Insurance Coverage Urged for All Heart and Liver Transplants

A federal advisory panel Monday recommended that government health programs and all private insurers pay for heart and liver transplants, calling such operations “as safe and effective as other procedures they cover.”

The Task Force on Organ Transplantation, in a report to Congress and the Health and Human Services Department, urged that public and private plans pay for heart and liver transplants.

“We have recommended that the current wealth discrimination that exists with heart and liver transplants be ended,” panel member John A. Robertson said at a press conference. “The procedures are well established. There is no reason to exclude them.”

Exclusion Called Unfair

Robertson, a University of Texas Law School professor, added: “We have asked the community to donate organs for the good of others. It seems unfair to exclude certain members of the community who can’t afford to pay for them.”

While the federal government has acknowledged that such operations have become routine, it has thus far failed to move to include them under Medicaid (known in California as Medi-Cal) or Medicare. Medicare now covers kidney and corneal transplants, as well as liver transplants for certain eligible children with congenital liver disease.

However, for the adult population, liver, heart and other transplants are still considered experimental and are not covered.

There were 719 heart transplants and 602 liver transplants performed in 1985, the panel said. In total, there have been 1,787 heart transplants and 1,441 liver transplants. The one-year survival rate is 80% for a heart transplant and 65% for a liver transplant, according to the committee. The cost of a heart transplant ranges from $57,000 to $110,000, and a liver transplant costs between $135,000 and $238,000, the panel said.

‘In Line With Reality’

“Given the current status of the procedures, if we’re going to be fair in terms of our policy, we should bring it in line with reality,” said Roger W. Evans, a research scientist with the Battelle Human Affairs Research Centers in Seattle and another member of the panel.