Jan 11, 2008

The case of the missing liver transplant

Scott Gottlieb looks at the story of Nataline Sarkisyan, a 17-year-old girl who was denied a liver transplant by her health insurer and subsequently died.

John Edwards used the girl's story as a morality tale in which the big, bad insurance company allowed an innocent child to die out of greed. The implication being that the poor girl would have been saved had we the single-payer plan Edwards supports. Not so, says Gottlieb, who looks at data from the US and the UK, which has a single-payer system.
A study published in 2004 in the journal Liver Transplantation compared the relative severity of liver disease in transplant recipients in the U.S. and U.K. The results were striking. No patient in the U.K. was in intensive care before transplantation, one marker for how sick patients are, compared with 19.3% of recipients in the U.S. Additionally, the median for a score used to assess how advanced someone's liver disease is, the "MELD" score, was 10.9 in the U.K. compared with 16.1 in the U.S. -- a marked gap, with higher scores for more severe conditions. Both facts suggest even the sickest patients are getting access to new organs in the U.S.

On the whole, the U.S. also performs more transplants per capita, giving patients better odds of getting new organs. Doctors here do far more partial liver transplants from living, related donors, but also more cadaveric transplants (where the organ comes from a deceased donor). In 2002 -- a year comparative data is available -- U.S. doctors performed 18.5 liver transplants per one million Americans. This is significantly more than in the U.K. or in single-payer France, which performed 4.6 per million citizens, or in Canada, which performed 10 per million.

The truth is that liver transplants are costly and outcomes aren't always certain. In any given "system" someone must make the decision as to whether a transplant--or other costly procedure--should be performed. Edwards would merely replace an insurance company executive with a government official as the ultimate arbiter. Most of us would rather rely on our doctor.

The Sarkisyan case is particularly poignant because the insurance company eventually changed its mind about the transplant, but not in time to save her. Who thinks it would have been approved faster if a government agency was making the decision?

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