Some Of Oregon Poor Losing Chance At Organ Transplant

By The Associated Press

PORTLAND -- Funding cuts to the Oregon Health Plan are leading some hospitals to remove poorer uninsured patients from waiting lists for organ transplants or to keep them off the lists altogether.

They say they fear such patients won't be able to afford the $1,000 a month or so it costs for drugs to keep a new organ from being rejected.

"If they can't get their medication, they will reject their organ and they will die," said Dr. Susan Tolle, director of the Center for Ethics in Health Care at Oregon Health & Science University (OHSU).

That would be doubly tragic because the rejected organ could have gone to someone else, said Dr. Douglas Norman, OHSU director of transplant medicine.

OHSU doesn't plan to reduce the number of transplants, he said, "but those available organs are not going to go to Oregon Health Plan patients" unless the Legislature restores their drug coverage.

Transplant programs have tried to avoid a double standard, said John Niemitz, manager of transplant services at Legacy Good Samaritan Hospital and Medical Center in Portland.

"How are we going to say no to someone because they don't have the money?" Niemitz asked.

In the past, he said, they could use Medicaid or the Oregon Health Plan as a safety net.

It was the death of a 7-year-old boy seeking a transplant in Portland in 1987 that led to the creation of the original Oregon Health Plan that covers low-income residents.

To save money, the Legislature had voted to stop paying for all but kidney and cornea transplants for welfare patients.

Coby Howard, a leukemia patient, died before his unemployed mother could raise money for a bone-marrow transplant. A public outcry prompted Medicaid reform. The result was the Oregon Health Plan.

The state last month cut the Medically Needy Program for 9,000 Oregonians and Health Plan coverage for 100,000. This month, the Legislature partially restored both but only through June 30.

"That leaves us in the lurch," said Nancy Boyle, OHSU's chief social worker for cancer and organ-transplant patients.

To glimpse the possibility of a transplant, only "to find out you can't do it because you may not have enough drug coverage is devastating," Boyle said.

When a patient gets an organ transplant, the health-care system makes "an implied promise" to follow through, OHSU's Tolle said.

"They went through everything, including the $150,000 transplant operation," Tolle said. "Now, what society is saying to them is: You're not worth the $1,000 a month it takes to keep you alive."

The waiting list for a kidney transplant in Oregon is about 50 or 60 names long. Who gets a new kidney depends on blood type, tissue match, age, medical condition and wait time.

This article posted April 11, 2003.

Some Of Oregon Poor Losing Chance At Organ Transplant

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