Intestinal and Multivisceral Transplantation

Letter sent accepting formal request.

Technology assessment requested for more literature.

Requestor notified of request for assessment.

Received Technology assessment

Based on review of the technology assessment, a number of issues remain for clarification. In that regard, we are asking all interested parties to respond to the question noted below, with particular regard to the evidence they can provide in support of their responses.

Questions in need of additional evidence:

What clinical manifestations define "failed total parenteral nutrition (TPN)" and what literature is available to support this definition?

Is there scientific evidence to support coverage of small bowel and multivisceral transplantation in the age 65 and older population?

Scientific evidence considered in the assessment is based primarily on the experience in two hospitals. Is there evidence to expand Medicare coverage to this procedure in other facilities?

Is there scientific evidence to support specific facility criteria (similar to Medicare coverage of liver, heart and lung transplants) that should be met prior to Medicare coverage of transplants in that facility?

Is there scientific evidence to support small bowel and multivisceral transplantation in patients with malignant disease and if so, what types of malignant disorders?

Awaiting answers.

Received additional information from requester in response to questions. Extended due date.

Due to the complexity of the issue, we will need a few extra weeks to complete our review. We are extending the due date on this topic until October 1, 2000.

Posted to the web a Decision Memorandum that would provide for coverage of intestinal transplantation to patients who have failed TPN in facilities that meet specified criteria.