Isolated Small Bowel Transplant

This policy covers isolated small bowel (intestinal) transplantation — primarily cadaveric and, only when a cadaveric graft is unavailable, living‑donor transplants — for adults and children with intestinal failure (for example short bowel syndrome) who cannot maintain protein‑energy, fluid/electrolyte or micronutrient balance and/or are TPN‑dependent with severe TPN‑related complications or progressive TPN‑associated liver disease; retransplantation after graft failure is also included. Coverage requires meeting transplant criteria and member benefit provisions, excludes patients who can tolerate TPN or who have active/high‑risk malignancy, untreated systemic infection, or psychosocial/substance issues impairing adherence, and prohibits coverage for organs procured via forced organ harvesting (specified countries); lifelong immunosuppression and transplant risks apply.

"Adult and pediatric individuals with intestinal failure characterized by loss of absorption and inability to maintain protein-energy, fluid, electrolyte, or micronutrient balance (cadaveric small b..."