I just can't stand to live in this country any more

[R00k]

After the operation, her liver failed and doctors referred her for an emergency transplant. Although she was fully insured and had a matching donor, Cigna refused to pay on the grounds that her healthcare plan "does not cover experimental, investigational and unproven services".

She already had a liver - they just didn't want to pay for the operation.

[seremtan]

christ geebs i'm glad you're not my doctor

[Geebs]

After the operation, her liver failed and doctors referred her for an emergency transplant. Although she was fully insured and had a matching donor, Cigna refused to pay on the grounds that her healthcare plan "does not cover experimental, investigational and unproven services".

She already had a liver - they just didn't want to pay for the operation.

Note also that she "had been in a coma for weeks". The story doesn't tell us why, could have been a vascular brain injury, could have been anything up to a fungal meningitis (extremely bad news). Being on a liver ITU all of that time, with immunosuppression post bone marrow graft would have made her a shoo-in for a systemic infection, especially since I suspect she was intubated and ventilated. i.e. the survivability and potential for return to normal life of the procedure was likely very low. Add in the fact that an OLT is a 6ish hour procedure and she was probably throughly depleted in platelets and clotting factors, she would have had a high probability of dying on the table.

Her case is highly tragic because a bone marrow transplant is actually a pretty safe procedure. What I was trying to illustrate was that a) no, it wasn't a straightforward transplant - she was in even worse condition than most people who get one, and that's saying a lot and b) despite the Guardian's spin of this story to support its generalized loathing of the Great Satan, there's not a chance in hell that she'd have qualified for a liver in the UK.

The hospital also didn't do the procedure pro bono. I looked up the absolute contraindications for a liver transplant in the US, and depressingly enough, one of the absolute contraindications cited for the procedure is "inability to pay".

[Geebs]

christ geebs i'm glad you're not my doctor

Yeah, I'd DNR you on the grounds of advanced age the second you came in the door

[seremtan]

and moments later, your supervisor would call you a blind cunt send you over to optometry for a pair of milk bottle bottoms

[LawL]

Get over it pedotan he doesn't specialise in geriatric patients suffering from AIDS.

[R00k]

After the operation, her liver failed and doctors referred her for an emergency transplant. Although she was fully insured and had a matching donor, Cigna refused to pay on the grounds that her healthcare plan "does not cover experimental, investigational and unproven services".

She already had a liver - they just didn't want to pay for the operation.

Note also that she "had been in a coma for weeks". The story doesn't tell us why, could have been a vascular brain injury, could have been anything up to a fungal meningitis (extremely bad news). Being on a liver ITU all of that time, with immunosuppression post bone marrow graft would have made her a shoo-in for a systemic infection, especially since I suspect she was intubated and ventilated. i.e. the survivability and potential for return to normal life of the procedure was likely very low. Add in the fact that an OLT is a 6ish hour procedure and she was probably throughly depleted in platelets and clotting factors, she would have had a high probability of dying on the table.

Her case is highly tragic because a bone marrow transplant is actually a pretty safe procedure. What I was trying to illustrate was that a) no, it wasn't a straightforward transplant - she was in even worse condition than most people who get one, and that's saying a lot and b) despite the Guardian's spin of this story to support its generalized loathing of the Great Satan, there's not a chance in hell that she'd have qualified for a liver in the UK.

The hospital also didn't do the procedure pro bono. I looked up the absolute contraindications for a liver transplant in the US, and depressingly enough, one of the absolute contraindications cited for the procedure is "inability to pay".

Obviously you know more about the medical details of it than I ever would. I was just relying on the doctors' statements as evidence that it would have helped her.

Here in the states it is very, very hard to get a transplant, and it is extremely hard to qualify for an emergency transplant because organs are in such short supply. But her doctors not only qualified her for an emergency transplant, they also wrote a letter to the insurance company urging them to approve it for her. I'm only assuming, but to me that makes it sound like it had a very high chance of improving her circumstances, and also that she had a very good chance of surviving. Those are two of the things that they look at for qualification.

The only reason I know anything about liver transplants is that a relative of mine had to have one, and it was a nightmare. The transplant eventually started failing after a few years, but he could not be approved for a second one, even though there was a likelihood that it could/would have done better than the first and lasted for a long time. The chance of it actually working out was greatly outweighed by the risk of it failing again, and thus wasting a very valuable organ for someone that it had a much higher chance of helping.

[seremtan]

Get over it pedotan he doesn't specialise in geriatric patients suffering from AIDS.

shame, that's one less lifeline for your dad

[Dave]

Here in the states it is very, very hard to get a transplant, and it is extremely hard to qualify for an emergency transplant because organs are in such short supply. But her doctors not only qualified her for an emergency transplant, they also wrote a letter to the insurance company urging them to approve it for her. I'm only assuming, but to me that makes it sound like it had a very high chance of improving her circumstances, and also that she had a very good chance of surviving.

Exactly... All respect to geeb's education, which I'm sure makes him an expert in the field of transplants, he wasn't there.

[Dr_Watson]

usually when i'm looking to depress myself about helathcare i just flip over here.

[Big Kahuna Burger]

Looks like the insurance company is sticking by their decision http://rawstory.com/news/2007/Cigna_off ... _1225.html

[LawL]

Get over it pedotan he doesn't specialise in geriatric patients suffering from AIDS.

shame, that's one less lifeline for your dad

And one less Doctor willing to treat you for AIDS.

[tnf]

Hmm. She was immunosuppressed because of the bone marrow transplant, liver failure was likely either due to antibiotics or immunosuppressants, and she would have required more of both to survive a liver transplant. Plus, donor livers don't grow on trees. I expect she would have dies on the transplant list either way; plus these sorts of treatments are much less available in countries other than the US.

Then again, insurance companies refusing to pay up for e.g. diabetes is pernicious.

That seems to be the tough part of all this. Considering the relative scarcity of donor livers, it must make for a very difficult choice by the docs to say patient X has a higher chance of survival than patient Y, and therefore gets the liver.

As for the liver failure being due to immunosuppressants and antibiotics...sure she would need more of both to survive the transplant, but if she has another liver in her wouldn't the risk posed by those to her liver be reduced to some extent? Or are you talking about needing more prior to surgery while she is on her own liver?

[Geebs]

More that she was extremely unlikely to survive to benefit from the liver, given that she was already comatose for weeks, and given an already high risk of infection, more immuosuppression would have made her very vulnerable. There's not really a reason to assume that the donor liver would be injured in the same way as her own; presumably she had a fulminant hepatic failure as a result of her previous treatment, which is usually an idiosyncratic reaction.

Her doctors quoted a figure of 65% likely survival with good function, which is a bit suspect.

[Foo]

Surely if there's any hope, you go ahead.

Otherwise it is just about the dollar figure.

[Geebs]

It's never, ever that simple even if money is no object.

[R00k]

I haven't seen the 65% figure before, but why do you think it's suspect? Do you think her doctors were trying to grease the wheels for her and make exceptions even though she might not last that long?

[tnf]

Surely if there's any hope, you go ahead.

Otherwise it is just about the dollar figure.

That might be a bit idealistic and not really possible considering the demand for organs and the people on waiting lists. With limited resources I think doctors have to go with those who have the best chances for surviving - I guess you could say those with the most hope. Those considerations don't make it all about money.

Now, on the other hand -
My aunt had a heart transplant, and I will say that her doctor had to fight hard for her to be put on the list. Other docs gave her little to no chance at living very long with or without a transplant due to the number of surgeries she had and her past history with cancer as a teenager. She is 12 years post transplant now and doing well. If the majority decision had won - if they had just gone purely with statistical information and her surgeon hadn't had the pull he does - she wouldn't be around today. It's definitely one of those things where there will always be someone who gets screwed who really shouldn't.