fixthedocfix

If he has dilated cardiomyopathy (DCM) resulting from a viral illness, it would not be expected to recur in the transplant.

OP: I'd humbly advise that you consult a heart failure specialist at an academic center if you've not done so already. You're too young to not investigate all your options.

You can absolutely administer medications through an epidural while billing for a general anesthetic. You should discuss this with your billing-interested mentors and ideally move to change your department's practice as soon as possible. You must specify the anesthetic type as GA and you must not start anesthesia time with the placement of the catheter (as this would constitute fraud).

How does your institution wake up thoracotomies? On 4 mg of dilaudid and then slowly administer the set rate of epidural so that they don't go apneic? Do you wake them up with severe pain and splinting and only then administer an activating dose?

Where I have practiced, no surgeon performing debulking/HIPEC would allow epidural placement out of concern for thrombocytopenia.

The data for epidurals improving time to recovery of bowel function (among other meaningful endpoints like total IV opioids) is robust, but there are no studies (to my knowledge) demonstrating earlier discharge times after abdominal surgery.

Replace "life-saving surgery" with food, water, heat, shelter, primary care, etc. How many of those are legally required to be provided at point of care without regard to an individual's ability to pay, do you think?

Answer: only treatment of emergent conditions by hospitals with an emergency department. EMTALA dictates that emergent treatments be provided without regard to a person's financial/insurance situation. Try going into a grocery store or realtor's office and demanding food or shelter on a payment plan with no credit and see how far you get.

Second, the bone marrow transplant was neither emergent nor life-saving (and not even a surgery if we're gonna worry about accuracy today). The idea of something being "life-saving" is so nebulous as to be meaningless when talking about healthcare - we reduce morbidity/mortality and consider all treatments with regards to the number needed to treat to prevent an endpoint. The NNT to prevent an endpoint (death, stroke, MI, whatever) is never 1.