Saudi received organ ahead of others in L.A.?

One of the top organ transplant hospitals in California has suspended its liver program following allegations a Saudi national improperly received an organ ahead of dozens of other needy American patients.

The Los Angeles Times reports that officials at St. Vincent Medical Center also discovered that, following the transplant, some hospital staff allegedly falsified records of the operation on numerous occasions, ostensibly to shield the process from scrutiny or discovery.

The September 2003 transplant was paid for by the Royal Saudi Embassy, the paper said. The hospital’s $339,000 fee covered the cost of the operation and the patient’s resultant hospital stay.

That figure, the Times said, was 25-30 percent higher than the customary rates paid by insurance companies and government health care programs. However, the paper also noted patients without insurance – such as many foreign nationals – typically pay a higher rate than the discounted prices negotiated by insurance companies.

The Saudi national, who was not identified, was No. 52 on the regional waiting list, which covered much of southern California. The liver should have gone instead to a patient at UCLA Medical Center.

There were no details on the disposition of that patient, or the patient who ultimately received the organ, and it was unclear how long St. Vincent’s suspension would last. Hospital officials said they were in the process of notifying all organ transplant patients of the suspension.

Two surgeons involved in the operation – Drs. Richard R. Lopez, Jr., and Hector C. Ramos – are not affiliated with the transplant program any longer. Ramos’ lawyer said he did nothing wrong and intends to fight to clear his name; Lopez’ attorney told the Times he didn’t have enough information to comment on the charges.

Transplant patients are ranked according to severity of disease, who has been on the list the longest, whether or not they can hold up under major surgery and whether they can take the organ immediately.

Hospital president and chief executive Gus Valdespino said the improper operation was discovered only this month, in response to a routine audit by the United Network for Organ Sharing, the nonprofit organization that manages the national donation program.

Since that discovery, he says a hospital investigation has found several more instances where staff fabricated records and documentation, according to the Times.

UNOS guidelines say no more than 5 percent of donated organs – livers, kidneys, hearts – should go to foreign nationals. And though the national average is actually much lower, the number of foreign nationals who had received liver transplants at St. Vincent was about 8 percent of patients; the number of foreign nationals receiving other donated organs was less than 5 percent, the Times reported.

Giving an organ to someone other than the most deserving patient is considered the ultimate sin within the transplant industry, as there usually are many more patients in need than donors to supply them. Consequently, in order to preserve faith in the system, UNOS, transplant centers and doctors associated with transplant programs typically strive to ensure fairness.

“Having a system that the public views as equitable and views as worthy of their trust and their investment is really critical to serving the needs of 90,000 people that need transplants,” Dr. Mark Fox, associate director of the Oklahoma Bioethics Center and a former chairman of the United Network on Organ Sharing’s ethics committee, told the Times. “I feel pretty comfortable that this is not a widespread problem.”