Medical Ethics Corner: Conditions of Participation for Transplants

By: Dr. Brent Schillinger, Guest Contributor

Quality control measures developed by the Centers for Medicare and Medicaid Services (CMS) seem to be creating an ethical dilemma for some of the sickest patients and their physicians.  This dilemma appears to be the case amongst liver transplant candidates based on an observation that has been quantitatively measured in a new nationwide study commissioned by the American College of Surgeons (ACS).

In 2007, CMS started a new regulatory policy on liver transplants called Conditions of Participation.  The policy was intended to encourage safe, high quality transplant services in Medicare-participating facilities.   New benchmarks for “quality” were arbitrarily constructed.  If the transplant centers were unable to meet the stipulated conditions there were consequences that followed.  The patient outcomes were specifically used to categorize a facility as a “good” or “bad” performer.   This label of  quality could greatly affect the patient and the referring physician confidence, and thus the quantity of referrals, as well as the size of the Medicare payment for services.  In fact if the rating was below a certain level, a hospital could actually lose Medicare funding altogether. Continue reading