Three national transplant organizations have come out strongly against changes the state of Arizona has made which prevent Medicaid patients from getting certain life-saving transplants, saying the actions will cause patient deaths.
"This baseless exclusion of coverage to Arizona citizens for services that represent the best treatment option for patients with end-stage organ failure represents an actual death sentence for many of these citizens of Arizona," said Maryl R. Johnson, MD., president of the American Society of Transplantation (AST).
The changes became effective Oct. 1, 2010, and were made to cut costs because of the state’s budget shortfall. The American Society of Transplant Surgeons (ASTS), the United Network for Organ Sharing (UNOS) and AST have issued a letter to Arizona’s governor requesting a meeting.
The exclusion of Medicaid transplant coverage for lung, pancreas only, pancreas after kidney, heart for non-ischemic cardiomyopathy and liver for diagnosis of hepatitis C is unprecedented in the United States. The state is also excluding unrelated donor bone marrow transplants which affect blood cancer patients.
According to UNOS, as of November 5, 2010, 61 Medicaid patients (i.e., six heart candidates, five lung candidates, two pancreas candidates and 48 liver candidates) were on the national waitlist for these specific types of transplants.
Those already affected include 32-year-old Francisco Felix, a married father of two, who has hepatitis C. He was admitted to a Phoenix hospital recently and prepped for surgery only to learn he would not get the liver that had been secured for him. A hospital spokesman said Felix is one of 23 patients at the hospital who need liver transplants but won’t get them because of the cuts. He said Felix faces death if he doesn’t get a liver transplant in the next two years.
In October, an anonymous donor stepped forward to fund a bone marrow transplant for leukemia patient Mark Price after the state denied funding for the procedure. Doctors said the 37-year-old father of six would have died without the transplant.
The Arizona state legislature does not go back into session until Jan. 2011 and some lawmakers have called for a special session to address the transplant issue. Additionally, four state transplant centers have formed a medical advisory committee, with representatives from each Arizona transplant center, and has proposed that this group collaborate with the state Medicaid agency. The transplant organizations believe an ongoing review of cost-saving opportunities through the reform of health care delivery could reduce costs more effectively than the outright elimination of transplant benefits.
"The determined involvement of our national transplant organizations sheds light on the severity of the issue facing patients," said Rainer Gruessner, MD, head of transplantation at the University of Arizona and chairman of its department of surgery. "All four of Arizona's transplant centers have agreed on an alternative plan, including the elimination of certain evaluation tests that will achieve the same cost savings without eliminating life-saving transplants. To date, our plan has not been acknowledged, and patients will die as a consequence."
Resources:
American Society of Transplantation: http://www.a-s-t.org/
American Society of Transplant Surgeons: http://www.asts.org/
United Network for Organ Sharing: http://www.unos.org/
Letter to Arizona’s Governor:
http://www.a-s-t.org/files/pdf/public_policy/Joint_ASTS_AST_UNOS_LTR_Brewer_2010_10.29.pdf
State of Arizona Transplant Changes Summary: http://www.azahcccs.gov/reporting/Downloads/Transplant/TransplantChangesSummary10_6_10.pdf
Valley Man Denied Life-Saving Liver Transplant
http://www.kpho.com/news/25811486/detail.html
State Cuts Prevent Patient From Liver Transplant
http://www.myfoxphoenix.com/dpp/health/patient-doesnt-get-liver-11-16-2010