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Should Medicaid Patients Be Denied Organ Transplants?

Neurological surgeon David McKalip M.D., a Florida delegate to the American Medical Association (AMA), this week lead the effort to ensure the AMA would stand strongly in favor of organ transplantation for Medicaid patients; and not for rationing such medical treatments because of funds.

“As a doctor, I have long stood against any act of the rationing of medical care by the government.” says McKalip. “I could not stand by while the leadership of my profession at the AMA chose to side with government rationing policies instead of the patient.”

The AMA Board of Trustees had previously recommended that they not adopt the policy to the key policy making body of the AMA, the House of Delegates (HOD), requiring McKalip to respond.

“If the government has promised access to high quality medical care to patients through a government program such as Medicaid, the government should keep their promises.  It is not acceptable to tell a Medicaid patient they may be an organ donor, but not an organ recipient.”

The issue presented itself when Governor Jan Brewer decided that the State of Arizona could not afford to pay for organ transplants for Medicaid patients in 2010. The state ultimately reversed the decision after a large public outcry. The Florida delegation worked to have the AMA stand on the side of Medicaid patients beginning in November of 2011, but no action was taken by the AMA Board until this annual meeting.

The AMA Board of Trustees (BOT) was recommending that the AMA not support expanding Medicaid coverage for organ transplants. In doing so the AMA BOT relied on the New AMA policy “Stewardship of Healthcare Resources” to conclude that Medicaid patients should not receive organ transplants if there were limited resources to fund it.  That 2012 policy states that physicians are “obligated” to be “prudent stewards of shared societal resources,” a policy that was acknowledged to conflict with the need to serve the medical needs of the patient first.

McKalip worked through the process at the AMA House of Delegates to rally unanimous support for his position on behalf of the entire Florida delegation. Others, including Delegations from New York, California, the District of Colombia, joined the call to provide good medical care to patients pointing out that it is duty of the doctors to stand up first for the patient and to let the government determine how it would pay for the costs of the programs it has created. Other colleagues pointed out that the cost of living with organ failure while awaiting an organ transplant or the critical care of dying with organ failure was often more costly than the organ transplant itself.

Thomas Peters, M.D., a transplant surgeon from Jacksonville offered, “It is not appropriate to first do a wallet biopsy of my patient to determine if they are eligible for an organ transplant.”

McKalip concluded, “I am proud of my colleagues at the AMA House of Delegates for standing up for patients and advising their elected leaders on the AMA Board of Trustees that the AMA must stand up for patients, and not participate in rationing. I am humbled by their support on this issue but also happy that I had the opportunity to use my years of experience there and knowledge of health policy to make a difference in the lives of Americans through action at the AMA.”


  1. My son is 43 and is in desparate need of a liver transplant. He is not currently on a list and is living in Seattle, WA, but is relocating to Ohio where his father and brother live to be closer to the Cleveland Clinic. He is currently on Medicaid and I am really concerned that he will be turned down for a liver due to the fact that he is on Medicaid. This would be tragic, as I was looking on the internet and saw that David Crosby and Larry Hagman both received their livers within the month they were diagnosed probably because they donated money somewhere and due to their celebrity status they received a transplant with little or no trouble. It’s sad to think that other people less fortunate have to struggle in order to get on a list and receive a much needed transplant. I lost my husband last year and I don’t want to lose my son due to a glitch in the system!!! That would be a travesty.

    • my husband was denied a liver transplant right before he died. At that point he was to sick to go to another center.

      my best advise for you is to make appointments at other centers for a consult. once he has an appointment at a center he should get all testing done required asap. Then you must push for the answer if they will list him. Each center has a board that meets 2 to 3 times a week. They will know if he is a candidate for “their” center by the end of the meeting.

      Also, I found out the top rated centers are only top rated because they turn away the very sick high risk patients and only transplant the healthier lower risk patients. so be aware of this.

      good luck to your son

  2. It was great to read McKalip and Peters’ opinions to this sensitive topic. I am with them. Doctors should stand for their patients!

    I was sad not to see Illinois included among the state delegations as New York, California and the District of Colombia joining the call. Health is a human right!!!

  3. I was fortunate enough to receive a living donor kidney 7 months ago. While I have my own health insurance I don’t know if I would have been able to afford the transplant and subsequent lifelong drug regimen without Medicare.

    I think it is unfortunate that Medicare does not cover or assist with other organ transplant, nor do I understand why we have not been able to pass the Immunosuppresive Drug Coverage Extension bill that has been before Congress for the past few years.

    Coverage for the medications costs Medicare about $12000 per year, while dialysis is more than $80,000 and a kidney transplant is upwards of $120,000.

    Surely we can find a way to help those who are unable to pay for a transplant and the expensive drug regimen that follows for the life of the transplant. We find ways to pay for billions of dollars of much less important things with our tax money, why not help those who need it to live?

  4. The same idiots who tried to scare us out of much needed health care and health insurance reform with death panel talk are now the ones who would be happy to let the poor die. How would they accomplish that…probably by creating things like panels that determine who lives and who dies by the amount of wealth they have.

    • I agree with you completely they let my daughter die young just because the cost that the government didn’t want to pay. Even though they spend billions on things that don’t even matter if your poor you might as well forget it I think that is what they want in some ways it seems population control but only taking out the poor. If I was wealthy I guarantee my daughter would be alive right now.

  5. Simple. If they’re not qualified to receive a transplant, then the obvious choice is to take themselves out of the donor pool. They’ll get a reversal of policy quick enough.

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