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AMA House of Delegates
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Letting states restrict or cut coverage of transplantation for financial rather than medical reasons would be tantamount to “organ allocation by wallet biopsy,” says transplant surgeon Thomas G. Peters, MD, an alternate delegate to the Florida Medical Assn. Photo by Peter Wynn Thompson / www.peterthompsonphoto.com

AMA meeting: Medicaid organ transplants need federal money

State budget shortfalls should not limit access to lifesaving transplants, delegates contend.

By — Posted July 1, 2013

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The American Medical Association House of Delegates voted to support federal funding of organ transplants for patients on Medicaid.

The move came after a 2010 action in Arizona that cut funding for certain “optional services,” including some organ transplants. The policy affected nearly 100 Arizona patients on the organ wait list and was overturned in 2011 after intense pressure from transplant surgeons and the public.

Delegates to the AMA Annual Meeting in June wanted to take action on the issue because transplantation is not among the core medical services that must be covered by states under the joint state-federal Medicaid program. With the struggling economy driving many state budgets deep into the red, physicians feared that other states would move to restrict or cut coverage of transplantation for financial rather than medical reasons.

Allowing that sort of coverage decision would be tantamount to “organ allocation by wallet biopsy,” said Jacksonville, Fla., transplant surgeon Thomas G. Peters, MD, an alternate delegate who spoke on behalf of the Florida Medical Assn.

Telling student drivers about donation

The house also voted to encourage states and local organ procurement organizations to provide educational materials about organ and tissue donation to driver education and safety classes. Nine in 10 Americans say they are interested in registering as organ donors, but less than a third know how to do so, according to Donate Life America, the nonprofit alliance of organ procurement organizations.

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Dr. Kief

Including education about organ and tissue donation could help narrow the gap, said Jan Kief, MD, a Highlands Ranch, Colo., internist.

“I work with a lot of high school students, and many don't think they're allowed to make that decision themselves, and there's a lot of confusion about that. This will be very important for those students,” said Dr. Kief, an alternate delegate for the Colorado Medical Society who testified in favor of the action in reference committee testimony. Individuals 18 and older can register as organ donors through their state systems.

Meanwhile, a proposal asking the Association to study the feasibility of a unified registry of living kidney donors was referred to the AMA Board of Trustees for a decision. The Organ Procurement and Transplantation Network already is working with the American Society of Transplant Surgeons and other bodies to examine this issue, and delegates did not want to duplicate those efforts.

Nearly 120,000 Americans are on the United Network for Organ Sharing's transplant waiting list. More than 96,000 of these candidates await a kidney.

When patients are fortunate enough to receive a kidney transplant, those who are uninsured are at greater risk of renal failure due to the cost of the immunosuppressive drug regimens and nephrology care they need. Medicare, for example, covers kidney transplants for patients of any age, but only those 65 and older enrolled in the program will have their follow-up care covered.

Delegates adopted new policy supporting “private and public mechanisms that would extend insurance coverage for evidence-based treatment of renal transplant care for the life of the transplanted organ.”

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