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When the University of Arkansas for Medical Sciences announced it had recruited Dr. Youmin Wu to inaugurate its liver transplant program, it noted that Wu held the record for a successful transplant in the youngest person — a 19-day-old baby.
In a recent wide-ranging interview with the Times, Wu said one of the reasons he came to Arkansas in 2004 was that he’d been promised he could start a pediatric transplant program at Arkansas Children’s Hospital. “I was very happy coming here because I thought I could do a very good pediatric transplant program,” the native of Nanjing said. “Children’s Hospital is a first class hospital. Number 6 in nation.” But Children’s was dragging its feet, he said. “I can’t explain it.”
But Children’s is dragging its feet no more. CEO Dr. Jonathan Bates said Tuesday that the hospital’s financial director is working with the state Medicaid office to reimburse the hospital at a level that would make it possible to start a pediatric liver transplant program.
“There’s daylight,” Bates said. A committee at Children’s had announced March 10 that it could not endorse a pediatric transplant program because of TEFRA rules limiting reimbursement. After that decision was made public, the Medicaid office called Children’s to discuss a waiver of the limits, Department of Health and Human Services spokesman Julie Munsell said.
The state Medicaid program is now paying for pediatric liver transplants out of state, so it’s likely there would be no extra cost of the state program to offer them in state. Bates said Children’s refers an average of five children a year to hospitals outside the state for liver transplantation, and estimated the average cost at $150,000.
Without a waiver, the state’s Medicaid reimbursements would fall “way below the hospital’s expenses” for a liver transplant program, Bates said.
Munsell said a waiver would raise the reimbursement for the surgery to full cost. The same process was used 18 months ago to allow UAMS to offer liver transplants to patients without private insurance. Children’s has also received a waiver in the past, when the late Dr. Jonathan Drummond-Webb expanded its pediatric heart transplant program.
Children’s come-about was welcome to Wu, who last week had said the committee’s decision to put off the transplant program was making him think hard about whether to stay in Arkansas. Tuesday he said a program at Children’s “will be good for the kids and the state.”
Medicaid’s call “put a whole new complexion on the [previous] decision,” Bates said. If Medicaid agrees to a higher reimbursement, Bates said the only remaining obstacle to putting a program in place would be assembling the medical team to assist in the surgery, assuming the hospital gets approval from UNOS (United Network for Organ Sharing). Because children are small and livers can regenerate, organs from living donors can be used. Most pediatric donors are parents; Wu would care for them at UAMS and their children at ACH.
Wu trained under the liver transplant pioneer Dr. Thomas E. Starzl of the University of Pittsburgh and has 20 years’ experience in pediatric liver and small bowel transplants. He will be joined this summer by Dr. Frederick Bentley, a specialist in liver, kidney and kidney-pancreas transplants at the University of Louisville, whose solid organ transplant program Bentley developed.
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