One Miracle, Many Doubts

A feat of heart surgery sharpens the debate over benefits and costs

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Dr. Thomas Starzl, a noted transplant surgeon at the University Health Center in Pittsburgh, argues that "the cost of transplants is no higher than the cost of dying from severe diseases of vital organs." A patient can run up expenses of $250,000 before getting a liver transplant, Starzl points out. Nevertheless, the prices of organ transplants remain staggering: heart transplants cost somewhere between $100,000 and $200,000 (Clark's hospital bill was $200,000, not counting $9,000 for the artificial heart, $7,400 for its pump, and the $3,000 or so per year that it would have cost him to run the system if he had survived). The prices for other organs are comparable. A liver transplant costs $135,000, and a year of rehabilitation treatment can double that. Bone-marrow transplants run to $60,000.

Organ transplants are by no means the only miracle cures provided by high-tech medicine. A hemophiliac's Autoplex injections, which stimulate blood coagulation, can cost up to $100,000 to keep him alive for three months. Dialysis machines for kidney patients, which pump the blood through an artificial cleansing device, cost nearly $20,000 per year.

If there were only a few desperately ill patients to be saved, extraordinary measures could be organized to save them. At one of the Humana press conferences last week, a young woman named Theresa Garrison sat wearing a T shirt that said HELP US HELP AMIE LIVE. Amie Garrison, 5, of Clarksville, Ind., was born without bile ducts, which drain bile out of the liver, and she will die unless she gets a liver transplant. A country-and-western band has so far helped raise $20,000, but the Garrisons also need publicity to find a liver donor. Both Indiana Senators are assisting. To further promote Amie's cause, the Garrisons hope she can join President Reagan in lighting the national Christmas tree next week.

But there are at least 150 other Amies around the country who are hoping for liver transplants, and the need for other organs runs into many thousands. Medical insurance firms generally decline payment for such operations on the ground that they are still experimental, though Blue Cross of California has paid between $95,000 and $100,000 for each of two heart transplants this year. The prospect of the Federal Government taking over the financing is none too cheering either, since the Social Security system is already staggering under a burden of an estimated $85 billion in annual medical costs.

The only real precedent for a federal intervention is Congress's decision in 1972 to pay 80% of the ruinous cost of kidney transplants and dialysis for anyone whose kidneys fail. Congress expected to pay nearly $140 million for 5,000 to 7,000 dialysis patients. The first year's bill came to $241 million for 10,300 patients. In a decade, the number of patients has soared to 82,000—including dying cancer victims and nursing-home octogenarians—at a cost of $2 billion, which accounts for 10% of all Medicare payments for physicians.

Heart replacements could run considerably higher than that (some guesses go as high as $40 billion).

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