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HMO Approves Kidney Transplant for HIV Patient
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Comments from Jules Levin: Over the course of the past few years evidence has been increasingly mounting supported by study reports at HIV and hepatitis science conferences that liver transplants can be successfully performed in HIV+ individuals. Success is related to improving immunity with HAART. Success rates of transplants in studies of HIV-infected individuals in the last 2 years have been comparable to HIV negative individuals. But the concern was that insurers would have to accept this data in order to provide adequate financial support to perform these costly and labor intensive procedures. So, this AP article cuts to the core of the issue.
Associated Press Oct 8, 2003 Dan D'Ambrosio
Kaiser Permanente - one of the largest US health maintenance organizations - approved a kidney transplant for a Denver man with HIV on Wednesday, reversing an earlier decision. In September, Kaiser had rejected John Carl's request for a new kidney, calling a transplant on someone with HIV or AIDS too risky because drugs used to suppress rejection of a new organ can jeopardize their already weakened immune systems.
"I think [this decision] reflects further understanding of HIV," said Dr. John McGrory, the Kaiser physician handling the case.
Kaiser has referred Carl to the transplant program at the University of California-San Francisco, where his name was added to its transplant list, said McGrory. "That doesn't mean he'll get a kidney," McGrory added, referring to the often-lengthy waits patients endure before a suitable organ becomes available.
Carl, 53, tested positive for HIV in 1988 and, with the help of drug advances, was in fairly good health until kidney failure in 2001 forced him to undergo dialysis three times a week.
Despite being accepted by the United Network for Organ Sharing's national list, Carl was turned down for the transplant, according to Lambda Legal, a New York-based gay advocacy group.
Hayley Gorenberg, AIDS Project director at Lambda Legal, pointed to mounting evidence that HIV "does not significantly affect the outcome of kidney transplantation."
"It takes time for people to assimilate what they learn at these national conferences and then put it into practice," said McGrory, adding that there are still many transplant programs that will not consider a kidney transplant for an HIV-infected patient.
McGrory said data from studies not yet published helped the HMO reverse its decision. "I was able to talk to kidney doctors in California who helped me with the data from national meetings concerning success rates of transplants in HIV patients," he said. "This is truly cutting edge medical technology and information. It wasn't thought about when [Carl's request] was initially denied."
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