Improving timely transplantation while reducing cancellation of scheduled surgery

John K Peel; Jennifer Whiteley; Terri Stuart-McEwan; Thomas K Waddell; Markus Selzner; Eugene Litvak; Marcelo Cypel; Shaf Keshavjee

doi:10.1016/j.jtcvs.2025.10.037

Improving timely transplantation while reducing cancellation of scheduled surgery

J Thorac Cardiovasc Surg. 2025 Nov 6:S0022-5223(25)00965-1. doi: 10.1016/j.jtcvs.2025.10.037. Online ahead of print.

Authors

John K Peel¹, Jennifer Whiteley², Terri Stuart-McEwan³, Thomas K Waddell², Markus Selzner⁴, Eugene Litvak⁵, Marcelo Cypel⁶, Shaf Keshavjee⁷

Affiliations

¹ Department of Anesthesiology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
² Toronto Lung Transplant Program and Division of Thoracic Surgery, University Health Network, Toronto, Ontario, Canada.
³ Oak Valley Health, Markham, Ontario, Canada; Bloomberg School of Nursing, University of Toronto, Toronto, Ontario, Canada.
⁴ Division of General Surgery & Ajmera Transplant Center, University Health Network, Toronto, Ontario, Canada.
⁵ Institute for Healthcare Optimization, Newton, Mass.
⁶ Toronto Lung Transplant Program and Division of Thoracic Surgery, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.
⁷ Toronto Lung Transplant Program and Division of Thoracic Surgery, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada. Electronic address: shaf.keshavjee@uhn.ca.

PMID: 41205904
DOI: 10.1016/j.jtcvs.2025.10.037

Abstract

Background: Organ transplant programs must mobilize perioperative resources at short notice, a stress to the system that is frequently managed by cancelling scheduled operations. We performed a quality-improvement initiative to restructure surgical services at one of the largest multi-organ transplant programs in North America (Toronto General Hospital, University Health Network, Toronto, Canada) by adapting the system developed by the Institute for Healthcare Optimization.

Methods: The resultant University Health Network Institute for Healthcare Optimization system involved (1) dedication of 2 emergency (standby) operating rooms for urgent/emergency cases and (2) revised and formalized standards to classify transplant urgency. We performed a retrospective, before-after, single-center study to measure the impact of our initiative on access to transplantation and use of operating room resources.

Results: After the University Health Network Institute for Healthcare Optimization system was implemented, we observed a significant reduction in cancellation of scheduled surgeries per month (3% [2.4%-3.6%] vs 9% [8.1%-9.4%]; P < .001), with transplant recipients more likely to enter the operating room within the target time (P < .001 for all organ types), no increased likelihood of after-hours transplantation, and no decrease in the number of scheduled cases completed each month (715 ± 156 operations vs 729 ± 50 operations; P = .684).

Conclusions: The University Health Network Institute for Healthcare Optimization system has allowed our center to accommodate increasing transplant volumes without negatively impacting other surgical services.

Keywords: operating rooms; organizational management; transplantation.