What will happen to Jackson’s currently closed heart transplant program? There’s an update
A Jackson Health System vice president said this week that despite the abrupt closure of its heart transplant program due to deaths and other bad outcomes, the program would be “100% back on track” once independent regulators complete their investigations.
Dr. Chris Ghaemmaghami painted a rosy picture for the Public Health Trust board of trustees on Wednesday, within an hour of the Miami Transplant Institute receiving a critical report — which he said he had not yet read — from the organ transplant organization leading the main probe. Jackson Health System is Miami-Dade’s publicly owned hospital network; the Public Health Trust board governs it.
Nonetheless, Ghaemmaghami reassured board members at their board meeting that a plan was already in place to resuscitate the adult heart transplant program, which Jackson suspended in mid-March after the nonprofit United Network for Organ Sharing (UNOS), signaled to Jackson officials that it had received complaints warranting an investigation. The organ sharing network manages the U.S. organ transplant system under contract with the federal government.
Ghaemmaghami said the problems at the Miami Transplant Institute’s program, which he identified as teamwork, communications and leadership, were “eminently addressable.” Jackson said work is already underway. The Miami Transplant Institute, which is housed at Jackson Memorial Hospital and is staffed with physicians from the University of Miami medical school, is still performing pediatric heart transplants as well as lung, kidney, liver and other transplants.
The adult heart transplant program was suspended following a letter from the organ sharing network in which the organization urged the institute to do so after complaints regarding deaths, infections and other issues in the program, which has been led by Dr. Matthias Loebe. Jackson told the Herald at the time that the organ sharing network would oversee a peer review of the program, which occurred the week of April 4, and in the weeks following issue a report.
Jackson received that report Wednesday morning, the same day Ghaemmaghami spoke to the Public Health Trust.
Jackson has refused a public records request from the Miami Herald to provide the report or the original letter sent by the organ sharing network urging Jackson Health to suspend the program, citing a legal exemption that makes the documents “not subject to inspection and copying.”
Ghaemmaghami acknowledged the update on the status of the transplant center was not originally part of the agenda for Wednesday’s meeting, but it was added since there have been questions surrounding the suspension of heart transplants and when they might resume. He said the heart program had been seeing “very good” outcomes, which were “maybe not great” but only “marginally below” the national average.
Jackson officials have previously acknowledged that the adult heart transplant program has not been performing as well as Jackson’s other transplant programs involving kidneys, livers and other organs.
But Ghaemmaghami said the heart program’s outcomes would “not ordinarily” be the reason for investigations and that he found it “interesting” that the issues “had gotten to this level.”
Though it is unclear whether the organ sharing network suggested when and if they recommended resuming heart transplants, the Jackson VP said Jackson was “appealing” to the network “to have them understand” that Jackson’s outcomes were “in a place” where they should “be allowed to go forward.”
He also said the transplant institute presented the organ network with its own action plan during the nonprofit’s visit highlighting remaining issues and how they will be addressed.
“We have made a lot of changes, and we’d like them to show some flexibility in terms of when we can fully restart the program,” Ghaemmaghami told the board. Those changes include at least the removal of Loebe as chief.
In October 2022, the institute’s director, Dr. Rodrigo Vianna, told Loebe in a letter that he would “no longer serve in the role of chief of Heart Transplant and Ventricular Assist Devices effective Feb. 13, 2023.” However, up until the program’s suspension, Loebe had still been serving in that capacity, since Jackson had not found his replacement. A week ago, Jackson confirmed to the Herald that Loebe “was no longer seeing patients” but refused to elaborate, stating that “Jackson has ample coverage with other heart transplant surgeons.”
Ghaemmaghami said senior Jackson leadership — beyond the heart transplant program and the Miami Transplant Institute — would be involved with the program and its organizational structure “at least for the foreseeable future.”
He also told the board Jackson is recruiting for “key positions” to improve the processes. Other than discuss the pending replacement for Loebe, Jackson has not responded to questions from Herald reporters about other personnel changes.
It’s unclear whether a new chief needs to be named before the program resumes.
Ghaemmaghami, who is also Jackson’s chief physician executive and chief clinical officer, told the Herald after the meeting that they are still discussing the heart transplant program with the organ sharing network and doesn’t know when the program will reopen.
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Two other agencies, investigations
The Centers for Medicare & Medicaid Services and Florida’s Agency for Health Care Administration, which licenses and regulates hospitals in the state, visited the transplant institute the week of April 10. Jackson sources previously told the Herald that a report had been sent to the Medicare and Medicaid agency highlighting complaints about the heart-failure team and the implantation of Left Ventricular Assistance Devices, basically a heart pump. The team is led by Dr. Anita Phancao.
Ghaemmaghami told the board that the state agency left after a “thorough” four-day review with no findings. The Medicare and Medicaid agency, he said, had “no immediate findings” but did request additional medical records for further review, which were provided.
“Their early early indications were that they were pleased with the work we were doing. We found that very reassuring,” Ghaemmaghami said.
The report sent to the Medicare and Medicaid agency, which was reviewed by the Herald, cited poor patient outcomes and detailed over 20 deaths since 2020 within a year of heart pump procedures. The deaths were characterized by the authors of the complaint as preventable.
Ghaemmaghami did not specifically address the heart pump implantation procedure or complaints surrounding it during Wednesday’s meeting. Jackson has told the Herald that Phancao remains as a cardiologist who heads the heart-failure team.
Jackson CEO weighs in on plans moving forward
Jackson Health System CEO Carlos Migoya assured the board of trustees during an afternoon meeting following the one that Ghaemmaghami spoke at that Jackson was prioritizing finding a replacement for Loebe. “We know what it takes to be successful — our lung transplant program, for example, is a model that we are striving to replicate for heart transplantation. I have no doubt that we’ll get there.”
The lung program was previously also headed by Loebe.
“I can confidently say that our team is dedicating the time, energy and resources needed to ensure that we can safely reinstate the program as soon as possible,” Migoya told the board.
Now that the report has been issued, Jackson and the University of Miami medical school can accept the recommendations or challenge them, according to Loebe, who explained the process to the Herald in an interview earlier this month. It would be unusual for a transplant program to challenge a peer-review panel’s recommendations to the extent that it would require a formal appeals hearing in Chicago, Loebe said.
Once Jackson-UM accepts the panel’s recommendations, then Jackson and the Miami Transplant Institute would be monitored by the organ sharing network for at least one year and possibly up to two years. The institute would have to file a report every six months that spells out its progress in meeting certain benchmarks set by the peer-review panel. Once Jackson meets those benchmarks, it would no longer be under close monitoring by the organ network.
