Transplant Nurses, what's your take on this scenario?

[grayblueyes]

here's the scenario:

a middle-aged, poor woman, who suffered from insulin-dependent diabetes mellitus, demanded that medicaid pay for a pancreas transplant. this patient was reported to be uncooperative in her previous diabetic regimen and disliked giving herself insulin injections. even though medicaid in that state has a fiscal policy that denies payment for this surgery to all program recipients, the state supreme court ruled that this woman had a right to the surgery because other people with insurance or adequate funds have access to the surgery.

do you think the patient had a "right" to this surgery?

should society (through taxes) pay for the surgery, even though the patient was known to be a nonparticipant in the needed regimen?

so i'm going no on both accounts. how would you expect a patient to follow post-transplant protocol if they are not able to follow the treatment plan for diabetes? is there something i'm missing in this scenario and what is your experience as a transplant nurse?

i've posed this question to a few co-workers and gotten the same answer but my hospital not a large hospital and does not deal with transplants of any kind.

[AugustRain]

I think this is actually a two sided issue - one is access to the surgery, the other is eligibility for it.

You are correct that this woman would likely not be placed on the transplant list if she's currently non-compliant with her existing treatment. Evaluating a patient for transplant is a complex process, but the general idea is to get an organ to the place where it can do the most good.

That being said, here is where I think the court decision comes into play: insurance should not be the barrier between a patient and a potentiall life-saving procedure. If, down the line, the transplant team re-evaluates this patient and decides she's a candidate for surgery, there won't be time for a lengthy battle with an insurance company.

In the situation you've described, it seems that the court is saying that since this procedure is covered by other insurance companies, it is fair that her insurance provides the same benefit, if she meets the medically necessary requirements. The ruling says nothing about her eligibility to receive a kidney - that determination is still in the hands of the transplant team.