Impact of institutional case volume of solid organ transplantation on patient outcomes and implications for healthcare policy in Korea

Abstract

Solid organ transplantation is distinguished from other high-risk surgical procedures by the fact that it utilizes an extremely limited and precious resource and requires a multidisciplinary team approach. For several decades, institutional experience, as quantified by center volume, has been shown to be strongly associated with patient outcomes and graft survival after solid organ transplantation. The United States has implemented a minimum case volume requirement and performance standards for accreditation as a validated transplantation center. Solid organ transplantation in Europe is also governed by the European Union, which monitors patient outcomes and organ allocation. The number of solid organ transplantation cases in Korea is increasing, with patient outcomes comparable to international standards. However, Korea has outdated regulations regarding hospital facilities, and performance indicators including patient outcomes after transplantation are not monitored. Therefore, centers perform solid organ transplantation with no meaningful oversight. In this review, data regarding the impact of institutional case volume of kidney, liver, lung, and heart transplantation are summarized, followed by a description of current transplantation center regulations in the United States and Europe. The basis for the necessity of adequate transplantation center regulations in Korea is presented.

Impact of institutional case volume on intensive care unit mortality

“…The observed center volume effect on specific types of surgeries and patient populations, which demonstrates improved patient mortality, has prompted discussions about whether these procedures should be limited to high-volume centers with favorable outcomes [ 41 , 42 ]. The significant volume effect on mortality in solid organ transplantation and trauma centers has led to policy changes requiring minimum case volumes for center accreditation.…”