THIS WEEK

The chief executive of St George's Healthcare trust has expressed sadness at the deaths of a number of patients at its cardiothoracic unit and hope that a critical Commission for Health Improvement report into the service can provide guidance for other heart and lung transplant units.

The deaths of 10 patients between December 1999 and October last year were probably due to the 'inadequate' selection of suitable candidates for heart and lung transplants, according to the CHI investigation. It said the assessments led to operations on patients who were either 'too well' or 'too ill'. CHI stressed that it was 'very unlikely' that any of the deaths following surgery were the result of statistical coincidence.

Chief executive Ian Hamilton said: 'We are of course saddened by the deaths of our patients following transplantation, as they build a very close relationship with our clinical team and the loss of each patient is felt very deeply.'

St George's no longer carries out heart and lung transplants following the government's decision to reduce the number of centres in England to four. CHI's report did find evidence of good practice at St George's and, unlike at Bristol Royal Infirmary, staff at the cardiothoracic unit immediately reported the high death rates when they first emerged.

But there were failures in clinician/management communication, clinical governance and accusations that there was a lack of surgical leadership which was linked to the absence of a documented surgical involvement in the assessment of patients for transplant.

Mr Hamilton said the report 'helps us better understand the complexity of care when treating seriously ill patients and what lessons can be learned for future transplant programmes'.

CHI director Dr Peter Homa said: 'Some patients were probably given the wrong treatment by a team whose leadership had broken down and who failed to follow their own rules about which patients should receive heart transplants. No one doctor or manager is responsible for this, but many people in many roles share accountability for what happened.'