There are 127 centers in the U.S. that perform liver transplants. If you need an organ transplant, your doctor will refer you to one of these centers, where you will be evaluated, given a score based on the severity of illness, and placed on the center’s waiting list, if you are indeed a candidate for transplant.
The center’s waiting list feeds into a national database managed by the United Network for Organ Sharing (UNOS), a nonprofit organization that contracts with the federal government to manage the nation’s organ transplant system.
UNOS works with 58 organ procurement organizations (OPOs) that coordinate organ distribution in their region of the country. When an organ becomes available, the OPO in that region searches the UNOS database for a local match using blood type (and other biological considerations), the patient’s severity score, and the time spent on the waiting list. If a match can’t be made within that region, the organization expands its search to neighboring regions.
The problem—or the advantage for some patients—is that not all OPOs are created equal. Some regions contain nearly 15 times as many people as others, and their waiting list times vary widely. Patients in the smaller OPOs tend to be less sick and experience shorter wait times before getting an organ. In the Tennessee OPO where Jobs received his transplant, the median wait for a liver between 2002 and 2007 was just over four months. The national average was just over a year, and in some OPOs it was more than three years.
Though there is always the possibility of preferential treatment once a patient is on a waiting list—UNOS conducts periodic audits of transplant centers for exactly this reason—it is unlikely that someone like Steve Jobs can “cut the line” of the transplant waiting list.
The reason that some people might be able to get transplants more quickly is that they’re standing in more lines. Nothing prevents someone from being evaluated and listed at multiple transplant centers. As long as a patient has the wherewithal to fly around the country—and be available at the drop of a hat if a liver becomes available (this is where the private jet comes in handy)—a patient can, in theory, be evaluated by all the transplant centers in the country.
“The system works at two levels,” explains Arthur Caplan, PhD, the chair of the department of medical ethics at the University of Pennsylvania. “One, who gets in to a center. Two, who gets transplanted off a particular center’s list when an organ becomes available. Most of the attention goes to stage two, but the biggest ethical challenges are really at stage one.”
Jobs underwent surgery for pancreatic cancer in 2004. (He reportedly had a type that grows more slowly—and has a better prognosis—than others.) He was said to have recovered, but last year he appeared in public looking thin and sick. He took a leave of absence in January and underwent a liver transplant a few months later. However, it’s not clear how long he was on the transplant waiting list, or if he was on the waiting list for a center other than the one in Tennessee.
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