State Medicaid rejects liver transplant for Altoona man with HIV

The Pittsburgh Post-Gazette ^ | Friday, November 21, 2003 | Anita Srikameswaran

[Willie Green]

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.

[freeangel]

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.

[NewLight]

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.)

[Boxsford]

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.

[Bikers4Bush]

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.

[Kozak]

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.

[Kozak]

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.

[Bikers4Bush]

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.

[cinFLA]

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.

[Kozak]

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.

[Bikers4Bush]

I object to their and anyone elses automatic inclusion.

The thought of the state automatically assuming posession of someone's organs unless that person is informed enough to know to opt out of such a program is odious to me.

I can certainly see the point of giving priority to those in need who are willing to donate their own organs and would be in support of something like that.

Provided it does not penalize those who are not eligible to donate for whatever reason.