Lambda Legal Wins Judgment Ordering Medicaid to Approve Liver Transplant for Man with HIV

(Pittsburgh, Wednesday, December 10, 2003) - In a decision made public today, a judge ordered Pennsylvania’s Medicaid program to approve a life-saving liver transplant for an HIV-positive man with advanced hepatitis.

Lambda Legal argued its appeal at a hearing before an administrative law judge in late November. The appeal sought to reverse Medicaid’s denial in light of a range of scientific data and the man’s personal health history and experience. The decision released today noted that patients with HIV have successful transplant rates and well managed HIV is not a life-limiting disease.

“This decision may save our client’s life”, said Hayley Gorenberg, AIDS Project Director at Lambda Legal. “In the last seven years since the advent of better treatments for people with HIV, the medical community nationwide has learned a great deal about organ transplants. When real research on HIV and AIDS is considered, reasonable people come to reasonable conclusions, and that’s exactly what happened in this case.”

William Jean Gough, a 46-year-old resident of Altoona, was denied a liver transplant shortly after being accepted as a candidate in August by the transplant team at the Thomas E. Starzl Transplant Institute because Medicaid said the procedure was experimental and not considered “medically necessary.” The Starzl Institute is a part of the University of Pittsburgh and has performed transplant surgeries on people with HIV for years. Gough suffers from advanced liver disease and is often not well enough to care for himself because of the ailment.

In the decision, Adminstrative Law Judge Bernadene Kennedy said, “[Mr. Gough] could live ten, twenty, thirty years or more with a liver transplant. Given his ability to successfully control his HIV, [he] may live a prolonged life and maintain quality of life equivalent to non-HIV transplant patients.”

In the appeal, Lambda Legal said Medicaid’s justification was simply untrue. “It’s flat-out wrong that liver transplants for people with HIV are experimental and have unfavorable outcomes,” Gorenberg said. “There’s a solid and growing body of scientific and medical evidence that clearly shows HIV does not significantly affect the outcome of liver transplantation.”

“I can think of no better gift for the holidays for Mr. Gough than getting the liver that will enhance and prolong his life,” said Yolanda French Lollis with the AIDS Law Project of Pennsylvania.

In another case two months ago, Lambda Legal successfully argued to overturn Kaiser Permanente’s decision to deny a kidney transplant for a Colorado man with HIV. Lambda Legal filed a formal appeal with Kaiser Permanente, asking the HMO to reverse its denial in light of a range of scientific data and client John Carl’s personal health history and experience.

In both cases, Lambda Legal cited mainstream medical journals that show “no evidence of poorer survival among otherwise healthy HIV-positive patients who are receiving anti-retroviral therapy,” which Gorenberg said is precisely Gough’s situation. The articles conclude that “transplantation in HIV-positive patients should … not be considered experimental.”

Gough tested positive for HIV and hepatitis C in 1996. While Gough’s viral load has been undetectable for years and he suffers no disabling symptoms from HIV, the hepatitis has caused an advanced form of liver disease. The effects of his liver disease are at times completely debilitating, requiring his longtime partner Bob Hoffman to care for him.

According to Lambda Legal, people with HIV are sometimes blocked from being considered for transplants, even though medical and scientific evidence makes it clear that they should be evaluated on a case-by-case basis like any other transplant candidates.

In Matter of William Jean Gough, Gorenberg is handling the case for Lambda Legal. AIDS Law Project of Pennsylvania is co-counsel.

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Contact: Lisa Hardaway, 212/809-8585 ext. 266; pager: 888-987-1971