The Transplant Freeze

The decision of the Massachusetts General Hospital (MGH) board of trustees to prohibit human heart transplants could discourage other institutions from performing similar transplants.

The Board's decision, based primarily on how much hospital time, money and equipment the operations require, followed ten months of debate over a proposal by MGH's medical leadership to perform six transplants each year. The MGH chief of surgery, Dr., W. Gerald Austen, refused to comment on the decision.

"This represents one of the first times a major medical hospital made a decision not to go ahead with major medical technology," Dr. Harvey V. Fineberg, assistant professor of health services administration at the School of Public Health, said yesterday, calling it "a very brave landmark decision."

Moreover, the decision by the lay board of trustees about undertaking a sophisticated medical procedure will "generate discussion all around," Fineberg added.

About 40 human heart transplants are performed annually in the United States, mostly at the Stanford Medical Center in California. Dr. Stuart W. Jamieson, chief resident of the cardiac program at Stanford, said the operations cause "very little" diversion of resources and that 65 percent of their transplant patients survive the first year of the operation.

The University of Arizona started performing heart transplants ten months ago with a minimal capital investment and has not had to divert its resources to the operation, Dr. Jack G. Copland, associate professor of surgery at U. of Arizona, said.

Copland said the MGH decision would discourage smaller institutions from performing the operation, which costs about $25,000.

Dr. Alexander Leaf, Jackson Professor of Clinical Medicine at Harvard and originally a proponent of transplants at MGH, said yesterday he and most of the other surgeons uphold the board's decision. "Much more research on its therapeutic effectiveness and cost efficiency needs to be done," he added.