State Medicaid rejects liver transplant for Altoona man with HIV

The Pittsburgh Post-Gazette ^ | Friday, November 21, 2003 | Anita Srikameswaran

[Willie Green]

State Medicaid officials have refused to pay for a liver transplant for an Altoona man because he is infected with HIV, a position the man's attorneys argue is discriminatory and not based on current medical knowledge and practice.

William Jean Gough, 46, meets the medical criteria for the procedure and his survival chances are as good as someone who isn't infected with the AIDS virus, said Hayley Gorenberg, AIDS project director at Lambda Legal in New York, which, along with the AIDS Project of Pennsylvania, is representing Gough in his appeal of the decision.

[Bikers4Bush]

If he finds a relative or friend willing to give him a piece of theirs and he can find doctors willing to do the surgery then more power to him.

[Born Conservative]

Important points: 1. Is Hepatitis C eradicated from the body after a liver transplantation? If not, what are the chances of the transplanted liver being ruined by the Hepatitis? 2. HIV patients are usually on multi-drug "cocktails"; are these meds toxic to the liver? If so, then that would shorten the survival of the transplanted liver 3. What stage of HIV is he in; if he is in the later stages, then a "triage" decision must be made to defer the organ to someone who does not have a disease that would shorten that recipient's lifespan (in my humble opinion). 4.; There is a shortage of donor organs, thus a moral decision will probably enter into the equation (giving the organ to a person who has a liver condition that is genetic or congenital as opposed to someone who has liver disease as a result of behavioral choices.

My guess would be that he received the diseases via either a blood transfusion, or through drug abuse. Hep C is not commonly transmitted sexually.

[cksharks]

Yessssss!

[cksharks]

Unless you f-----g need one like me. Then its not so (SUCKEY).

[agrace]

I think HIV is a little different than an inoperable brain tumor. Magic Johnson doesn't have AIDS and he's been HIV positive for what, 15 years now?

[dhs12345]

Is the disease itself cured by the transplant?

[Bikers4Bush]

The combination of HIV and Hep C are a death cocktail for this guys body.

Magic only has HIV.

[MainFrame65]

My brother - an interventional radiologist, the medical specialty that performs surgical procedures via catheters and other special tools introduced into the body via the circulatory system - was infected with hepatitis C from one of his patients at the teaching hospital where he used to work. It probably happened as a result of a glove failure, but that was never established. He could still have taught, if interferon treatment had succeeded, but instead it caused clotting problems that eventually cost him use of one arm, on top of the infection that will destroy his liver in the next few years. He has also lost a kidney, and needs colon surgery but has not decided that it is worth the ordeal.

Every time I talk to him the subject of whether his life is worth living seems to arise. He used to be physically active, but any exertion now leaves him weak and confused due to associated problems with circulation to his brain. A transplant would not change that, or restore use of his arm.

Dangerous for the surgeon? Yes, I think so. I know so. And my brother is worth more than every one of these low-lifes that ever existed.

[verity]

...Hayley Gorenberg, AIDS project director at Lambda Legal in New York...

I would not object if they used her liver for the transplant.

[dhs12345]

Sorry to hear about your brother. We take doctors, nurses, for granted.

If I were part of the "selection process," your brother would be at the top of the list.

Best wishes to him (and to you).

[leadpencil1]

Sorry to hear about your liver. How's your pumper doing?

[MainFrame65]

1. hepC is NOT eradicated by a transplant, and eventually the transplant probably will be damaged or destroyed by it. That said, understand that hepC is the MOST FREQUENT REASON for a liver transplant.

2. and 3. I have no answer.

We clearly need to define new priorities for organ access. While no usable organs should go to waste, prisoners and illegal aliens shold be moved way down the list, subject to the specific wishes of the donor or donor family. Tissue match, health, and physical condition are primary, of course. But long term survival is a reasonable issue, and HIV has to be part of that.

The recent case of a death row prisoner receiving a heart is a travesty. Some real, honest, lawful citizen died for that.

[cksharks]

I was referring to his remark about organ transplant system.But my liver keeps taking the hits from the transplant meds. Heart is doing great thank you.I had liver biopsy two months ago every fine so far.

[MainFrame65]

Actually, he has told me that in his condition, the trauma of a transplant that would still leave him crippled is not worth it. He would not allow me to be tested for a lobe transplant a couple of years ago, and now I am over the age limit.

[Centurion2000]

"There's really a problem with discrimination against people with HIV who need transplants," Gorenberg said. "They should be in the running, just like anybody else."

No he shouldn't ... he has a lethal diease with no cure ..... give the liver to someone that might take better care of themselves.

AIDS victims should be triaged right out of hospitals for long term care.

[Bikers4Bush]

Excellent points.

I'm very sorry about your brother. It's one thing to contract a disease through risky behavior, it's another to do so trying to treat someone else.

[bigfootbob]

"Is the disease itself cured by the transplant?"

From what I've read yes, most times. It's rare when HCV reappears.

[leadpencil1]

It's one thing to contract a disease through risky behavior, it's another to do so trying to treat someone else.

To clarify from your ealier post, are you saying it is a sick person's past behavior that should determine their position on the waiting list, not the fact they have Hep C?

[CholeraJoe]

How often do Hepatitis patients get liver transplants?

Hepatitis C is the most common reason for liver transplants in the US. Priority is based on severity not cause.