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Budget Cuts Halt Liver Transplant

Arizona Legislature denies organ transplants to about 100 Medicaid patients



Last November, Francisco Felix of Laveen, Ariz., was given another chance at life. After the sudden death of a friend, the deceased's liver was donated to Felix, 32, whose liver has been ruined by hepatitis C.

"I was speechless. I couldn't believe it. I had an opportunity to live," says Felix. So he and his wife, Flor, went to Banner Good Samaritan Medical Center in Phoenix, where further evaluation showed he was stable enough to endure the transplant surgery. But within hours the procedure was canceled.

That's because the state legislature had voted in March for budget cuts to deny organ transplants to about 100 people who had already been approved for them, including Felix. The cutbacks, which took effect Oct. 1, affect patients covered by the Arizona Health Care Cost Containment System (AHCCCS), the state's Medicaid agency, who are seeking heart, liver, pancreas, bone marrow (from an unrelated donor) or lung transplants.

Despite the cuts, the hospital contacted AHCCCS after the liver was donated to Felix in hopes that the agency would agree to pay for the surgery, which could cost up to $500,000. "In initial contact with the agency," says Charlie Thomas, a transplant social worker at Banner Good Samaritan, front-line office staff said they thought "they could make it work."

"We were waiting for approval from AHCCCS or the governor," says Flor Felix. However, a final decision denied it, and the liver went to another transplant patient.

Rep. John Kavanagh, R, chairman of Arizona's House Appropriations Committee, acknowledges the lawmakers' vote was made on medical data about success rates that has "proved to be suspect." When the legislature reconvenes in January, he says, "we hope to correct any errors we made."

Arthur L. Caplan, director of the Center for Bioethics at the University of Pennsylvania, calls the lawmakers' action "morally heinous."

"To break a promise about coverage, and retrospectively tell people who relied on the program to pay for their own transplants, and pull the rug out from under them is an ethical disaster," Caplan says. "It's the closest I've seen to putting 'death panels' into action."

With each passing day, Felix, a father of four young girls, says he worries about maintaining his health, but he's resolved: "I want to live for my daughters. I'm going to continue fighting for my life."

Laurie Udesky is a writer in San Francisco.

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