Breaking News Bar
updated: 7/5/2013 8:13 AM

Illinois Medicaid won't cover rare transplants

hello
Success - Article sent! close
  • Brandy Whitfield, 32, of Lombard, rests in a suburban Chicago hospital. Whitfield is one of two Illinois women seeking a rare type of organ transplant called a multi-visceral transplant.

      Brandy Whitfield, 32, of Lombard, rests in a suburban Chicago hospital. Whitfield is one of two Illinois women seeking a rare type of organ transplant called a multi-visceral transplant.

 
Associated Press

Two Illinois women are seeking a rare type of organ transplant, but they have learned that the Illinois Medicaid program considers the surgery experimental and won't pay for it.

The Illinois decision is based on a recommendation from an ethics panel convened to study the procedure, which involves transplanting the intestine and other organs, Crain's Chicago Business reported . No Illinois hospitals perform the surgery, which is called a multi-visceral transplant.

Order Reprint Print Article
 
Interested in reusing this article?
Custom reprints are a powerful and strategic way to share your article with customers, employees and prospects.
The YGS Group provides digital and printed reprint services for Daily Herald. Complete the form to the right and a reprint consultant will contact you to discuss how you can reuse this article.
Need more information about reprints? Visit our Reprints Section for more details.

Contact information ( * required )

Success - request sent close

In February, Indiana University Health lobbied Illinois Medicaid to cover the transplants Brandy Whitfield, 32, of Lombard and Barbara Sensney, 67, of Olney. Medicaid is a government health program for poor and disabled patients.

Whitfield said she needs a new small intestine and stomach after a failed surgery to remove a benign tumor. Sensney said she needs a new liver, pancreas and intestine because of cirrhosis and liver cancer.

"I'm kind of in a fog right now," Sensney said after learning the state's decision. "I knew in my heart all along they weren't going to do it, but you always hope."

The surgeries were expected to cost more than $1 million each. IU Health's University Hospital in Indianapolis has performed 38 of the operations in four years.

The Illinois Medicaid program covers 2.8 million people with a budget of $17.8 billion. One year ago, Gov. Pat Quinn signed a package of $2.7 billion in cuts and tax increases he said was needed to save the state's bloated program from collapse.

Illinois Medicaid authorizes the multi-visceral transplant surgery for children, but until now didn't have a policy about whether the procedure would be covered for adults. A six-member ethics committee met May 17 to study the situation. It recommended unanimously that Illinois Medicaid should not approve such requests for adults.

The ethics committee noted that the Indiana hospital's transplant program and its surgeons are "reputable and qualified," but "they have not been able to provide definitive and specific outcome data measuring post-op quality of life and lifespan in each of those 38 patients."

Julie Hamos, director of the Illinois Department of Healthcare and Family Services, accepted the recommendation.

The new Illinois policy on the transplant states: "There is no peer-reviewed and published literature that demonstrates the effectiveness and safety of this procedure and, thus, it is experimental in nature."

Fewer than a dozen hospitals across the country perform the most of the surgeries, according to transplant surgeons and the Organ Procurement and Transplantation Network.

"I just want to get back to normal," Whitfield said. "I want to be able to interact with my child without being in constant pain."

Share this page
Comments ()
Guidelines: Keep it civil and on topic; no profanity, vulgarity, slurs or personal attacks. People who harass others or joke about tragedies will be blocked. If a comment violates these standards or our terms of service, click the X in the upper right corner of the comment box. To find our more, read our FAQ.