Court Finds Maryland Should Have Paid for 2 Pediatric Liver Transplants

The high court said Maryland was required to pay for the transplants, which were performed by the Johns Hopkins Hospital at its own expense.

"The federal guidelines allow states no discretion to use an 'appropriateness' test in deciding whether a person under 21 can receive medically necessary treatment," the appeals court said in a unanimous ruling that applies only to patients under the age of 21.

Dr. Lola Metz of the Maryland health department said because of dramatic improvements in drugs and surgical techniques in recent years, the agency has approved all requests for organ transplants for minors for at least the last four years.

"Today, technology is so good that extremely sick, sick patients survive," Metz said.

In one of the two cases that resulted in the appeals court ruling, the state paid for two liver transplants for a boy who had developed liver disease, but refused to pay for a third transplant when he was 13 on the grounds that the boy "remains at great risk for future transplant failure."

The third transplant performed by Hopkins in 1996 was successful and the patient "remains alive today," the court observed.

In the other case, Maryland refused to pay for a transplant for a 14-year-old girl with liver failure, contending the treatment was experimental because she also suffered from chronic hepatitis and an immune deficiency disease.

Hopkins performed transplant surgery on April 30, 1996, but the girl died of liver failure in September 1997.