In December 2014, UNOS changed kidney allocations rules, factoring in considerations other than a person's place on the wait list. Among other changes, the new system is priority matching patients and donor kidneys with the highest life expectancies and "increasing priority for candidates whose immune system is not compatible with most donor kidneys," according to the OPTN.
For Colquhoun and other transplant leaders, as the world of transplantation evolves, they are tasked with managing increasingly complex and tightly regulated clinical programs and payer pressures, as well as strategizing new ways to compete for patients and organ donors.
Success key No. 1: Create a high-performing matrix
At the Bronx, New York–based Montefiore Einstein Center for Transplantation, which performs liver, kidney, and pancreas transplants, Milan Kinkhabwala, MD, chief of the division of transplantation at the center and director of abdominal transplantation, stresses that successful programs must have administrative structures that can accommodate the potential for strong revenue, while at the same time handling regulatory oversight and risk.
Transplant administrative structures have changed a lot over 20 years, he says. "It used to be driven by surgeons who were part of surgical departments. They performed the surgery, administered all of the things in the program." There was no standardization, minimal regulatory oversight, and payment was largely fee-for-service.
Now, "most hospital systems that are doing transplants on a large scale have organized their transplant programs into some kind of matrix center," says Kinkhabwala, who oversees 100 employees. By matrix he means a tightly coordinated center with a physician and an administrative leader who work together tending to everything from business planning and regulations to quality and outreach.