Despite the apparent problems with the transplant system, past efforts at reform have generally failed.
In the late 1990s, the U.S. Department of Health and Human Services issued new regulations that would have given priority to the sickest patients, regardless of region. This would have eliminated the geographic disparities that make approval at multiple transplant centers advantageous, but Congress blocked the regulations and instead asked the Institute of Medicine (IOM), an advisory organization that belongs to the National Academy of Sciences, to consider the issue.
The IOM’s proposal was less far-reaching, but they did recommend standardizing the size of the organ donor pool for the sickest patients. Congress failed to implement this measure as well, however.
Some transplant centers advocated the shift away from the OPO system, but others vigorously lobbied Congress to oppose the new policy. The smaller transplant centers were concerned that in a national organ allocation system, they would receive fewer transplants and be driven out of business. The larger transplant centers, meanwhile, wanted to maintain the size and geographical reach of the OPOs in their areas.
“There was a huge split in the transplant community,” says Paschke. “It was very territorial at the time, and there was a lot of maneuvering going on. There were a lot of business interests on the part of the transplant centers.”
UNOS itself has been split on the issue of multiple listing. The organization’s board of directors has voted on whether to restrict multiple listing three times in the past 15 years; the first vote resulted in a tie, and in the others the proposal was rejected by a divided vote.
The inequity revealed in the liver transplant process is symptomatic of the larger inequalities in the American health-care system, says Caplan, who also cochairs a UN task force on organ trafficking. In countries such as Canada or Switzerland that have national health-care systems, a patient’s finances don’t influence access to organs to the same extent, he says.
“Money doesn’t play such a big role in entry into the system,” he says. “Steve Jobs’s transplant is relevant to why we need some health reform.”
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Did Steve Jobs’s Money Buy Him A Faster Liver Transplant? Vote
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There’s one question that nobody seems to be asking about Steve Jobs and his liver transplant: is Steve Jobs a registered organ donor?
It’s not fair to give an organ to a non-donor as long as there is a donor who needs it. But about 50% of the organs transplanted in the United States go to people who haven’t agreed to donate their own organs when they die. It’s no wonder there’s such a large organ shortage. If organs were allocated first to organ donors, more people would agree to donate and fewer people would die waiting for transplants.
Anyone who would like to donate their organs to other organ donors can join LifeSharers at http://www.lifesharers.org or by calling 1-888-ORGAN88. Membership is free. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.
Regarding the question of whether Steve Jobs is a registered donor, we should hope that he is not. Anyone who has been diagnosed with an metastatic cancer, such as Jobs’ pancreatic cancer, is inelibible to donate blood or tissues. There have been cases in which tissues were transplanted from dead people to patients, and later it was determined that the donors had undiagnosed cancers that had already invaded the grafted tissues. Transplanted cancer cells can spread in recipients quickly due to the immunosuppressive drugs these people take to prevent rejection of the grafts.
Any one qualifying for an organ transplant should NOT be an organ donor. From a medical stand point it makes no sense. If you’re sick enough to be on the list, you shouldn’t be donating.
SR, RN