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State Medicaid rejects liver transplant for Altoona man with HIV
The Pittsburgh Post-Gazette ^ | Friday, November 21, 2003 | Anita Srikameswaran

Posted on 11/21/2003 12:43:16 PM PST by Willie Green

Edited on 04/13/2004 2:35:24 AM PDT by Jim Robinson. [history]

State Medicaid officials have refused to pay for a liver transplant for an Altoona man because he is infected with HIV, a position the man's attorneys argue is discriminatory and not based on current medical knowledge and practice.

William Jean Gough, 46, meets the medical criteria for the procedure and his survival chances are as good as someone who isn't infected with the AIDS virus, said Hayley Gorenberg, AIDS project director at Lambda Legal in New York, which, along with the AIDS Project of Pennsylvania, is representing Gough in his appeal of the decision.


(Excerpt) Read more at post-gazette.com ...


TOPICS: Culture/Society; Government; US: Pennsylvania
KEYWORDS: aids; grids; healthcare; homosexaulagenda; homosexual; homosexualagenda; lambdalegal
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1 posted on 11/21/2003 12:43:17 PM PST by Willie Green
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To: Willie Green
Just curious -- how risky is it for the surgeons? They are dealing with infected blood.
2 posted on 11/21/2003 12:46:47 PM PST by dhs12345
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To: Willie Green
There is NO cure for aids. Eventually he will die and what is to keep the Hep C from ravaging the new liver?

Giving him a liver would be like giving someone with an inoperable terminal brain tumor a new organ. Pointless.
3 posted on 11/21/2003 12:47:17 PM PST by Bikers4Bush
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To: Bikers4Bush
To be fair, we are all dying. There is no cure for old age. Eventually we will all die.

Handle this case by case and hope for the best. If he has an unusually short lifespan expected, then it may be wise to pass him up for the organ transplant.

It's not unusual for AIDS patients to live for long periods of time - advances in drugs and treatment make living a more full life more realistic.
4 posted on 11/21/2003 12:52:03 PM PST by HitmanLV (I will not be pushed, filed, stamped, indexed, briefed, debriefed or numbered. My life is my own.)
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To: dhs12345
how risky is it for the surgeons?

Live transplant is an incredibly difficult and bloody procedure. They can bleed more than anyother surgery, and the lines necessary to safely do this proceudre as multiple and complex. This is horrendously risky for both the surgeon and the anesthesiologist.

5 posted on 11/21/2003 12:53:43 PM PST by gas_dr (Trial lawyers are Endangering Every Patient in America)
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To: dhs12345
I thought that as well.

Any doctor certainly can opt out of the operation because of the risk involved.

That probably also increases the cost of the operation a substantial amount as well.
6 posted on 11/21/2003 12:54:01 PM PST by anobjectivist (The natural rights of people are more basic than those currently considered)
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To: Bikers4Bush
There is NO cure for aids. Eventually he will die and what is to keep the Hep C from ravaging the new liver?

The article does not say aids - it say HIV.

7 posted on 11/21/2003 12:55:45 PM PST by cinFLA
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To: Boxsford
Your own backyard
8 posted on 11/21/2003 12:57:13 PM PST by discostu (You figure that's gotta be jelly cos jam just don't shake like that)
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To: HitmanNY
You're right we are all dying, but we all haven't fast tracked ourselves in that process by engaging in risky behaviors.

He either caught AIDS and Hep C by sharing needles or through his sexual practices. Had he caught it through a blood transfusion you can bet they'd have mentioned it. Either way neither of those diseases is curable and both are ultimately fatal.

There's an organ shortage as it is in this country, there's no point in putting the few that are available into people with terminable diseases that replacing an organ won't fix.

9 posted on 11/21/2003 12:59:38 PM PST by Bikers4Bush
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To: Bikers4Bush
bump to post #9
10 posted on 11/21/2003 1:01:09 PM PST by KantianBurke (Don't Tread on Me)
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To: cinFLA
HIV and Aids are one and the same, one stems from the other.

To say that they aren't is ignoring the facts and perpetuating a lie.

Cancer is cancer, they could have done the same thing the aids activists did and called what happens to the body as a result "cancer related illnesses" but it still wouldn't change the fact that the cancer killed you.
You get HIV and the results of the HIV is the destruction of the immune system and a subsequent breakdown. Calling the process by which the HIV virus kills the body by another name doesn't change the fact that contracting the HIV virus caused the breakdown.
11 posted on 11/21/2003 1:06:25 PM PST by Bikers4Bush
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To: HitmanNY
It boils down to who is the most likely to benefit (quality of life, etc.) from the transplant.

It would be a tough decision; AIDS/HIV or not.

How often do Hepatitis patients get liver transplants? Are they low priority?

12 posted on 11/21/2003 1:06:38 PM PST by dhs12345
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To: gas_dr
Can't blame the doctor for not wanting to take the risk.
13 posted on 11/21/2003 1:07:56 PM PST by dhs12345
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To: Bikers4Bush
I basically agree with you, but what I'm saying its case-by-case.

Big drinkers ruin their livers - they are fasttracked to death because of their behavior. Yet, they get organs just like anyone else would/

It's case by case. I'm with you though - the whole organ industry royally sucks, but what can we do? Until we can develop machines that can be used for organs, or be able to clone organ parts, it's a sucky system out there.
14 posted on 11/21/2003 1:08:01 PM PST by HitmanLV (I will not be pushed, filed, stamped, indexed, briefed, debriefed or numbered. My life is my own.)
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To: HitmanNY
Actually that's not comletely true. Alcoholics can be and are denied transplants if they continue to drink or refuse to enter rehab programs.

Same thing with smokers and lung transplants. They can be and most of the time are refused the transplant if they won't stop smoking.
15 posted on 11/21/2003 1:10:12 PM PST by Bikers4Bush
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To: HitmanNY
And I agree that the system in place isn't ideal but at this point it's all we've got.
16 posted on 11/21/2003 1:10:47 PM PST by Bikers4Bush
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To: Bikers4Bush
I know - what I am saying it's case by case. It's entirely possible someone who damaged their organ (yet turned over a new leaf) could be given a new organ.
17 posted on 11/21/2003 1:11:22 PM PST by HitmanLV (I will not be pushed, filed, stamped, indexed, briefed, debriefed or numbered. My life is my own.)
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To: Bikers4Bush
He could try to find a living donor. Then there would be no complication with the "waiting list".
18 posted on 11/21/2003 1:12:26 PM PST by leadpencil1 (Kill your television)
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To: dhs12345
"How often do Hepatitis patients get liver transplants? Are they low priority?"

#1 cause of liver transplants world-wide.

19 posted on 11/21/2003 1:13:33 PM PST by bigfootbob
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To: HitmanNY
Very true. There are cases like that.

I just shudder to think of this guy getting a liver that could have gone into some kid instead and the kid dying waiting for another one while the diseases that this guy has contracted continue to ravage his body and the new organ.

In a case like this that guy should be last on the list, if everyone else that could be offered the organ refuses it then he gets his shot.
20 posted on 11/21/2003 1:14:39 PM PST by Bikers4Bush
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To: leadpencil1
If he finds a relative or friend willing to give him a piece of theirs and he can find doctors willing to do the surgery then more power to him.


21 posted on 11/21/2003 1:16:09 PM PST by Bikers4Bush
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To: Willie Green
Important points: 1. Is Hepatitis C eradicated from the body after a liver transplantation? If not, what are the chances of the transplanted liver being ruined by the Hepatitis? 2. HIV patients are usually on multi-drug "cocktails"; are these meds toxic to the liver? If so, then that would shorten the survival of the transplanted liver 3. What stage of HIV is he in; if he is in the later stages, then a "triage" decision must be made to defer the organ to someone who does not have a disease that would shorten that recipient's lifespan (in my humble opinion). 4.; There is a shortage of donor organs, thus a moral decision will probably enter into the equation (giving the organ to a person who has a liver condition that is genetic or congenital as opposed to someone who has liver disease as a result of behavioral choices.

My guess would be that he received the diseases via either a blood transfusion, or through drug abuse. Hep C is not commonly transmitted sexually.

22 posted on 11/21/2003 1:17:39 PM PST by Born Conservative ("Forgive your enemies, but never forget their names" - John F. Kennedy)
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To: dhs12345
Yessssss!
23 posted on 11/21/2003 1:18:04 PM PST by cksharks
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To: HitmanNY
Unless you f-----g need one like me. Then its not so (SUCKEY).
24 posted on 11/21/2003 1:20:13 PM PST by cksharks
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To: Bikers4Bush
I think HIV is a little different than an inoperable brain tumor. Magic Johnson doesn't have AIDS and he's been HIV positive for what, 15 years now?

25 posted on 11/21/2003 1:23:43 PM PST by agrace
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To: bigfootbob
Is the disease itself cured by the transplant?
26 posted on 11/21/2003 1:24:43 PM PST by dhs12345
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To: agrace
The combination of HIV and Hep C are a death cocktail for this guys body.

Magic only has HIV.
27 posted on 11/21/2003 1:25:38 PM PST by Bikers4Bush
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To: dhs12345
My brother - an interventional radiologist, the medical specialty that performs surgical procedures via catheters and other special tools introduced into the body via the circulatory system - was infected with hepatitis C from one of his patients at the teaching hospital where he used to work. It probably happened as a result of a glove failure, but that was never established. He could still have taught, if interferon treatment had succeeded, but instead it caused clotting problems that eventually cost him use of one arm, on top of the infection that will destroy his liver in the next few years. He has also lost a kidney, and needs colon surgery but has not decided that it is worth the ordeal.

Every time I talk to him the subject of whether his life is worth living seems to arise. He used to be physically active, but any exertion now leaves him weak and confused due to associated problems with circulation to his brain. A transplant would not change that, or restore use of his arm.

Dangerous for the surgeon? Yes, I think so. I know so. And my brother is worth more than every one of these low-lifes that ever existed.
28 posted on 11/21/2003 1:33:55 PM PST by MainFrame65
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To: Willie Green
...Hayley Gorenberg, AIDS project director at Lambda Legal in New York...

I would not object if they used her liver for the transplant.

29 posted on 11/21/2003 1:38:45 PM PST by verity
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To: MainFrame65
Sorry to hear about your brother. We take doctors, nurses, for granted.

If I were part of the "selection process," your brother would be at the top of the list.

Best wishes to him (and to you).
30 posted on 11/21/2003 1:42:36 PM PST by dhs12345
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To: cksharks
Sorry to hear about your liver. How's your pumper doing?
31 posted on 11/21/2003 1:43:49 PM PST by leadpencil1 (Kill your television)
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To: Born Conservative
1. hepC is NOT eradicated by a transplant, and eventually the transplant probably will be damaged or destroyed by it. That said, understand that hepC is the MOST FREQUENT REASON for a liver transplant.

2. and 3. I have no answer.

We clearly need to define new priorities for organ access. While no usable organs should go to waste, prisoners and illegal aliens shold be moved way down the list, subject to the specific wishes of the donor or donor family. Tissue match, health, and physical condition are primary, of course. But long term survival is a reasonable issue, and HIV has to be part of that.

The recent case of a death row prisoner receiving a heart is a travesty. Some real, honest, lawful citizen died for that.
32 posted on 11/21/2003 1:55:27 PM PST by MainFrame65
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To: leadpencil1
I was referring to his remark about organ transplant system.But my liver keeps taking the hits from the transplant meds. Heart is doing great thank you.I had liver biopsy two months ago every fine so far.
33 posted on 11/21/2003 1:58:30 PM PST by cksharks
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To: dhs12345
Actually, he has told me that in his condition, the trauma of a transplant that would still leave him crippled is not worth it. He would not allow me to be tested for a lobe transplant a couple of years ago, and now I am over the age limit.
34 posted on 11/21/2003 2:00:34 PM PST by MainFrame65
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To: Willie Green
"There's really a problem with discrimination against people with HIV who need transplants," Gorenberg said. "They should be in the running, just like anybody else."

No he shouldn't ... he has a lethal diease with no cure ..... give the liver to someone that might take better care of themselves.

AIDS victims should be triaged right out of hospitals for long term care.

35 posted on 11/21/2003 2:02:58 PM PST by Centurion2000 (Resolve to perform what you ought, perform without fail what you resolve.)
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To: MainFrame65
Excellent points.

I'm very sorry about your brother. It's one thing to contract a disease through risky behavior, it's another to do so trying to treat someone else.

36 posted on 11/21/2003 2:08:52 PM PST by Bikers4Bush
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To: dhs12345
"Is the disease itself cured by the transplant?"

From what I've read yes, most times. It's rare when HCV reappears.

37 posted on 11/21/2003 2:12:13 PM PST by bigfootbob
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To: Bikers4Bush
It's one thing to contract a disease through risky behavior, it's another to do so trying to treat someone else.

To clarify from your ealier post, are you saying it is a sick person's past behavior that should determine their position on the waiting list, not the fact they have Hep C?

38 posted on 11/21/2003 2:20:21 PM PST by leadpencil1 (Kill your television)
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To: dhs12345
How often do Hepatitis patients get liver transplants?

Hepatitis C is the most common reason for liver transplants in the US. Priority is based on severity not cause.

39 posted on 11/21/2003 2:20:48 PM PST by CholeraJoe (Daddy, how many US soldiers have to die in defense of Freedom? Daughter, if necessary, all but 9.)
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Comment #40 Removed by Moderator

To: HitmanNY
The doctors and nurses are not at risk from catching cirrhosis though. Just as in life, many HIV and AIDS carriers don't care about how many they infect. They don't care while they are dying either. And of course, the nurses can't opt out. It's not a matter of saving a life anymore but a matter of dying because of others lifestyles and their "rights" to do whatever feels good.
41 posted on 11/21/2003 3:21:02 PM PST by freeangel (freeangel)
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To: civil discourse
I like the idea of "you have to be willing to give in order to receive". Makes sense to me! That would encourage more people to register as organ donors and make more organs available to everyone.
New Light (I like new ideas.)
42 posted on 11/21/2003 3:55:02 PM PST by NewLight
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To: Bikers4Bush
That's not true. But, I agree with the rest of your post. Likely the behavior will not change and his health will be in jeapardy once again.
43 posted on 11/22/2003 1:14:28 PM PST by Boxsford
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To: leadpencil1
Absolutely. It's something that should, and is, taken into account when they are being screened.

For instance if a smoker is in need of a lung transplant but refuses to quit smoking that person would be turned down.

If someone engages in risky behavior, needle sharing etc. and as a result they contract Hep C then the fact is that even if they get an organ they may go right back to participating in the same behavior rendering the donated organ ultimately useless.

Meanwhile someone who had a congenital defect or caught Hep C through no fault of their own may have to continue to wait.
44 posted on 11/24/2003 6:32:55 AM PST by Bikers4Bush
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To: dhs12345
Just curious -- how risky is it for the surgeons? They are dealing with infected blood.

Just life or death for the surgeons. One nick with a scalpel or if they stick themselves with a suture needle it could be a death sentence. Something all of us in medicine deal with on a daily basis. At least in this case they KNOW. Most of the time we DON'T.
45 posted on 11/24/2003 6:36:31 AM PST by Kozak (Anti Shahada: " There is no God named Allah, and Muhammed is his False Prophet")
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To: cinFLA
The article does not say aids - it say HIV.

A distinction without a difference. The only time I am aware of that having the infectious organism isn't considered a disease. If you are infected with Hepatitis B virus, you have Hepatitis B even if assymptomatic. If you have Plasmodium Falciparum in your RBC's or liver you have Malaria, even if you have no crisis. This HIV AIDS distinction is a political legacy of the early days when we did not have an organism and diagnosis was based of clinical findings. It's medically meaningless now.
46 posted on 11/24/2003 6:41:47 AM PST by Kozak (Anti Shahada: " There is no God named Allah, and Muhammed is his False Prophet")
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To: civil discourse
I'd agree with what you said except for the children opting out part.

The government already controls too much of our childrens lives controlling their bodies be default as well is not acceptable.
47 posted on 11/24/2003 6:55:51 AM PST by Bikers4Bush
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Comment #48 Removed by Moderator

To: Kozak
A distinction without a difference.

Apparently you are totally ignorant on the difference between HIV positive and AIDS. Some can live forever with HIV but if you have AIDS (a syndrome - NOT a disease) you are most likely already dying.

49 posted on 11/24/2003 6:38:57 PM PST by cinFLA
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To: cinFLA
If you think anyone can live forever you are the one who is ignorant.

And the definition of AIDS is? Here's a description of the disease process ( and it is a disease look up the definition of "disease"). From the CDC Web site.

SYMPTOMS OF HIV INFECTION Many people do not have any symptoms when they first become infected with HIV. Some people, however, have a flu-like illness within a month or two after exposure to the virus. This illness may include Fever Headache Tiredness Enlarged lymph nodes (glands of the immune system easily felt in the neck and groin These symptoms usually disappear within a week to a month and are often mistaken for those of another viral infection. During this period, people are very infectious, and HIV is present in large quantities in genital fluids.

More persistent or severe symptoms may not appear for 10 years or more after HIV first enters the body in adults, or within two years in children born with HIV infection. This period of "asymptomatic" infection is highly individual. Some people may begin to have symptoms within a few months, while others may be symptom-free for more than 10 years.

Even during the asymptomatic period, the virus is actively multiplying, infecting, and killing cells of the immune system. The most obvious effect of HIV infection is a decline in the number of CD4 positive T cells (also called T4 cells) found in the blood -- the immune system's key infection fighters. At the beginning of its life in the human body, the virus disables or destroys these cells without causing symptoms.

As the immune system worsens, a variety of complications start to take over. For many people, the first signs of infection are large lymph nodes or "swollen glands" that may be enlarged for more than three months. Other symptoms often experienced months to years before the onset of AIDS include

So you see, it's a difference without a distinction. They may not become symptomatic for years or decades, but the virus is in there, slowly killing their immune system. Some people seem to have a genetic predisposition to slower progression, ala Magic Johnson, don't bet on his being alive in 20 years.
50 posted on 11/24/2003 7:05:02 PM PST by Kozak (Anti Shahada: " There is no God named Allah, and Muhammed is his False Prophet")
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