Buoyed by a legislative victory in California and a court ruling in Arizona, advocacy groups say they are making significant headway in efforts to ensure that HIV-positive people have the same access as other patients to kidney and liver transplants (search).
California recently became the first state to prohibit insurers from denying coverage for organ transplants based solely on a patient's HIV status. In Arizona, a judge ruled that the state's Medicaid program can't deny a liver transplant to an HIV-positive woman on the basis of her health status.
"There are a lot of optimistic signs," said Jon Givner, who heads the HIV Project at the Lambda Legal Defense and Education Fund (search), a New York-based gay-rights group. "When presented with the evidence, reasonable people have a hard time coming to the conclusion that an HIV-positive person should be denied a transplant."
In the past, insurers often refused to pay for transplants for HIV-positive patients and many transplant centers also balked at approving such procedures, believing that the always-tight supply of donor organs should be directed toward patients whose survival prospects weren't clouded by the complication of HIV.
However, the development of effective anti-retroviral therapy (search) extended the longevity of HIV-positive people and changed the thinking of many experts. An ongoing pilot study at the University of California, San Francisco, has found no evidence of lower survival among HIV-positive patients after more than 30 organ transplants, said Dr. Peter Stock, the study's leader.
Still, Arizona's Medicaid program had maintained a policy of refusing to pay for transplants for HIV-positive people. But last month, in a case pressed by Lambda Legal, an administrative law judge said the program can't cite HIV as sole grounds for denying a liver transplant for Brenda Gwin, a 49-year-old from Phoenix who was diagnosed with end-stage liver disease in November 2004.
"We're relieved that the judge saw that Medicaid's decision to deny this woman a transplant was not based on good medicine or sound science," said Jen Sinton, a Lambda Legal attorney.
Though abiding by the judge's order, the Medicaid agency did not immediately overhaul its transplant policy. Spokeswoman Liz Olson said the agency would "explore modifications" to the policy based on an evaluation of medical evidence.
Gwin, meanwhile, can now begin the process of qualifying for a transplant through a national organ-donor network, with doctors evaluating her prospects along with other transplant candidates on a case-by-case basis. One of her Phoenix-based lawyers, Srini Varadarajan, said the delay caused by the legal proceedings did not seriously harm her health prospects, assuming a donor liver can be found.
The pioneering California legislation was signed into law in September by Gov. Arnold Schwarzenegger.
"There are many reasons why a patient with HIV may not be suitable for a transplant, but the sole fact that they are HIV-positive is no longer considered a legitimate reason," said the bill's sponsor, Assemblyman Paul Koretz.
Givner said he hoped the legislation would send a message to insurers and health-care providers across the country, several of whom have been successfully challenged by Lambda Legal after transplants were denied. One target of a challenge, the federal Department of Veterans Affairs, subsequently agreed to offer transplants to appropriate HIV-positive patients.
"In the experience of our clients and others like them, their HIV is under control and they had been living very active lives before they experienced complications from organ failure," Givner said. "There is no justifiable reason to deny lifesaving treatment."
Givner said transplant access is a critical issue because roughly one-third of people living with HIV are co-infected with Hepatitis C, which can often progress to potentially fatal liver disease.
National trends are difficult to track because most states and medical insurers — unlike Arizona's Medicaid agency — do not have written policies citing HIV status as grounds for denying transplants, Givner said. Instead, he said transplant coverage is sometimes denied in HIV cases on the less specific ground that the procedure is "experimental."
"Some insurance companies are holding onto policies that are a decade out of date," Givner said.