"Did Steve Jobs jump the liver transplant queue ?"

"Since the Wall Street Journal announced on Friday that 54-year-old Steve Jobs, co-founder and chief executive of Apple Inc, underwent a liver transplant, questions have been raised about whether he got preferential treatment."

"Livers for transplant surgery aren’t easy to come by. As another WSJ article pointed out over the weekend, 5,771 Americans are currently awaiting a liver. Last year, 1,481 people died before they received one.

The wait for liver transplants, WSJ reporter Laura Meckler wrote, 'is particularly agonizing. Kidney replacements can often be put off for years through dialysis, where a machine does the work of the kidneys. But there is no such treatment for liver disease.'

Why Tennessee?
Where Jobs went for his surgery seems to be the element of this story that has raised the most eyebrows. Although he lives in California, Jobs received his new liver in Tennessee — a state with a much shorter waiting list. In its own Sunday piece on the controversy, the San Francisco Chronicle reported that 1,615 people sought liver transplants in California in 2008 compared with 295 in Tennessee.

(According to United Network for Organ Sharing (UNOS), the organization that runs the national computer registry that matches donor organs to recipients, 506 Minnesotans are currently registered and waiting for a liver donation.)

The WSJ noted that waiting times disparities have 'led to a sometimes nasty fight among hospitals.'

The current system relies heavily on illness and geography, with the chances of getting a donated liver much better for those waiting in the same local area as the donor. In many cases, priority is given to those who sign up locally, even if there are sicker patients waiting in the next city or next region.

But, as the Chronicle article makes clear, anybody can opt to get on another state’s wait list:

'Transplantation is a very public, transparent process,' said UNOS spokesman Joel Newman. 'It certainly wouldn’t be unheard of for people to look at the potential waiting times, look at their center options and make a decision based on that.'

Indeed, it’s not just celebrities who travel to another state in hopes of upping their odds of receiving a new liver. I did a quick Internet search and found a news report of a Massachusetts couple who moved to Florida in 2008 to improve their daughter’s chances of getting the life-saving surgery.

Too soon to judge
It would certainly appear that Jobs went to Tennessee in hopes of having an earlier surgery date. But without knowing the medical details, it’s impossible to speculate whether he jumped the queue once he was put on Tennessee’s list.

It seems unlikely. Newman told the Chronicle that the median wait throughout the country is 20 days for the most acutely ill patients and 100 days for patients at the next highest level of illness. Those are median waits, so half the people in those categories get into the operating room faster than that. News reports had Jobs seeking a liver transplant at least as early as January. His surgery was in April — well past the 100-day mark.

Also, an institution can be severely sanctioned, said Newman, if it doesn’t follow the proper protocol for determining who receives a donor organ. (The Chronicle article didn’t say, however, if any institution had ever received such sanctions.)

A need for change
Due to turf wars, many institutions resist efforts to eliminate the disparities in waiting times. Noted the WSJ:

Over the years, there have been efforts to decrease the importance of geography, and changes have been made in an effort to even out the disparities. But each time there has been resistance from transplant centers.

The controversy over Jobs’ transplant illustrates the ongoing need for more organ donors. If you haven’t already signed up to be a donor with LifeSource, the nonprofit organization that manages organ and tissue donation in the Upper Midwest, you might want to do so now.

Some of you may remember that a similar media storm raged around baseball great Mickey Mantle’s liver transplant in 1995. Charges were made in the press that Mantle had been taken off the transplant list ahead of five other patients because of his celebrity status. UNOS conducted an independent review and determined that Mantle’s organ transplant was done 'properly and according to established policy.' Not everybody was satisfied with that finding, but the publicity surrounding Mantle’s transplant had an immediate positive effect: Requests for organ donor cards skyrocketed."

Source:
http://www.minnpost.com