Medicare To Pay For Intestine Transplants For Some Patients

WASHINGTON (AP) -- Medicare will now pay the cost of intestinal transplants, an operation that offers the only hope of survival for some patients, a federal agency announced Thursday.

In a notice posted on its Web site, the Health Care Financing Administration said Medicare would pay for transplanting new intestines into some patients with intestine failure, but only at hospital centers with a record of success in the procedure.

The notice said it would apply only to patients with intestine failure who also have failed total parenteral nutrition, or TPN, a technique for feeding patients whose digestive systems are unable to absorb nutrients.

Only centers that perform at least 10 intestinal transplants a year and have a 65 percent one-year patient survival rate will be eligible for the Medicare payments, the notice said.

Dr. Kareem Abu-Elmagd, a transplant surgeon at the University of Pittsburgh Medical Center, said in a statement that the federal decision is an important victory for transplant patients.

"Without the financial burden and associated hassles, patients can now concentrate on getting well with transplants," said Abu-Elmagd.

In a February 1999 presentation to HCFA, the University of Pittsburgh had requested that intestinal transplant be included in Medicare. The medical center had argued that survival rates for intestinal transplants were now comparable to rates for other types of organ transplants.

Medicare already pays for most of the costs associated with many transplants of the heart, kidney, lung and liver.

Lisa Rossi, a spokeswoman at the University of Pittsburgh Medical Center, said that her center and at least two others, the University of Miami and the University of Nebraska, Omaha, will meet the HCFA standard to qualify for Medicare payment for intestinal transplants operations.

Under the new rules, Medicare will pay for the transplant costs for patients with failed intestines who also have experienced complications from TPN.

TPN is the only way patients with failed intestines can be nourished. The technique involves supplying sugars, fats, vitamins and carbohydrates to the patient in a fluid that is dripped into a blood vessel.

Rossi said there are about 40,000 patients in the U.S. being sustained with TPN and that about 13,000 of these patients eventually will develop life-threatening complications. A transplant is the only hope for survival for such patients.

Because liver failure often follows intestinal failure, many patients receive transplants of both organs at the same time.

TPN complications include liver failure, blood clots and severe infections. All of these adverse events would make a TPN patient eligible for Medicare-supported intestinal transplants.

Intestinal transplant operations costs vary from patient to patient, but are generally are about $400,000 or more. For the rest of their lives, the transplant patients also must take an immune suppression drug that costs about $10,000 a year. Medicare may not cover all of the lifetime costs of the drug, Rossi said.

This article posted October 14, 2000.

Medicare To Pay For Intestine Transplants For Some Patients

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