Pediatric Heart Transplant Center Proposal In Orlando Draws Opposition

A proposal to build a fifth pediatric heart transplant center in Florida is drawing opposition from at least two of the existing programs.

Critics of the plan say there aren't enough patients to support another transplant center, and spreading existing patients among more centers would have a negative effect on the overall quality of care.

Nemours Children's Hospital in Orlando is asking the state's Agency for Health Care Administration if it can open a new pediatric heart and lung transplant center. To do so, it needs approval under the state's "certificate of need" rules.

Last year in Florida, 37 pediatric heart transplants were performed at the four existing centers.Ed Jimenez, CEO of UF Health Shands, the site of one of the state's existing heart transplants centers, said Nemours is not performing enough heart surgeries on children now to justify the exemption.

"If it gets approved, you and I as citizens of this state should say 'How does that happen when they don't even meet the minimum thresholds to be able to apply for this?’" Jimenez said.

Nemours filed an application with the state in October to open the center and AHCA is expected to release its decision on Friday. In its application, Nemours argues that patients requiring pediatric lung transplants are underserved in Central Florida.

“The development of a pediatric heart and lung transplant program at Nemours Children’s Hospital will allow families access to world-class care in their own community,” said Josh Wilson, director of public relations for Nemours.

Jimenez said existing centers have the capacity to perform more transplants but there are not more patients in the state who need them.

“If you can imagine a world where the volume is tripled in any one year, we could likely accommodate it,” Jimenez said. “I just don’t know how the world of transplants gets tripled. So I cannot imagine a circumstance where we would be unable to accommodate more patients.”

The concept behind certificate of need regulations in Florida and other states, is that it helps consolidate highly specialized procedures, such as transplants, at a limited number of facilities. That way the health care teams at those facilities do more of the procedures, gaining more experience and expertise.

Opening another center would mean all the centers would serve fewer patients. And that could decrease the quality of care for all transplant patients in Florida, said Dr. Jeffrey Jacobs, surgical director of the heart transplant center at Johns Hopkins All Children’s Hospital in St. Petersburg.

“The reality is that having too many programs will dilute the quality of care,” Jacobs said. “In striking the balance between quality outcomes and convenience, quality must win every time.”  

The director of the proposed transplant center at Nemours would be Dr. Peter Wearden, a leader in the field of pediatric heart surgery who has participated in the care of more than 170 pediatric transplant patients, Wilson said.  

“When you create something new and improve upon the status quo there is undoubtedly going to be impact in the market,” Wilson said. “Nemours strongly believes that our efforts will lead to superior care for children with complex heart conditions so (we) are pleased to be leading that charge.”

Editor's note: An earlier version of this story incorrectly credited a statement from Josh Wilson,  director of public relations for Nemours.

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