Kaiser Permanente Approves Kidney Transplant for HIV-Positive Colorado Man After Initial RefusalKaiser Permanente, one of the nation's largest HMOs, on Wednesday reversed an earlier decision and approved a kidney transplant for an HIV-positive Colorado man, the AP/9News.com reports (AP/9News.com, 10/8). In September, Lambda Legal, a national gay-rights group, filed a formal appeal with Kaiser Permanente on behalf of 53-year-old John Carl of Denver, Colo., challenging the company's refusal to provide insurance coverage for Carl's kidney transplant because he is HIV-positive. Carl, who tested HIV-positive in 1988, takes antiretroviral drugs and was in good health until 2001, when he experienced kidney failure. Carl has undergone kidney dialysis three times per week since 2001. Officials from Kaiser Permanente had said that the transplant would be too risky because the drugs used to suppress organ rejection could harm Carl's already weakened immune system (Kaiser Daily HIV/AIDS Report, 9/24). "I think (this decision) reflects further understanding of HIV," Dr. John McGrory, the Kaiser Permanente physician handling the case, said, adding, "In the last four years we have drugs now to treat HIV-positive patients we never had before." McGrory said that the HMO has referred Carl to the transplant program at the University of California-San Francisco, which has added Carl's name to its transplant list. However, McGrory said that does not mean Carl will receive a new kidney because it "often takes years" before a kidney becomes available for any individual patient (AP/9News.com, 10/8).
Attitudes about organ transplants for HIV-positive people have been changing since the mid-1990s, when advances in antiretroviral drug therapy began to help HIV/AIDS patients live longer, healthier lives. Antiretroviral drug treatment can restore patients' immune systems enough to allow them to withstand transplants and the immune-suppressing drugs that prevent the rejection of new organs (Kaiser Daily HIV/AIDS Report, 9/24). Hayley Gorenberg, director of Lambda Legal's AIDS Project, said there is growing scientific evidence that HIV infection "does not significantly affect the outcome of kidney transplantation." However, McGrory said that many transplant programs still will not consider HIV-positive patients as kidney transplant candidates. "It takes time for people to assimilate what they learn at these national conferences and then put it into practice," he said, adding that unpublished data helped Kaiser Permanente reverse its original decision. "This is truly cutting-edge medical technology and information," McGrory said, adding, "It wasn't thought about when (Carl's request) was initially denied" (AP/9News.com, 10/8).