Subsidy Program Also Sought : Expanded Insurance Urged for Transplants

A federal task force is recommending significant expansion of health insurance to cover organ transplants, including a subsidy program for people who cannot afford the costly operations.

Although the Task Force on Organ Transplantation will not issue its report until next month, a final draft has been circulated on Capitol Hill.

“We are saying that if you don’t now cover transplants of hearts, livers and kidneys, you ought to. And for those with no means to pay, there ought to be something in place to help,” Linda Sheaffer, executive director of the task force, said Sunday.

The White House has expressed concern that acting on the proposals might entail more than $70 million a year in increased government costs.

Beyond expanding insurance coverage, the panel of 25 specialists also recommends various steps to increase the number of transplants that can be performed. For example, hospitals that receive Medicare payments would be required to ask the relatives of dying persons to authorize donation of the patient’s organs.

Limit on Foreign Access

At the same time, the task force suggests placing a 10% ceiling on the proportion of all organ transplants that can be made available to foreigners who come to the United States for surgery. About a third of the kidney transplants at some American hospitals are performed on non-resident foreigners, a 1983 study found.

The federal Medicare program now pays for more than 90% of the kidney transplants in this country, but does not cover heart or liver transplants. Neither does Medicare cover the cost of medications patients must take after surgery to prevent bodily rejection of the donated organ. The task force recommends that Medicare also pick up the cost of such drugs for people who cannot afford them.

Private insurers now cover about 80% of all heart and liver transplants. The task force proposes that private and public insurance programs, including Medicare and Medicaid, also cover the heart and liver operations. The federal portion of these costs might total $42 million to $70 million a year, the task force said.

Subsidies for Uninsured

Some people, however, still would not be covered by private insurance, Medicare or Medicaid and would not be able to afford an organ transplant. The task force proposes that these people be covered by a subsidy program, supported by private, state and federal funds, that would cost between $21 million and $35 million a year.

“The task force believes you should not be denied a transplant solely because you can’t pay for it,” Sheaffer said.

The average cost of an organ transplant in the first year is about $35,000 for a kidney, $95,000 for a heart and $130,000 for a liver. These figures include drug therapy, which may cost as much as $5,000 a year.

In 1985, surgeons in the United States performed 7,800 kidney transplants, 719 heart transplants and 602 liver transplants.