Transplant services guidelines

Transplant facilities and programs must meet certain criteria to be part of the Humana National Transplant Network (NTN). Transplant programs that do not meet NTN criteria will be suspended from network participation until such time that they meet NTN participation criteria. In most circumstances, members may remain at the facility under continuity-of-care provisions.

Solid organ transplant requirement

NTN participation requires that each solid organ program:

  1. Meet established annual volume requirements as reported by the Organ Procurement and Transplantation Network (OPTN).

  2. Meet outcome requirements data as reported by the Scientific Registry of Transplant Recipients (SRTR).

    Any organ transplant program with lower-than-expected outcomes for respective 1-month and 1-year periods will be subject to a participation warning. If outcomes do not improve in the next reporting period, the program will be suspended from participation in the NTN until such time as the outcomes improve.

Annual minimum volume requirements

Pediatric volume information is attained from SRTR, as reported for the 2-and-a-half year period used to determine program performance or from OPTN, as reported for the preceding 2 years.
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Organ Adult/year Pediatric/period Heart 10 9 Lung 10 9 Heart/lung Heart and lung programs must be approved Heart and lung programs must be approved Kidney 10 9 Pancreas Kidney programs must be approved Kidney program must be approved Liver 10 9 Intestine Liver programs must be approved Liver program must be approved Multivisceral Liver and intestine programs must be approved Liver and intestine programs must be approved

Bone marrow (stem cell) transplant (BMT) requirements

NTN participation requires that each BMT program meet the following requirements:

  • Adult and pediatric autologous BMT: 90% 100-day survival rate*
  • Adult and pediatric allogeneic BMT: 70% 100-day survival rate*
  • All participating programs must be accredited by the Foundation for the Accreditation of Cellular Therapy (FACT)

* Programs that perform fewer than 35 annual autologous or 35 annual allogeneic transplants will be required to submit data from the immediately preceding year's transplants in order to obtain a statistically significant number of transplant cases (35).

 

Certification requirements

Adult transplant programs must be Medicare certified and will be subject to the following criteria:

  • Solid organ transplant programs will be reviewed twice annually, following the release of updated statistics from SRTR.
  • American Society for Blood and Marrow Transplantation (ASBMT) statistics/forms (including the 100-day survival statistics) must be received by NTN no later than Oct. 1 of each calendar year. Reporting volumes and outcomes of the previous calendar year should be included. If these statistics are not submitted by Oct. 1 of each year, the result will be immediate suspension of referrals and authorization of new patients.
  • All facilities must execute an NTN agreement in order to participate in the NTN.

Find answers to frequently asked questions about Humana transplant services.

Transplant services questions