Ethical and legal controversies concerning consolidation of congenital heart programs in the United States of America

Abstract

Consolidating congenital heart surgery programs by collapsing low volume centers into higher volume centers has been proposed to improve outcomes. Recent large database reviews advocate that a minimum volume of 200-300 cases/year reduces mortality. Supporters of consolidation argue that national outcomes could be improved with regional high-volume centers. Opponents point to outstanding clinical outcomes achieved at select lower volume centers. Others note unintended consequences of limiting local access to care and imposing travel burdens for patients and families. This chapter examines the data and ethical issues influencing these opinions.