Are uninsured people really denied organ transplant in the USA?

[md2000]

About a decade ago there was a major kerfuffle in the news about one province (Alberta?) which had denied an organ transplant to a mentally handicaped person. The doctors insisted, though, the reason was not “mentally handicapped persons’ lives are not worth as much”, the reason was that the anti-rejection drug regimen someone would be on for the rest of their life was sufficiently complex that it was judged the person was not capable of properly managing that.

There was a big uproar also about 20-plus years ago when a major figure in the Conservative party back-rooms got a heart transplant, some suggestion that he had jumped the queue. however, everyone denied this and of course, as everyone else has mentioned, the supply is limited and a match is a roulette gamble.

Recall the suggestion that Mickey Mantle had jumped the queue or skirted the requirements in the USA for a liver transplant. There was discussion whether he still had alcohol dependency issues which would mean a liver transplant was a waste of a valuable organ. (Regardless, it failed.)

The criteria in the Canadian system is simple - what is the chance of success? If you are too far gone, have other major issues, resulting quality of life problems, etc. - you are rated lower. One of my high school teachers had a heart transplant a few years after I graduated, I met him several years later at a reunion. He added 15 good years to his life. AFAIK he had no financial issues with the procedure, it was just done.

yes, a transplant is expensive, but probably no more so than open heart surgery, a heart bypass, or any other major surgery that requires a lot of attention, precision where the doctors are messing with your vital organs. Surgeons get good money in Canada, but not the millions upon millions that some in the USA might make. The room, anesthetist, nurses, etc. probably cost the same whether it’s a transplant or an appendectomy. The cost of transporting the organ, depending on distance, may or may not be a significant expense, but generally, an ambulance or helicopter ride costs the same whether its an organ or a critically ill patient.

The other issue is the follow-on drugs; and there was an earlier thread here on prescription drugs and how they are covered. Peple who are seriously financially challenged by drug costs get help from the government. (But as a teacher, likely he had a prescription benefit from his union).

[Wendell_Wagner]

md2000 writes:

> . . . the millions upon millions that some in the USA might make . . .

Let’s be precise here. Surgeons don’t make millions of dollars a year in the U.S. They average perhaps $250,000 to $300,000 a year.

[Broomstick]

@md2000

yes, a transplant is expensive, but probably no more so than open heart surgery, a heart bypass, or any other major surgery that requires a lot of attention, precision where the doctors are messing with your vital organs.

Incorrect. Transplant involves at least two teams of doctors/nurses (one to harvest the organs, one to transplant them), they take longer to complete, the follow up involves a complex cocktail of drugs that require some time to balance correctly, and then there’s lifetime maintenance.

The room, anesthetist, nurses, etc. probably cost the same whether it’s a transplant or an appendectomy.

Incorrect, just from the point of view of the time involved. An appendectomy can be done in less than an hour. Organ transplants take multiple hours.

The other issue is the follow-on drugs; and there was an earlier thread here on prescription drugs and how they are covered. Peple who are seriously financially challenged by drug costs get help from the government.

Yes and no. For example, people who get kidney transplants receive government support for a couple of years after the operation, but after that point the assistance is cut under the assumption that the person has resumed full time employment with full private health insurance, and that cut takes place whether or not that has occurred.

[MissTake]

@Broomstick

Yes and no. For example, people who get kidney transplants receive government support for a couple of years after the operation, but after that point the assistance is cut under the assumption that the person has resumed full time employment with full private health insurance, and that cut takes place whether or not that has occurred.

That’s incorrect. When I finally get the call, Medicaid will surplant my regular employer insurance for the month of transplant. That’s it. Then the month-to-month scrip fees of $2000 are on me/my insurance.

[nearwildheaven]

@hajario

It’s not like some procedures where it’s merely a matter of being expensive. There are only a limited number of organs available and all of the money in the world won’t get you one if there isn’t a match available.

If you need a new organ, you go on a regional waiting list that is Federally controlled. You aren’t going to get high on the list if they don’t think that you’re a good candidate to survive. One if the many factors is ability to be able to afford the upkeep.

And it is anonymous.

BTW, one aspect of organ transplantation that isn’t discussed is that a huge percentage of the people who have them remain chronically ill, just in a different way than they were before. It’s also not uncommon for them to stop taking their anti-rejection drugs, whether some or all of them, because they would rather reject the organ than deal with the side effects, which can be dreadful.

There was a hand transplant recipient who decided that his quality of life without a hand would be better than life on those drugs (he was unable to work because of the side effects) so he stopped taking them, and the hand was amputated when he did indeed reject it.

And there have been stories about people who stopped taking their meds and never rejected the organ. :eek: It’s theorized that either the match was nearly perfect, or that stem cells from the transplanted organ engrafted and tricked the immune system into thinking it was the original kidney or liver or whatever. I remember reading about a woman who had a liver transplant, and the side effects from the meds caused her to have violent mood swings. Her husband could deal with it, but he feared for the safety of their child, so he left her and took the child with him. (Trust me, nobody would condemn a woman for doing the same thing if her husband acted that way, regardless of why.) In her depression, she stopped taking her meds as a suicide attempt - and never rejected the organ. She and her husband did not reconcile, but she did eventually rebuild a relationship with her child.

[nearwildheaven]

@Nava

In most of Spain (heck, most of Western Europe), a car isn’t necessary for daily life - it may make it easier, but it’s not needed and note the may (my cousin didn’t bother get a license until her early 40s and doesn’t have a car; my mother has never had a license). Calendar or watch? That homeless person, once transferred to social services and if they’re willing to play the game, will have a home and caretakers, and the caretakers will dispense meds. Someone who’s put-together enough mentally to qualify for that transplant they need (alcoholics for example will be considered very low-priority) will be able to play the game.

I would never have thought of it in terms of “offering” a transplant. You’re told you need one; if an organ is found, you’re called in to get it. I guess “offer” is the right term, since you can reject it… but short of JW’s I can’t imagine who would.

Most transplant centers will not do them on people who destroyed their organs from alcoholism or drug addiction (meth addiction is not an uncommon cause of kidney failure nowadays) unless they became clean before their organs failed. And Jehovah’s Witnesses will usually accept organ transplants. It’s blood transfusions that they won’t take.

[nearwildheaven]

@Hari_Seldon

There was a story, I think it was real, about a Tea Party meeting shortly after the Health care act was passed and the speaker asked the audience just that question. What should happen if a poor uninsured person needed some treatment. The answer, accompanied by wild cheering: “He dies”.

A congressman from, I think, Kentucky, arguing to end the food stamps program (it provides food for people in poverty and has had bipartisan support for 40 years) quoted–or claimed to quite–something from the bible that said, “He who will not work, shall not eat.” I am not familiar with the bible, but I would like to know the context. Does that imply that an infant with an unemployed father ought to starve to death? That could be the effect of ending the program.

:mad:

I volunteered at a food pantry one summer when I was in college, and wanna know what the largest percentage of their clientele was?

SENIOR CITIZENS. I was surprised too; I had expected it to be mostly single parents, and there were quite a few but most of the women were recently widowed. The single fathers almost always told the same story: His ex-wife wasn’t paying child support, and the collection agency was dragging their feet helping him because he was a man. :rolleyes: Granted, this was 20 years ago, but I understand many agencies aren’t much better now. And last time I checked, it costs just as much to raise a child if you’re man as it does if you are a woman, and just because you’re male doesn’t necessarily mean you have a high-paying job.

[nearwildheaven]

@md2000

Recall the suggestion that Mickey Mantle had jumped the queue or skirted the requirements in the USA for a liver transplant. There was discussion whether he still had alcohol dependency issues which would mean a liver transplant was a waste of a valuable organ. (Regardless, it failed.)

That transplanted liver had cancer in it that was undetected prior to the transplant, and because he was immune suppressed, it spread rampantly and was terminal by the time it was detected.

Humorist Erma Bombeck had polycystic kidney disease, and was on the transplant list for a while and stricken from it when she was diagnosed with breast cancer. (Cancer automatically knocks a person off the list unless the transplant is needed to treat the cancer - for instance, cancer in both kidneys). When the cancer went into remission, she was placed back on the list, got her transplant, and sadly died a few weeks later from surgical complications.

And then there was ex-vice president Dick Cheney, who was and is extremely unpopular, who recently got a heart transplant at age 71. Just the fact that he was 71 in itself put him at the bottom of the list, and at that age, he would have been on Medicare regardless of who he was.

[nearwildheaven]

@Broomstick

just from the point of view of the time involved. An appendectomy can be done in less than an hour. Organ transplants take multiple hours.

(snipped)

Yes and no.

Liver, heart, and bowel transplants can take a long time because of the complex anatomy involved, as can multiple-organ transplants, but kidney transplants don’t take that long. My cousin’s didn’t, in part because his father was the donor, and was in the very next room.

Neither experienced any surgical complications, and they’re doing great. My cousin had a rare disease he inherited from his mother (IDK what it is), and she was on the transplant list for a while but was taken off when her condition deteriorated to the point where she would not have benefited from it, and died some time later.

[Nava]

@nearwildheaven

And Jehovah’s Witnesses will usually accept organ transplants. It’s blood transfusions that they won’t take.

Yeah, but since major surgery is one of the cases in which someone is likely to need a transfussion, if you’re not willing to take blood you can’t take a liver.

[Running_with_Scissors]

@Hari_Seldon

There was a story, I think it was real, about a Tea Party meeting shortly after the Health care act was passed and the speaker asked the audience just that question. What should happen if a poor uninsured person needed some treatment. The answer, accompanied by wild cheering: “He dies”.

No tea party fan am I, but this is somewhat of a mischaracterization of this dialogue. The question was put to Ron Paul by Wolf Blitzer during one of the Republican presidential debates. He asked

@Wolf Blitzer

A healthy 30-year-old young man has a good job, makes a good living, but decides I’m not going to spend 200 or $300 a month because I’m healthy, i don’t need it. But something terrible happens, all of a sudden he needs it. Who will pay if he goes into a coma, who pays for that?

So the hypothetical person in question had specifically chosen not to get insurance even though it was available to him.

[obbn]

@Hari_Seldon

There was a story, I think it was real, about a Tea Party meeting shortly after the Health care act was passed and the speaker asked the audience just that question. What should happen if a poor uninsured person needed some treatment. The answer, accompanied by wild cheering: “He dies”.

A congressman from, I think, Kentucky, arguing to end the food stamps program (it provides food for people in poverty and has had bipartisan support for 40 years) quoted–or claimed to quite–something from the bible that said, “He who will not work, shall not eat.” I am not familiar with the bible, but I would like to know the context. Does that imply that an infant with an unemployed father ought to starve to death? That could be the effect of ending the program.

Great story! I’m a conservative and my friends and I always sit around, drinking beer and telling each other hypothetical stories in which some poor minority dies, We then have a heart laugh and tell another one. :smack:

Do you really think that conservatives as A whole act this way? You provide no cite, but claim it’s true. Are there assholes among conservatives? You bet, just as there are among liberals. But I have yet to see any of my conservative friends act in any way other than compassionate to those in need.

[Broomstick]

@MissTake

That’s incorrect. When I finally get the call, Medicaid will surplant my regular employer insurance for the month of transplant. That’s it. Then the month-to-month scrip fees of $2000 are on me/my insurance.

I stand corrected then - and I’m sorry our society is not more helpful.

Good luck with getting your transplant, and a speedy recovery!

[Nava]

@Hari_Seldon

…something from the bible that said, “He who will not work, shall not eat.” I am not familiar with the bible, but I would like to know the context. Does that imply that an infant with an unemployed father ought to starve to death? That could be the effect of ending the program.

The quote appears to be 2 Tes, 3:10. You can see it there in several versions; the context is not that he who cannot work should not eat, but he who refuses to work, specially those who can spend time making trouble. Paraphrasing, the author says “when we visited you, we didn’t let you feed us without doing some work ourselves; we believe that those who are able to work, should, and we acted accordingly.”

[aNewLeaf]

@Broomstick

You do realize that the uninsured are NOT just the homeless?

My home is paid for. I do not have health insurance.

@Broomstick

Someone working 40 hours a week at a job that offers no insurance might need a transplant, but would be denied simply because they don’t have insurance or be sufficiently wealthy to pay for it out of pocket. Not just the working poor - an entrepreneur might have a middle-class income but no insurance. You can have a home, great family/support network, be mentally stable, no addictions, and a full time job but if you don’t have medical insurance (or millions of dollars in your bank account) you’re screwed if you need a transplant.

Yes, this is exactly the point I’m making.
Even with a car, even with a job, even with private insurance, organ transplants are expensive and risky.
Anything that detracts from that ideal state also takes away survivability and increases expenses.

[aNewLeaf]

I wanted to mention- I wouldn’t qualify for organ transplantation anyway.
As a marijuana user I would never be considered for donating or receiving an organ.

[septimus]

@obbn

But I have yet to see any of my conservative friends act in any way other than compassionate to those in need.

With all this self-congratulatory compassion available, conservatives see no need for tax-assisted help, right? The needy should just contact their conservatives friends, or seek help from a church with conservatve donors.

[Jackmannii]

@PaulParkhead

I wonder if things have improved in the 14 years since that story was published.

Oh yes, they’ve definitely improved. :dubious:

[hajario]

@aNewLeaf

I wanted to mention- I wouldn’t qualify for organ transplantation anyway.
As a marijuana user I would never be considered for donating or receiving an organ.

Total bullshit. They would gladly accept one of your organs. You would qualify to get one if you quit smoking.

[obbn]

@septimus

With all this self-congratulatory compassion available, conservatives see no need for tax-assisted help, right? The needy should just contact their conservatives friends, or seek help from a church with conservatve donors.

I see zero problem with tax assisted help to those that need it. I also would like to think that many people would do what they can to help those in need. I’ve done my fair share to help when I can. Unfortunately I’m not in a financial position to do much, however if fortune were to ever smile on me you can bet your rear that I’d help.

Do you really think that each and every conservative hoards his money and turns a blind eye towards others? I know quite a few “liberals” who would pass by a homeless person holding a sign asking money for food who’s only action would be to tell the person to get a job. I don’t however base my entire opinion of liberals on the actions of a few. Sure, I have general beliefs about liberals, however I make it a point not to pigeon hole an individual into a general stereotype. That being said I have several liberal friends who are what I would consider some of the best people I’ve ever known and some who are nothing more than tree huggers waiting for the next cause to rally around. Same with my conservative friends. Some are great people, others not so much.

And FWIW, the majority of my conservative friends are very generous with their support of charities, some give until it hurts. But to try to paint all conservatives as evil demons who laugh at and enjoy the misery of others is laughable.