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February 13, 2009


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Miriam Lippel Blum

The question of whom is included or excluded in these kind of cost/benefit analyses is always troubling. I must admit that I find all these Value of a Statistical Life (VSL)computations quite chilling. As a disabled person on dialysis, I am so expendable to the government. In fact, if there is a pandemic here where I live, that interferes with health care delivery, the guidelines are that no care (palliative or otherwise) be given to me and those like me. Is my life of no value because I cannot generate as much income as others?

Alison Hymes

This is my impression also, that there is a group, how large would be good to know, that opts out of transplant due to cost and further that this group tends to be younger people who it would seem will live longer and cost Medicare more than older people who opt out. I wonder if there are statistics of how many people are turned down for the UNOS list due to financial ineligibility? Still wouldn't get at the folks who choose not to accept a living donation but there are so many reasons people choose not to go that route that I think it would be hard to get a clean statistic.


The fact that there are some people on dialysis who are refused a place on the UNOS list due to their inability to pay for immunosuppression medications (after the three-year Medicare benefit) is an affront to the spirit of the "Gift of Life."

One of the less publicized realities of transplantation.


Zack, et al. I am very concerned about being one of the people "who are refused a place on the UNOS list due to their inability to pay for immunosuppression medications." In a chilling meeting with the Social Worker at the transplant center in Charlotte, NC, I was asked flat out how I was going to pay the $1,800/month for drugs. I was still working at the time (and doing dialysis) and was not familiar with my employer's insurance benefit policy concering immunosuppression medications. Even with a secondary policy (Blue Cross/Blue Shield State Teachers Plan) usually any things that Medicare doesn't pick up - they won't pick up either.

I was told I did'nt qualify for a new kidney because of weight issues and that I needed to be under 200 lbs. (I was only 241 at the time.) I often wonder if it was more about money than weight.

Bill Peckham

There should be a way to put a number on how many are kept off the transplant list because of UNOS ability to pay rules. My impression is as many or more self withdraw but it could be a situation where people are saying you can't fire me, I quit.

I too think that people who self withdraw tend to be younger because if you're 59 or older you know that you will soon qualify for Medicare by meeting the normal age threshold. If you consider someone in their 20s who opts out that represents a lot of needless Medicare spending.

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