Medicare and transplants

cannoli · Mar 13, 2004

What happens after three years, and the person can't afford to continue the med on their own?

manna, BSN, RN · Mar 13, 2004

Interesting question, but I don't know the answer - even though I just read the book by Dr. William Frist about his work in the transplant service at Vandy.

caroladybelle, BSN, RN · Mar 13, 2004

I have a question about Medicare and tranplants. I gave a seminar today about health care costs and when researching the topic came across information on Medicare, specifically medicare B. They will cover the cost of a Kidney Transplant and meds up to 3 years after the surgery. Why don't they do this for heart and lung transplants as well? Why just kidney transplants?

I believe that it has to do with monetary, efficacy, and legal issues. It is rather complex.

Kidney transplants are rather effective, generally quite successful, inexpensive when compared to hemodialysis (for life) and renal failure meds and inexpensive when compared to other transplants. My understanding is that they are long lasting when good care is taken and there are fewer age constraints. Kidneys are also easily available with much closer HLA(?) matching, so rejection occurs less often than other transplants and fewer meds are needed for preventing rejection.

In other words, they make good health/financial sense.

Lung and Heart transplants are more difficult, are not as long lasting, a good match is much more difficult to come by, with lots of expensive long term meds required for the life of the organ. The longterm success of the organ in older adults is poorer (or so I have been told). And there are stricter age constraints that might be seen as age discriminatory with heart/lung transplants, that could lead to expensive llitigation.

If they do not specify that they cover that procedure, it gets them out of an expensive, and not all that long term effective procedure.

Now, many cases are seen on a case by case situation or covered by Medicaid. And I believe that Medicaid covers some continuing care of Kidney transplant patients. But I could be wrong.

People may have problems with the financially and age discriminatory policies, but there is a limit on organs available (especially hearts and lungs) and the organs/meds have to go to those that can get the best/most use and can care for them best. That can be seen as discriminatory as exemplified by a recent court decision, that forced UNOS to give organs to patients even though they were lousy transplant risks, rather than the better risk patients, and ocasionally having to transport organs long distances (despite that the time delay may harm organs and transplant success) because of ratings on the transplant list.

Just my view on the subject.

Brob · Mar 14, 2004

Hi,

My sister-in-law had a kidney transplant about 3 1/2 yrs ago. Medicare paid for not only for her surgery but also for my other sister-in-laws surgery who donated the kidney.

The reason medicare was so willing to do this was because of the extremly exhorbinant cost of dialysis estimated at approx. $55,000 a month!!!! where as the surgery and follow up for 1 yr was about $75,000 total.

I do not know why the other conditions are not covered but in this case it seems like a financially practical thing to do.

(Its nice to know that sometimes the financially practical thing to do is best for the patient!!!)