Massachusetts AIDS Activist Belynda Dunn Dies After Two Unsuccessful Liver Transplants
HIV-positive AIDS activist Belynda Dunn died yesterday morning at the University of Pittsburgh Medical Center after undergoing two unsuccessful liver transplants last week, the AP/Pittsburgh Post-Gazette reports. Dunn, who also had hepatitis C, underwent the first liver transplant on March 5, but that liver did not function properly, causing doctors to attempt a second transplant on Friday. That liver also failed to function, leading to multi-system organ failure. Dunn never regained consciousness following either operation (Rabinowitz, AP/Pittsburgh Post-Gazette, 3/13). "None of the complications that she had had anything to do with her HIV," Lisa Rossi, a spokesperson for the University of Pittsburgh Medical Center said, adding, "The type of complications she had are the type that are seen in patients who have undergone a major operation like liver transplantation" (Smith, Boston Globe, 3/13).
A Long Journey
Dunn had initially requested the liver transplant last March, but her insurer, Neighborhood Health Plan, denied her coverage for the procedure, and its internal appeals board rejected two subsequent requests. NHP said that it would not cover the surgery because liver transplants for people with HIV are considered "experimental" and such surgeries were not covered under the HMO contract Dunn had signed. The Gay and Lesbian Advocates and Defenders filed suit against the health plan on Dunn's behalf, but the Massachusetts Office of Patient Protection upheld NHP's decision to reject coverage for Dunn's transplant. Meanwhile, Boston Mayor Thomas Menino created a fund to raise money to pay for Dunn's operation. However, after a state Medicaid appeals board approved coverage of a liver transplant for a different HIV-positive patient, NHP reversed its decision, donating $100,000 to Menino's fund and saying it would cover any costs above the $240,000 raised by the fund. The two transplant cases have prompted the state Department of Public Health to develop guidelines to assist health insurers and health care workers in making decisions regarding which transplants should be considered experimental and which should be considered standard care (Kaiser Daily HIV/AIDS Report, 3/7).
Surgeons and medical ethicists have "increasingly begun to regard organ transplants [for people with HIV] as a logical, even ethically imperative treatment," the Boston Globe reports. "I would think that the nationwide experience at this point is that anybody who says that's an experimental procedure, the burden of proof is on them to prove that," Dr. Frank Riddick, chair of the American Medical Association's Council on Ethical and Judicial Affairs, said. "There is enough experience that patients with HIV on treatment do well, and they do survive transplants, and it does prolong their life," he added. Preliminary data from a study being conducted by researchers at the University of California-San Francisco show that the success rate of transplants in HIV-positive patients is about equal to those without HIV infection (Boston Globe, 3/13). Rossi said that Dunn, who founded an HIV outreach program for black churches in Boston through the AIDS Action Committee, was the 12th HIV-positive patient to undergo a liver transplant at the hospital and noted that nine of the recipients are still alive (AP/Pittsburgh Post-Gazette, 3/13). Menino said in a statement yesterday that Dunn "fought a valiant battle not only for her own life but for countless others with HIV and hepatitis C" (Boston Globe, 3/13).