The Relation between Experience and Outcome in Heart Transplantation

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Abstract
Although it is of historical interest, the paper by Laffel et al. (Oct. 22 issue)1 is of limited contemporary relevance. It reflects nothing more than the importance of the “period effect” in the assessment of forms of medical technology. Since 1987 there have been remarkable developments related to the provision of heart-transplantation services in the United States2-4. These include the implementation of criteria for transplantation programs by the United Network for Organ Sharing, the designation of transplantation centers by third-party payers, and the certification of transplantation personnel by appropriate professional associations (e.g., the North American Transplant Coordinators Organization)5-7. Each of these developments has been intended to enhance the outcomes of transplant recipients.