Transplant Organizational Structures: Viewpoints From Established Centers

Abstract

This personal viewpoint report summarizes the responses of a survey targeting established transplant programs with a structured framework, such as center, institute, or department, and stability of leadership to assure valuable experiential observations. The 18-item survey was sent to 20 US institutions that met inclusion criteria. The response rate was 100%. Seventeen institutions had a distinct transplant governance structure. A majority of respondents perceived that their type of transplant structure was associated with enhanced recognition within their institution (85%), improved regulatory compliance (85%), transplant volume growth (75%), improved quality outcomes (75%) and increased funding for transplantrelated research (75%). The prevailing themes in respondents' remarks were the perceived need for autonomy of the transplant entity, alignment among services and finances and alignment of authority with responsibility. Many respondents suggested that a dialogue be opened about effective transplant infrastructure that overcomes the boundaries of traditional academic department silos.

Determinants of Burnout Among Transplant Surgeons: A National Survey in the United States

“…Emotional exhaustion has long been considered the most obvious and taxing symptom of burnout . In a recent survey of established transplant centers, autonomy and resource allocation were seen as essential to the success of a transplant enterprise . The linkage to decisional authority, while evident for some, requires further deliberation and understanding given the diversity of practice settings.…”

Compensating the Transplant Professional: Time for a Model Change

“…Funding and functional alignment between transplant physicians and the transplant center cannot be overemphasized and are essential components for a sustainable and successful transplant center (27).…”

“…In the context of service line models and care integration in transplant centers (27), a wide range of transplant physician activities (outlined above), described as non wRVU-producing activities, are vital to the success of a program (and hence the institution). The means to support such activities should stem from the collective revenues generated in an institution.…”

Loss of liver transplant surgeons into alternate career paths: how to overcome?

“…Another important feature to raise the attractivity of transplant surgeon will (or must) be the creation of transplant centers or institutes with distinctive governance structures . This structuring will allow enhanced recognition (and thus self‐esteem), improved regulatory compliance, transplant volume growth with inherent quality improvement, and, importantly, increased funding for research and potential engagement of new staff members.…”

“…Transplant surgeons and teams disserve indeed a special status in relation to career planning and financial income. This is especially important when they are included in a surgical department structure .…”