The Miami Herald: Competition to perform organ transplants is heating up in South Florida

By John Dorschner
jdorschner@MiamiHerald.com

Jackson Memorial’s organ transplant program, a premiere service for four decades at the oft-struggling public hospital system, is now facing possible competition from four other South Florida medical facilities in moves that signal a major battle for regional prestige and market share.

The University of Miami, whose doctors perform the Jackson transplants, have filed a letter of intent with state regulators to do adult heart, lung, kidney and liver transplants at the University of Miami Hospital, across the street from Jackson Memorial.

The Cleveland Clinic, which has done transplants for decades at its Ohio facility, has expressed interest with Florida regulators to do adult heart and kidney transplants at its Weston hospital. Memorial Regional in Hollywood wants to do adult heart transplants. Broward Health Medical Center in Fort Lauderdale is interested adult kidney transplants.

Initial formal applications are due Wednesday, said Shelisha Coleman, spokeswoman for the Agency for Health Care Administration, the state regulatory agency.

Jackson Health System means to fight for its primacy. “We remain fully committed to transplant, and we aim to control the business,” spokesman Edwin O’Dell said Monday.

Sal Barbera, a former hospital administrator now teaching at Florida International University, said the moves make sense because transplants are profitable and can add a lot to hospitals’ bottom lines. “It adds prestige … and provides a good foundation for marketing. It can also open more doors for international referrals.” The leading competitor is likely to be nationally known Cleveland Clinic, which has been doing transplants for more than 50 years in Ohio. Barbera praised Cleveland Clinic’s reputation and “fully integrated model” of employing physicians at its facilities. “I can understand why other hospitals are worried.”

Joshua Nemzoff, a Philadelphia hospital consultant who used to work in Miami, said the burst of interest in South Florida is unusual because there is no national trend to expand transplant offerings. “Transplants are a highly specialized service that requires a significant level of skill and a very large population base,” he wrote in an email, noting that South Florida now may be large enough for more programs.

With both Jackson and UM struggling with major financial problems, Nemzoff said rivals may also be sensing an opportunity to take market share from them: “There are literally dozens of other hospitals standing by to pick up the pieces,” in transplant and other programs.

At present, Jackson and UM are partners in the Miami Transplant Institute, which began in 1970 and does more than 500 transplants annually. The institute boasts top quality ratings and adds that “more than half of the reported multi-organ transplants in the world have been performed” by the institute.

UM officials insist they don’t want to break up the partnership. Last week President Donna Shalala told The Miami Herald that UM plans “to continue to build a world-class program at Jackson. But transplant is an area where you can’t mess around. You have to have a very steady program. … carefully funded and maintained, and while we are in this period of trying to figure out where we’re going to be, we have be very careful that we protect the world-class physicians, scientists and program.”

Jackson Chief Executive Carlos Migoya said last week he has no doubt where transplants belong. In a message to his employees after UM filed its letters of intent with the state, he wrote that he hoped Jackson and UM will continue to partner but “regardless of the outcome, I can assure you that Jackson is fully committed to preserving and expanding our transplant service. We will take all the necessary steps to protect this unmatched program from being diluted by competitors.”

Martha Baker, president of SEIU Local 1991, which represents Jackson nurses and other healthcare professionals, questioned whether UM is using the transplant application process as “leverage” during the intense negotiations between the medical school and Jackson to forge a new basis for an annual operating agreement — talks that have been going on for months without conclusion.

Neither Jackson nor UM responded to questions about any relationship between the negotiations and the transplant application.

Cleveland Clinic spokeswoman Arlene Allen-Mitchell said the system’s mission is to expand the “very successful transplant programs in Cleveland… We are proud of that success and plan to bring that extensive experience, proven protocols and outcomes to our patients here and to the Weston/Florida community.”

Cleveland Clinic and UM filed their letters of intent on April 16. Memorial Regional filed on April 23, Broward Health on April 26.

Memorial intends to use its own staff for adult heart transplants, extending its current pediatric heart transplant program, spokeswoman Kerting Baldwin said.

Calvin Glidewell, chief executive of Broward Health Medical Center, said the hospital has had a liver transplant program with UM surgeons for the past couple years, and it’s been in preliminary talks with UM to extend that program to kidneys.

“It seemed like the next logical step,” Glidewell said, adding Broward at first planned to wait a year before applying, but moved more quickly when he saw the Cleveland Clinic letter of intent. Linda Quick, president of the South Florida Hospital and Healthcare Association, warned that too many transplant programs in the region might not be good, because transplants, like all surgeries, tend to have better outcomes when a team does a lot of them, and transplant operations require costly training that could drive up hospital expenses.

“But I don’t want to suggest which ones should do transplants and which ones shouldn’t,” Quick said.

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