Complaints, pressure from organ clearinghouse led Jackson to halt adult heart transplants

Top officials at the Miami Transplant Institute said this week they halted nearly all adult heart transplants at the urging of the U.S. organ transplant network, which has opened an investigation into its heart operations. Anonymous internal complaints about the heart program had also arisen.

In a letter to the Miami Transplant Institute, run by Jackson Health System, the United Network for Organ Sharing (UNOS) pushed for the pause until a peer-review team could review the unit’s operation.

UNOS, established in the mid-1980s, oversees the entire U.S. transplant system.

A few days after receiving that letter, Luke Preczewski, vice president of the Miami Transplant Institute, announced the program’s suspension in a staff Zoom meeting. He said in the meeting that the shutdown would not be publicly announced. The Herald learned of it independently.

The following day, March 21, in a statement to the Herald, Jackson said it “voluntarily placed its adult heart transplant program on temporary inactive status” while it undergoes “an in-depth review of our care.” The statement did not mention the behind-the-scenes pressure from UNOS.

That pressure was revealed to Herald journalists on Tuesday during an interview with Miami Transplant Institute physicians as well as Jackson administrators.

Under Florida’s public records laws, the Herald has requested the UNOS letter from the publicly operated Jackson, which thus far has not provided the letter while not yet citing an exemption from public records laws.

Anonymous complaints

In the wide-ranging interview with the Herald on Tuesday, doctors and administrators at the Miami Transplant Institute said they had been receiving anonymous complaints about the adult heart transplant program and wanted to put together a stronger team to operate it. They did not disclose details about those complaints.

Transplant programs are judged on a variety of metrics, which can range from survival rates to length of time spent on waiting lists. Administrators provided survival rates for various programs at the Tuesday meeting.

As of January 2023, Jackson’s patients had to wait three times the U.S. average for a heart transplant, according to the Scientific Registry of Transplant Recipients, which collects data on all U.S. transplant centers. How quickly a heart can be delivered is a major factor in survival of the transplant patient.

Jackson officials acknowledged that the adult heart transplant program has not been performing as well as the kidney, liver and other organ transplant programs at Jackson and that they plan to make major personnel changes — a process that began six months ago with a decision to search for a new leader of the heart transplant division.

“We have to find out why there is a discrepancy between every other transplant program and heart,” said Dr. Rodrigo Vianna, director of the Miami Transplant Institute and the chief of Liver, Intestinal and Multivisceral Transplants. “Obviously, people have different opinions why this happens. So, I think it was a good time to say ‘you know what, let’s fix that.’ ”

Dr. Chris Ghaemmaghami, executive vice president at Jackson Health, said there has been “some internal concern” about the adult heart transplant program.

“We’re hearing some feedback internally about concerns about the way things are being operated and being run as a complex team,” said Ghaemmaghami, who is also the chief physician executive and chief clinical officer at Jackson. “How do we address that before safety issues become significant?”

The shutdown was referred to as a partial shutdown at the Tuesday briefing. Two currently hospitalized patients with an urgent need for a new heart will still receive transplants at the institute if a compatible organ can be found, Vianna said.

Others on the adult heart transplant waiting list — 15 people — will not be able to get a transplant at the institute while the program is suspended, Jackson said. They could choose to go to another transplant center.

UNOS, the Richmond-based nonprofit that has been running the U.S. organ network since Congress enacted the 1984 National Organ Transplant Act, said it plans to investigate the Miami Transplant Institute’s heart program in an on-site peer review in April. Sources familiar with the complaints said the agency’s concerns dealt with adult heart patient “outcomes.”

Officials at Jackson and the Miami Transplant Institute, which uses doctors from the University of Miami health system, would not provide details of the complaints, but sources said they had received them internally and externally since December. Jackson and institute officials said they immediately began investigating those.

Once the peer review is completed, which Jackson estimates could take six to eight weeks, a decision will be made on when to reopen the program. Vianna and the other Jackson and Miami Transplant officials reiterated Tuesday the program will reopen. The Institute’s pediatric heart transplant and mechanical heart device programs are not impacted.

Replacing chief of heart transplant program

Several months before UNOS alerted Jackson and Miami Transplant officials, they decided to replace the chief of the heart transplant program, Dr. Matthias Loebe, 64, who started with the Institute in 2015. He had come from the Houston Methodist DeBakey Heart & Vascular Center.

On Oct. 13, 2022, the Institute’s director, Vianna, told Loebe in a letter that “you will no longer serve in the role of Chief of Heart Transplant and Ventricular Assist Devices effective February 13, 2023.”

“As discussed, we believe it is in the best interest of the Miami Transplant Institute to search for a new leader for these programs,” Vianna wrote, adding that “your administrative supplement of $150,000 will [be] removed effective February 28, 2023, in accordance with University of Miami policy.”

A senior Jackson spokesman, Matthew Pinzur, characterized the personnel change as a “demotion,” adding that Loebe would remain as chief until his replacement is found and stay on as a surgeon on the heart transplant team. Pinzur said the plan to replace Loebe is part of an effort to rebuild the heart program, but he would not comment on whether it was linked in any way to the peer review.

Contacted by the Herald, Loebe said: “I don’t agree that it is a demotion.”

Rather, Loebe said he began discussing the idea of stepping down as the heart transplant chief last fall in order to maintain “continuity” and lighten his duties after eight years in the demanding position. He said that he is serving on the search committee for his successor.

“The timing of this decision has absolutely nothing to do with the performance review” by UNOS, said Loebe, who added that he’s “totally convinced they will find there is nothing wrong.”

“Our [patient] outcomes are on target,” he said, “and we’re constantly trying to improve them.”

Florida among top heart transplant states

Currently, there are 221 people in Florida on a waiting list for a heart, according to the Organ Procurement & Transplantation Network.

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, both part of Memorial Healthcare System, and Cleveland Clinic Florida in Weston.

Jackson operates one of the largest public hospital transplant centers in the country.

In 2022, the Institute performed 721 organ transplants. Most of those involved kidneys and livers, however. Only 12 were adult heart procedures and five pediatric heart surgeries.

“We have one of the best kidney and one of the best liver programs in the nation. You know, A+. All of our programs should be there. So if we get these kinds of signals on a low-volume program before things start going in the wrong direction, I think it’s really good practice for us to manage this very proactively,” said Ghaemmaghami, Jackson’s chief physician executive.

The Institute has seen a decrease in heart transplants over the past several years, partly due to more patients receiving a mechanical heart pump, known as a ventricular assist device, or VAD. Previously, VADs were used to keep patients alive while they waited for a transplant. Now, some patients are surviving with the devices, Ghaemmaghami said.

And while the heart program’s performance appears to be on par compared to similar programs at other transplant centers, according to records provided at Tuesday’s briefing, hospital leaders said the program needs to do better.

“The dream of a transplant physician is that nobody should die on the waiting list, I think that’s what we want, and for that, there’s a lot we got to do to it,” Vianna said.

Vianna and others say because Jackson Health System is a public hospital, it accepts all patients, including those who are very sick and are considered to be “high risk.” Private hospitals, they said, will turn down patients.

The Miami Transplant Institute’s adult heart transplant program ranks No. 7 out of the state’s 10 adult heart transplant programs in terms of time duration before a transplant occurs, according to the Scientific Registry of Transplant Recipients.

“We as an organization are absolutely committed to offering heart transplants. We are adamant that we want not only to have these programs, but to have them performing at the highest possible level, said Preczewski. “That’s what we do. That’s why we constantly evaluate them. We are absolutely committed to doing what it takes to get there. No question.”