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Apple CEO Gets Hotly Debated Liver Transplant

June 29, 2009

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Ever since a Tennessee hospital disclosed that an internationally known businessman - Steve Jobs - recently received a liver transplant there, controversy has swirled around transplantation fairness.

by Nicole Cutler, L.Ac.

On medical leave from his company since mid-January, Apple CEO Steve Jobs has received a liver transplant. Because Jobs is an extremely wealthy man, his receipt of a liver transplant from Methodist University Hospital Transplant Institute in Memphis has prompted people to question if money can impact how organs are allocated.

Jobs' Health
Jobs' received surgery five years ago for a rare form of pancreatic cancer, an islet cell neuroendocrine tumor. Several doctors without firsthand knowledge about Jobs' health said the type of pancreatic cancer he had tends to be slow and if it were to spread, the liver is the first likely target.

In the beginning of 2009, Jobs reported that he was suffering from an easily treatable hormone imbalance and would remain Apple's CEO. Less than two weeks later, he said his medical problems were more complex, and that he would take a medical leave of absence for the first half of the year. While it is likely that the ambiguity surrounding his illness was intended to ease investor's fears, Jobs' receipt of a liver transplant confirms that he must have been extremely ill.

Top of the List
Many with end-stage liver disease spend years on the liver transplant list - hoping for a chance at survival. Especially because Jobs had not been previously linked with liver problems, it appears as if Jobs unjustly jumped to the top of the liver transplant waiting list.

In response to this concern, Methodist Healthcare assured the public that Jobs followed all protocols for evaluation and the liver transplant wait list. Methodist Healthcare added that Jobs was the sickest patient on the waiting list at the time a donor organ became available. In the U.S., the wait list for liver transplants is based on how sick a patient is, not how long they have been on the wait list.

In a June 24, 2009 press release from the United Network for Organ Sharing (UNOS), "whenever a person known to the public receives a transplant, it is tempting to compare that person's waiting time to national averages. Any comparison of one person's experience to that of thousands of others can be misleading." Known as a MELD score, liver waiting time is greatly influenced by a formula that assigns priority for organ offers based on the candidate's risk of dying within three months without a transplant. MELD uses objective calculations of common laboratory tests of liver and kidney function.

Improving the Odds
While UNOS' system aims to assure that livers are allocated based on need, Jobs found that there is a way to improve your chances of scoring an organ transplant. With the resources to travel upon a moment's notice and pay out of pocket for his medical care, Jobs obviously did his homework on liver transplantation. The following three strategies for improving transplant odds may have helped Jobs:

1. Finding a transplant center - The Scientific Registry of Transplant Recipients is an Internet database that gives average wait times, success rates and other details on every transplant program in the nation. "Anyone can go to that website and see which transplant centers transplant quicker than others," said Dr. Anthony D'Alessandro, liver transplant chief at the University of Wisconsin-Madison. According to UNOS, a transplant in Tennessee has a median waiting period of just 48 days, while the national median wait is 306 days.

2. Getting on a list - To get on a transplant center's list, a prospective patient must go there, be evaluated by the staff and have tests to confirm medical need. If accepted, the patient must be able to get to that center within seven or eight hours if an organ becomes available.

3. More than one - People can get on as many wait lists as they like as long as they can travel there and meet the transplant center's terms. According to UNOS, accepting someone already on another waiting list is at each transplant program's discretion.

By better understanding how the transplant system works, it is apparent that Jobs could not have "cheated" the system. Instead, he researched all of his options and used his resources to give him the best possible chance of survival. In addition to trusting that UNOS allocates organs based on need, researching the nation's liver transplant centers could help expedite a much-needed liver transplant.

References:

http://www.cbsnews.com/stories/2009/06/21/eveningnews/main5101417.shtml, Jobs' Liver Transplant Raises Questions, Retrieved June 26, 2009, CBS Interactive, Inc., June 21, 2009.

http://www.unos.org/news/newsDetail.asp?id=1265, PTN Statement Regarding Liver Transplant Waiting Times and Allocation, Retrieved June 27, 2009, United Network for Organ Sharing, June 24, 2009.

http://www.usatoday.com/news/health/2009-06-25-jobs-transplant_N.htm, Jobs' liver transplant shows money can make a difference, Marilynn Marchione, Retrieved June 26, 2009, USA Today, June 2009.

http://www.webmd.com/cancer/pancreatic-cancer/news/20090624/steve-jobs-liver-transplant-confirmed, Steve Jobs' Liver Transplant Confirmed, Miranda Hitti, Retrieved June 26, 2009, WebMD Health News, June 24, 2009.

Posted by Editors at June 29, 2009 10:45 AM

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