Concerns over the performance of liver transplants at UCLA
According to the LA Times, four Japanese citizens, otherwise barred from entering the United States for criminal activities, received liver transplants at UCLA. There has been no statement as to whether these patients were on a waiting list, and if so, where they placed. Nor has it been revealed what the etiology of the liver disease was - the major consideration in determining the candidacy for the transplant.
One of the patients, reportedly a Yakuza Gang Boss, was helped by the FBI to obtain a US visa in the hope that he would provide the FBI with information in return for arranging the surgery . It is unclear if the FBI assisted in facilitating the surgeries. Additionally a donation of $100,000 was made the patient to the UCLA Medical Center Discretionary Fund.
The surgeries were performed between 2000 and 2004, and in each of those years more than 100 patients died awaiting liver transplants in the Los Angeles area, according to the LA Times.
According to UCLA procedures for liver transplant: “… each patient's case will be presented at a weekly meeting of the UCLA Liver Transplant Consultation Team. This group includes specialists from surgery, adult and pediatric hepatology, cardiology, pulmonary, nephrology, hematology, infectious disease, psychiatry, as well as transplant coordinators and social workers. Thereafter, a determination is be made, to ensure the patient's candidacy for transplant.
Long-term survival is significantly affected by the etiology of liver disease. Without an appropriate assessment of the etiology of liver disease a waiting list becomes meaningless. There are clinically significant differences in the mortality risk ratio which are dependent upon a variety of disease processes as well as the age of the patient
Dr. Ronald Busuttil, the surgeon performing the subject liver transplants, reported in a peer review journal that the etiology of disease is determinative of ranges of the mortality risk ratio from 1.00 for PBC to a mortality risk ratio of 3.50 for malignancy. Patients older than 55 (at least one of the patients was over 60 years of age at the time of surgery) have an increased mortality risk ratio of (RR 1.59) due to age alone.
Questions:
1. Should UCLA be asked to disclose to the news media the listing criteria and etiology of disease of these four patients?
2. Should the UCLA Ethics Committee have been consulted before these surgeries went forward?
3. Should investigations by governmental agencies, be it the FBI or the Department of Home Land Security, be helped by medical centers in allowing informants to be placed at the top of the waiting list for organ transplant?
Bernard W. Freedman, J.D.,M.P.H. is an attorney at law and an active member of the California State Bar since 1976. (State Bar number 70888). He has specialized in medical legal law and acted as consultant in clinical bioethics and...