Mayo Clinic Transplant Program
Helps Shape National Collaboration

Points to Remember

• To improve organ transplantation, the US government in 2006-2007 evaluated 15 leading transplant centers and included elements from Mayo Clinic's model in its recommendations.
• Six key elements characterize the Mayo Clinic transplant model: 1) institutional vision and commitment, 2) a dedicated transplant team, 3) willingness and skill to treat complex patients, 4) patient- and family-centered care, 5) financial competency, and 6) protocol-driven results.
• Mayo has developed liver transplant protocols for procuring donor livers after cardiac death so the procedure is standardized to reduce ischemic time and preserve organ function.

The Challenge

From 1995 to 2007, organ donations of all kinds increased 62.5% and transplants of all kinds increased 46%. Despite these successes, the supply of donor organs is greatly exceeded by the demand for them—98,825 patients are currently candidates for some type of transplant and on a waiting list.

*Organ Procurement and Transplantation Network

In 2006-2007, the US Health Resources and Services Administration (HRSA) undertook a systematic evaluation of best practices in transplant programs to identify elements of success. Mayo Clinic's transplant program was among the 15 high-performing transplant programs that HRSA studied.

Six Elements of a Successful Transplant Program

According to the U.S. Department of Health and Human Services' Health Resources and Services Administration, 6 elements contribute to exemplary patient outcomes and graft survival in successful transplant programs:

1. Institutional vision and commitment

   The HRSA analysis cites this factor as "fundamental" to the success of a transplant center, noting: "Hospitals cannot dabble in organ transplantation. They must commit to it fully and provide the resources and support necessary."

2. Dedicated transplant team

   Attracting and retaining dynamic, dedicated, skilled transplant specialists who consistently function as a transplant team is another key to success. A collegial, nonhierarchical team approaches produces the best care.

3. Aggressive clinical style

   An aggressive clinical approach to caring for patients before, during, and after transplant is central to making best use of organs that are chronically in short supply.

4. Patient- and family-centered care

   Leaders organize health care around the needs of patients and families, instead of around the needs of the institution. This leads to practices such as streamlining processes to reduce paperwork burdens on patients; increasing education opportunities for patients and families about lifelong care of the transplant; and creating comfortable spaces in the hospital that do not isolate the patient from his or her family.

5. Financial intelligence

   Financial strength is a critical success factor. It involves keeping rigorously detailed accounting of program finances, sound financial management, and excellent payer relations.

6. Protocol-driven results

   The leading transplant centers consistently conduct improvement-oriented performance reviews based on protocols, data-driven quality control methods, innovation, and research.

Leaders in Liver Transplant

The Mayo Clinic transplant model helped HRSA identify 6 elements of a best-practices transplant program. The Mayo Clinic liver transplant model was especially helpful because of many factors, including outcomes. For example, Mayo Clinic in Jacksonville, Florida, is the only liver transplant program in the United States currently to exceed the expected patient survival rates at all time points: 1 month, 1 year, and 3 years.

Mayo Clinic's liver transplant program is highly specialized, particularly in the following areas:

• Transplants to treat cholangiocarcinoma
• Maintaining a large and successful living donor program
• Innovation in procuring donor organs after cardiac death

Cardiac Death Donation

Mayo has developed liver transplant protocols for procuring donor livers after cardiac death that standardizes the procedure and reduces ischemic times to preserve organ function. Mayo Clinic in Florida has performed more than 100 transplants from cardiac death liver donors.

The cardiac death patient is a relatively new organ donor population. The typical donor has been a young adult with brain death from injury. With cardiac death donation, this demographic is changing. The potential donor population is expanding to include both older and severely brain-injured donors. A patient's living will directive and family members may indicate that withdrawing support for a nonresponsive patient is reasonable, even if the patient does not meet all rigorous criteria for brain death, perhaps because evidence of minimal brain activity remains. If death ensues due to heart stoppage when support is withdrawn, the liver may be procured.