HIV-Positive Man Wins Transplant Ruling

By Randy Dotinga

A Massachusetts medical board ruled that an insurance company must pay for an HIV positive man's evaluation for a liver transplant.

For years, AIDS patients in need of a new liver or lung have been told there's no room for them at the transplant center. But a Massachusetts ruling in favor of a life-saving operation for an HIV-positive man is a sign that the times are changing.

This week, a Massachusetts state medical administrator ordered an insurance company to pay for a liver transplant for a 41-year-old man who suffers from hepatitis C. While the decision has no official impact outside of the state, gay advocates said the decision could be influential elsewhere.

"It's really going to have an impact. We've broken through a barrier here," said attorney Ben Klein of Gay Lesbian Advocates Defenders, a New England-based legal advocacy group that represented the patient.

Organ transplants for people with HIV and AIDS are extremely unusual, although they have become more common in recent years. Before new drugs turned AIDS into a treatable disease, insurance companies often refused to pay for the surgeries because the patients were not expected to live long.

In the Massachusetts case, an HMO that works for Medicaid refused to even pay for a consultation to see if the HIV-positive patient should have a liver transplant, Klein said. (In the state, Medicaid provides insurance to low- and moderate-income people.)

The HMO argued that the surgery would be "experimental."

It's true that doctors have worried that transplants could hurt AIDS patients because the immune system has to be repressed to prevent rejection of an organ, Klein said. AIDS patients already have weakened immune systems. But recent transplants have shown that anti-retroviral medications -- those in the AIDS drug "cocktail" -- protect HIV patients from high risks, he said.

"The insurer's claim that this is an experimental procedure is really based on outdated assumptions about HIV," he added.

The Massachusetts state administrator agreed that the transplant surgery is not experimental and ordered the insurance company to pay for a consultation and a full transplant if it is deemed necessary, said Richard McGreal, spokesman for the Massachusetts Division of Medical Assistance.

But even if the patient is cleared for surgery, there's no guarantee that a liver will be available. "My client is going on a waiting list like everybody else," Klein said.

He added that the national organization that matches organs to patients doesn't discriminate based on HIV status.

McGreal cautioned that the ruling in this case won't set a precedent. "It doesn't affect any other (Medicaid patient) who may seek the same service," he said.

But Klein hopes the ruling will influence doctors and patients all over the country. "Many doctors have not referred people with HIV for transplants because they assumed that insurance companies wouldn't pay for them," he said. "I hope this will stir some thinking about the really viable option of liver transplants for people who are going to die without them."

Copyright © 2001 PlanetOut.

This article posted December 25, 2001.