Heartbreaking Choice : Couple May Have to Divorce to Afford Organ Transplant

After nearly 25 years of marital happiness, Jeff and Rosemarie Litoff are considering a divorce. But not because of the usual problems that break up families.

Their fight is against a degenerative disease that is gradually weakening Jeff’s heart.

Last month, the 50-year-old appliance repairman was told by his doctors that without a heart transplant he had less than a year to live.

But at a cost of approximately $200,000 for the surgery and the first year of postoperative care--and with insurance covering only $50,000--the family cannot afford the transplant.

Short of a massive fund-raising campaign, divorce may be they only way to come up with the money, the couple says.

On Friday, an attorney told the couple that by breaking up their marriage they can transfer all their assets into Rosemarie’s name. Jeff can then declare himself indigent and apply for MediCal, which covers the cost of organ transplants.

“I may have to divorce to live,” said Litoff, a quiet, retiring man whose rosy cheeks belie his illness. “I will do anything to stay with my family as long as I can have a good quality of life.”

Divorcing in order to qualify for MediCal is legal, Rosemarie Litoff said after consulting with an attorney who specializes in MediCal law.

“It is not illegal,” she said. “It is finding a way to use the law the way it is written.”

The divorce would take place on paper only, Rosemarie said, adding that Jeff would not even have to move out of their Newbury Park home.

Sitting at the kitchen table of their home last week with their 19-year-old son, Brett, the couple said that although they consider divorce a bad option--an unethical stab at “beating the system”--it is a step they are willing to take.

“It stinks,” Rosemarie said. “It is basically taking it out of the taxpayers’ pocket, but if we can’t do it any other way, it is a possibility.”

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In a system in which only the very rich, the very poor or the well-insured can afford the lifesaving transplant surgery, they are not the only ones to consider the option, said Andrew Prislovksy, a patient coordinator for the Tennessee-based Organ Transplant Fund Inc., a national nonprofit organization that helps patients raise money for organ transplants.

Although it’s not common, he has seen other couples do it.

“It is very sad,” he said. “But it is one of those things that people have to do. We are sometimes raising money just to help people stay together.”

Prislovsky will help coordinate fund-raising efforts for the Litoffs so they won’t have to divorce.

“We are going to do everything we can so they don’t have to exercise that option,” said Alan Greenbaum, a rabbi at the Temple Adat Elohim in Thousand Oaks, where the couple worships.

The Litoffs’ problems began in November 1991 when Litoff was admitted to the hospital after a major heart attack. During surgery, doctors discovered that Litoff had four blocked vessels and a degenerative heart disease that had weakened 80% of his heart muscle.

A normal heart ejects about 55% to 70% of the body’s blood with each heartbeat, said Dr. John Hess, Litoff’s cardiologist at Westlake Medical Center.

Litoff’s heart was pumping only 20% to 25% of his blood per beat.

The damage, Hess said, was due to a lifetime of small, “silent” heart attacks.

Litoff, a diabetic, had a nervous system that was not as sensitive to chest pain as many, Hess said, so the attacks went unnoticed.

After unblocking two of Litoff’s four clogged arteries, doctors prescribed a medication and a no-salt diet.

But Litoff’s heart has continued to deteriorate.

Once active as a scoutmaster for Boy Scout Troop 754, Litoff had to give up hiking with the group. Now he only attends meetings.

And as his stamina has declined, Litoff has been forced to nap more and work less.

“I look after him a lot now,” said Brett, a sophomore at Moorpark College. “If he starts to lift something, my mom and I yell at him.”

When it became clear that medication wasn’t stabilizing his condition, Hess sent Litoff to the UCLA Heart and Lung Transplant Program for tests.

Last month, he became a candidate for a heart transplant.

And not only did he qualify, UCLA doctors said, Litoff was told that the waiting list for a heart of his blood type is very short.

There are very few candidates waiting for AB-positive-type hearts, said Johanna Salamandra, transplant coordinator for the UCLA program.

“What we tell AB blood types when we put them on the list is that they have to be ready for that day, because generally there are not very many, if any, on the list at that moment,” she said. “In contrast, we tell Type O that they will have at least a year’s wait.”

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But there was a catch: To be put on the list, Litoff had to prove that he could pay for the operation.

And with a shrinking income, skyrocketing bills and problems finding adequate health insurance, Litoff didn’t qualify.

“They have to be prepared to support the organ,” said Ruth Irwin, manager of financial counseling for the UCLA Medical Center. “It is a very scarce resource, and you don’t want a patient to lose it because they can’t pay for it.”

The family used to have a plum package of insurance benefits but lost them last year when Rosemarie Litoff lost her job at a small mail-order company due to downsizing.

The only private insurer that would cover Litoff will pay only $50,000 a year for his medical costs, a fraction of the estimated $200,000 bill for the first year of transplant care.

Meanwhile, Litoff’s income has dropped by 75% since his illness struck. And although his wife has started her own mail-order business, she had to take out loans from family members to do it, further restricting the family’s finances.

“We pay $700 a month in medication bills,” she said. “Our expenses are going up while our income is dwindling.”

“We are trapped,” Jeff Litoff said. “In order to get a heart, we have to be financially secure or . . . “

“Or he has to become indigent,” Rosemarie concluded.

* FINANCIAL AID: Financial contributions for the Litoffs can be sent in care of the family to Organ Transplant Fund Inc., P.O. Box 766, Newbury Park, CA. 91319-0766.

* FUND-RAISING: For those interested in assisting in fund-raising efforts, a brainstorming meeting led by Andrew Prislovksy of the Organ Transplant Fund will take place at 7 p.m. Sunday at the Temple Adat Elohim, 2420 E. Hillcrest Drive, Thousand Oaks.