feb. 28, 2023. Of those, 697 were in adults.

As for the patient’s place in line on the organ wait list, it usually doesn’t get affected in situations like this, Patel said. The amount of time a patient accrued on the wait list will generally transfer over to the new center.

Ten Florida hospitals operate transplant programs for various organs. In South Florida, transplants are performed at Memorial Regional of Hollywood, Joe DiMaggio Children’s Hospital, part of Memorial Healthcare System, and Cleveland Clinic Florida in Weston. In an email to the Herald Thursday evening, Memorial Healthcare System said it “has reached out to our counterparts at Jackson Health System and we are here to help them in any way possible, one safety net hospital to another.”

What are next steps for Jackson/UM transplant program?

Luke Preczewski, vice president of the Miami Transplant Institute, announced the adult heart transplant program’s temporary suspension in a staff Zoom meeting Monday. In the meeting, he said there would be no public announcement. The Herald learned of the suspension independently, prompting Jackson to acknowledge the suspension.

UNOS will conduct a peer-review visit in early April.

According to UNOS bylaws, a peer visit is considered to be an “objective, on-site evaluation” by experienced transplant professionals. A peer visit panel will “review records, interview staff and tour the facilities as desired,” and will then prepare a report for the MPSC, the Membership and Professional Standards Committee, which is in charge of reviewing, evaluating and monitoring members for compliance and reviewing reported violations.

The committee, working with Jackson, will then determine the next steps, including whether to reactivate the Miami Transplant Institute’s adult heart transplant program.

Miami Herald staff writers Nicholas Nehamas and Jay Weaver contributed to this report.