Blue Cross-Blue Shield denies liver transplant to HIV-positive man

BY admin

February 26 2005 12:00 AM ET

Lambda Legal is urging a Blue Cross-Blue Shield health plan to reevaluate its criteria for covering organ transplants for HIV-positive people after the firm refused to pay for a liver transplant for an HIV-positive Maryland man. Officials at the health care plan, called Horizon Blue Cross-Blue Shield, refused to authorize a liver transplant for Baltimore-area resident Morris Murray, 44, who also is suffering from liver damage related to hepatitis C infection, saying the surgery is considered experimental. Lambda Legal is urging the company to reverse its decision based on a range of scientific data showing stable HIV patients have the same success rates after organ transplantation as HIV-negative adults.

"To deny our client the care he needs, Horizon is ignoring published reports on organ transplants for people with HIV and not looking at its patient's individual health status," said Jon Givner, HIV project director at Lambda Legal, in a press statement. "In the last nine years, since the advent of better treatments for people with HIV, the medical community nationwide has learned a great deal about organ transplants. Denying this man a transplant because he has HIV is not based on good medicine or sound science, and it may cost him his life."

Murray's doctors at the University of Pittsburgh, one of the top transplant centers in the nation, approved Murray for placement on their transplant list in August. That same month doctors requested preapproval for the procedure, but Horizon's plan administrator denied the request, saying that "liver transplantation in HIV-positive patients remains investigational at this time."

Lambda became involved in the second-round appeal to the plan administrator, formally asking Horizon Blue Cross-Blue Shield's plan administrator to reverse course and allow Murray to be evaluated like any other patient. In a letter sent to the plan administrator and Blue Cross-Blue Shield, Lambda said that the justification for the denial is simply untrue. "It's flat-out wrong that liver transplants for people with HIV are experimental and have unfavorable outcomes," Givner said. "There's a solid and growing body of scientific and medical evidence that clearly shows HIV does not significantly affect the outcome of liver transplantation."

Lambda cited many examples of this data in its appeal letter, including a 2002 New England Journal of Medicine article on the subject that found "no evidence of poorer survival among otherwise healthy HIV-positive patients who are receiving antiretroviral therapy," which Givner said is precisely Murray's situation. The article went on to say that "transplantation in HIV-positive patients should not be considered experimental," and it further supported reimbursement for the patients.

In the last two years, Lambda has successfully persuaded other insurance providers (including Kaiser Permanente, the Department of Veterans Affairs, and a state Medicaid program) to evaluate patients with HIV for organ transplants based on the patients' individual health status and sound scientific data.

Tags: Health

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