The failure to attract enough patients amid heavy competition among Philadelphia-area organ-transplant programs has closed one and put two others at risk.

The liver program at Hahnemann University Hospital and the storied heart-transplant program at Temple University Hospital are in jeopardy of losing Medicare certification - and government payments - for the high-profile and profitable operations.

Hahnemann and Temple were among a first wave of transplant hospitals nationwide to face intensified scrutiny of surgical volumes and outcomes from federal regulators. Both have until early May to get their numbers back up, and executives said they expected to do so.

Lankenau Hospital will shut its five-year-old heart-transplant program next week.

Organ transplants are one of several areas where the federal Centers for Medicare and Medicaid Services (CMS) has sought use its enormous financial clout to drive quality improvement.

"In recent years CMS has been more aggressive," said Robert I. Field, chair of the health policy and public health department at the University of the Sciences in Philadelphia.

"This increased assertiveness has been occurring under a conservative Republican administration and, I think, there is a good chance that the trend will continue or accelerate under the Obama administration," Field said.

Last year, federal regulators began requiring all transplant programs in the nation to undergo on-site surveys to participate in Medicare and Medicaid. So far, 90 of the nation's 240 transplant hospitals have been scrutinized.

Hahnemann and Temple were in that first group because of low transplant volumes in their liver and heart programs, respectively. The results of the inspections were recently released by the Pennsylvania Department of Health.

Temple's heart program - for many years considered among the best in the nation - has failed for nearly three years to reach the federal requirement of 10 transplants in the previous 12 months. So the hospital that performed the region's first heart transplant in 1984 now faces a May deadline to get its numbers up or risk being dropped from Medicare.

At Hahnemann, the liver program also failed to reach the minimum during any 12-month period between Jan. 1, 2006, and Aug. 31, 2008.

And Hahnemann's kidney program faces potential termination from Medicare in May because patients died at higher-than-expected rates.

Leaders at both hospitals said they were confident that their recent addition of new doctors and other changes would enable them to avoid decertification.

"I think that with our very robust staff, our outreach efforts, and the commitment by the medical school and Hahnemann to provide for the growth of the [liver] program, our future is very bright," said David J. Reich, chief of multi-organ transplantation at Hahnemann.

Reich added that the worse-than-expected outcomes for kidney transplants was related to several factors, including the program's large number of HIV-infected and other high-risk patients. He said he is confident that the government's consideration of those factors and improved results would prevent termination.

Temple said it has already resolved the volume problems that caused it to be cited after it was surveyed this summer.

Temple surgeons in recent months have performed the requisite 10 heart transplants, said Sandy Gomberg, associate hospital director for clinical services. She said she expects the program to grow.

Despite performing fewer transplants than required, Gomberg said that the program has continued to provide the highest quality of care.

"Where we want to be is greater than 10 with the same superb outcomes that we have had," she said.

Ironically, Temple is on the verge of a milestone in heart transplants, with just two more needed to reach 1,000.