One fifth of all operating transplant centers in the USA are substandard, according to an investigation carried out by the Los Angeles Times. There are 236 approved transplant centers - 48 of them fail to meet standards for patient survival and minimum number of annual operations.

These centers work under the US Centers for Medicare and Medicaid Services - in other words, they are funded by Medicare, says the LA Times. Over a two-year period 71 more patients died within a year of receiving a transplant than expected.

Dr. Mark Barr, President of the International Society for Heart and Lung Transplantation, said that in the USA there are too many programs and many need to be weeded out and closed down.

The majority of America's centers are funded by Medicare. Many of the centers did not meet the minimum number of operations required for funding, says the report. The reason for a minimum number of operations is so that skill levels can remain high - the more operations doctors carry out, the better their skills. The LA Times quoted Wake Forest University Baptist Medical Center, North Carolina, where just two transplants were carried out last year. It has just done 12 transplants since 1999.

Some centers have asked for more time to improve their standards. Others say data on just two years is not enough to make a judgement.

LA Times Article