subject: Kidney Transplant Centers: Bigger Is Not Always Better [print this page] Most patients who are considering a kidney transplant and are looking for the best kidney transplant center think that the bigger the center the better it will be. In fact, this perception is cultivated by many doctors. In the absence of easy to find information on the success rates of kidney transplant centers, many doctors recommend larger centers to their patients. A patient I met shared why her doctor recommended a particular center: "This center does hundreds of procedures. They have experience."
So what is big? According to the above doctor's definition, "big" is how many kidney transplants a center does. The logic is that the more procedures it does, the more frequently the team practices their surgical skills to practice and the more opportunities they have to keep improving. In other words, practice makes perfect.
While there is certainly some truth to that, it is not always the case. With a complex treatment, such as a kidney transplant, that requires some degree of personalized care, size does not always go hand in hand with good care. A few years ago the Los Angeles Times reported low quality care at one of California's largest kidney transplant centers. Also, because of improved medical technologies, both in surgical techniques and new medicines, some small centers achieve the same or even better success as large ones. In our own research, funded by the National Institutes of Health, we found some small kidney transplant centers that had the best success rates over and over again over the past six years. These are small jewels that patients should not ignore.
Why is bigger not always better?
Many procedures but not so many doctors: Doing more kidney transplants does not necessarily mean the kidney transplant center has enough doctors, nurses and assistants to serve that many patients. For a complex medical procedure, where success depends on one-to-one care and attention to details, staff shortage can affect the quality of your care.
Slow down: A large transplant center means a more complex process. A more complicated process, if not managed well, can slow down each step of getting on the kidney transplant list: from referral, to evaluation to scheduling surgery. process is slower, slower to get on the list, health deteriorates in the meantime and therefore, your odds for a successful transplant go down
Longer wait list: Large kidney transplant centers have long wait lists for a kidney. If you are waiting for a kidney from a deceased donor your wait time could double at a larger center compared to a smaller one.
Depth of care may suffer: If a large center does not have the necessary staff to attend to its many patients, the depth of follow up after your kidney transplant may suffer. This could mean that a larger kidney transplant center may not have the capacity to detect complications early or manage complications effectively. Timely adjustments to your medications may also suffer. All this would risk the success of your kidney transplant.
Personal rapport may be compromised: If you need close personalized attention, you may get frustrated at a large center. In that case, that discomfort may compromise your ability to follow the center's instructions or ask key questions on how to take care of your health while waiting for a kidney or after you get your kidney transplant. Without clear communication with your center, the success of your transplant can be compromised.
If bigger is not always better, then how do you find the best kidney transplant center? Always, look at size side-by-side with the center's success rates. Never look at size alone. Look at the results they had with their patients: the center's survival and complication rates, as well as how long the center's transplants last. If these results are good at a large center and you are comfortable with that size, less personal attention and possible longer wait, then a large center is good for you. On the other hand, don't ignore a small center. If that small center has had good results consistently over the last six years and you are looking for personalized attention or possibly shorter wait, then small can be best for you.
