23 Miss. Code. R. 202-4.15 - Bilateral Lung Transplant
A. Prior
Authorization is required.
B.
Bilateral lung transplants are covered when the following criteria are met:
1. Candidate is less than sixty-one (61)
years of age.
2. NYHA Class III or
IV with rehabilitation potential.
3. Preserved nutritional state.
4. Meets facility's blood and tissue-type
compatibility standards.
5.
Infections controlled for at least forty-eight (48) hours prior to transplant,
unless the infection is limited to the lung to be removed.
6. Absence of irreversible and severe end
organ dysfunction, either hepatic, gastrointestinal, renal, peripheral
vascular, or cerebrovascular), or uncontrolled malignancy.
7. All other treatments have been attempted
or considered and none will prevent progressive disability and/or
death.
8. The candidate and/or
legal representative understands the transplant risks and benefits, gives
informed consent, and has the capacity and is willing to comply with needed
care, including immunosuppressive therapy.
9. The candidate has been approved by the
center's transplant review team.
10. Required serology studies have been
completed for HIV, Hepatitis (A, B, and C), Cytomegalovirus (CMV), and
Varicella.
11. Immunizations have
been administered as follows:
a) All
immunizations for children age two (2) to six (6) are up-to-date in accordance
with the most current recommended childhood immunization schedule developed and
endorsed by the Advisory Committee on Immunization Practices (ACIP), the
American Academy of Pediatrics (AAP), and the American Academy of Family
Physicians (AAFP).
b) Hepatitis A,
if serology does not indicate immunity.
c) Hepatitis B, if serology does not indicate
immunity.
d)
Pneumococcal.
e) Influenza,
annually.
12. A
psychosocial evaluation has been performed for the adult candidate or, if the
candidate is a child, for the family, with the following results:
a) Candidate's psychiatric disorders, if
present, are being treated.
b)
Candidate's social support system has been evaluated and found to be
adequate.
c) Candidate has no
previous history of significant non-compliance to medical treatment.
13. Specific Diagnostic Inclusion
Criteria:
a) End-stage fibrotic lung disease
unresponsive to alternative therapy with FVC <65% of predicted.
b) End-stage obstructive lung disease with
FVC <25% of predicted.
c)
End-stage pulmonary hypertension, either primary or secondary without
significant right heart dysfunction, unless heart-lung transplant planned
d) Cystic fibrosis with FVC
<40% and FEV1 <30% of predicted.
e) Bronchiectasis.
f) Bronchopulmonary dysplasia.
g) Obliterative bronchiolitis.
14. Facility is approved for lung
transplants by Medicaid.
C. Bilateral lung transplants are not covered
when the candidate has one of the following:
1. Active chemical dependence, drugs or
alcohol within the preceding six (6) months.
2. Steroid therapy >20mg/day, must be off
steroids or weanable from them.
3.
Bone marrow failure of any stem line: RBC, WBC, platelets.
4. Severe osteoporosis.
5. Severe chest wall deformity
6. Cachexia, body weight <70% of ideal for
height, or obesity, body weight >120% of ideal for height, in candidates
with Cystic Fibrosis.
7. Recent
pulmonary embolism or current deep venous thrombosis.
8. Viral hepatitis in candidates with Cystic
Fibrosis.
9. HIV.
10. Uncorrectable absence of an essential
psychosocial support system.
11.
Unmanageable psychiatric disorder felt to significantly compromise compliance
with the post-transplant regimen.
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.