Starting a lung transplant program: A roadmap for long-term excellence

Abstract

Lung transplantation is an eff ective therapy for many patients with end-stage lung disease. Few centers across the United States off er this therapy, as a successful lung transplant program requires signifi cant institutional resources and specialized personnel. Analysis of the United Network of Organ Sharing database reveals that the failure rate of new programs exceeds 40%. These data suggest that an accurate assessment of program viability as well as a strategy to continuously assess defi ned quality measures is needed. As part of strategic planning, regional availability of recipient and donors should be assessed. Additionally, analysis of institutional expertise at the physician, support staff , fi nancial, and administrative levels is necessary. In May of 2007, we started a new lung transplant program at the University of Iowa Hospitals and Clinics and have performed 101 transplants with an average recipient 1-year survival of 91%, placing our program among the top in the country for the past 5 years. Herein, we review internal and external factors that impact the viability of a new lung transplant program. We discuss the use of four prospectively identifi ed quality measures: volume, recipient outcomes, fi nancial solvency, and academic contribution as one approach to achieve programmatic excellence.