Regulatory Environment and Finances of Running a Pediatric Transplant Program

  • Cassandra Smith-Fields
Reference work entry
Part of the Organ and Tissue Transplantation book series (OTT)


Pediatric transplantation in the United States (USA) is subject to the same regulatory oversight through the Organ Procurement and Transplantation Network (OPTN) and the Center for Medicare and Medicaid Services (CMS) as adult transplant programs. Compliance with these regulations can be more challenging primarily related to volume. The volume of pediatric solid organ transplants within the USA is only 6% of the total volume of transplants performed. This low volume of procedures is spread across over 100 transplant programs, further diluting the aggregated volume within a single center. In particular staffing, maintenance of training and the ability to ensure staff competency is difficult when volumes are low. The financial operations of pediatric transplant programs are subject to a higher cost structure than their adult counterparts. Coupled with lower transplant volumes and poorer reimbursement through Medicaid, the finances of a pediatric transplant program can be significant. These challenges will be explored in this chapter.


Center of excellence CMS Conditions of participation KAS Medicaid NOTA OPTN Payors Reinsurance QAPI SRTR 


  1. Adachi I, Fraser C (2011) Mechanical circulatory support for infants and small children. Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann 14:38–44CrossRefGoogle Scholar
  2. Children’s Oncology Group. Accessed 26 June 2016
  3. CMS CoPs (2007) Medicare program: hospital conditions of participation: requirements for approval and reapproval of transplant centers to perform organ transplants: final rule. In: Services HaH (ed) Federal registrar: centers for medicare and medicaid. pp 15198–15280Google Scholar
  4. Health Cost Institute. Accessed 26 June 2016
  5. Ho, B., Skaro, A.I. & Abecassis, M.M. Curr Transpl Rep (2015) 2: 127. doi:10.1007/s40472-015-0062-9Google Scholar
  6. Kotulak R (March 24, 2006) Teens driven to distraction. Chicago TribuneGoogle Scholar
  7. OPTN Bylaws. Accessed 26 June 2016
  8. OPTN Pediatric Committee. Accessed 26 June 2016
  9. RAND Corporation tabulations using HCFA unpublished data for calendar year 1984 – Health Care Financing Review/Winter 1993/Volume 15, Number 2Google Scholar
  10. Schnitzler M, Valapour M, Skeans M et al (2016) Special issue: OPTN/SRTR annual data report 2014. Am J Transplant 16(52):169–194, January 2016CrossRefPubMedGoogle Scholar
  11. Shiffman ML, Rockey DC (2008) Role and support for hepatologists at liver transplant programs in the US. Liver Transplant 14(8):1092–1099CrossRefGoogle Scholar
  12. SRTR 2012 annual report – United States organ transplant SRTR & OPTN annual data report, 2012 Heart. Accessed 20 Sept 2015Google Scholar
  13. SRTR Special Request – email correspondence and data request with SRTR dated 2/10/15Google Scholar
  14. The Economic Times. Accessed 26 June 2016

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Phoenix Children’s HospitalPhoenixUSA

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