A special report from The Washington Post framed its story by stating how Apple co-founder Steve Jobs had received a liver transplant in 2009, albeit in Tennessee, several states and over 2,000 miles away from his Northern California hometown. This was the case, the report said, due to “money and the complexities of the U.S. transplant system.”
Most patients with failing organs are listed in just one transplant center close to where they live. But the nonprofit United Network for Organ Sharing’s guidelines allow people to apply for transplants and sign up for wait lists at multiple centers at the same time. As Jobs, being a high-powered tech executive, had enough resources to sign up for multiple wait lists, he was able to get a transplant in Tennessee. This allowed Jobs several advantages, the report stated – he had a better chance to move up a list, he had a better chance to be matched with the right organ, and he also had “an in” with transplant centers that had the shortest wait time, regardless of location.
Further, Jobs had access to a private plane, giving him a convenient way to fly to those centers while the organs were viable, and could afford temporary housing for the recovery period. These advantages, the Post said, are luxuries “that are difficult for all but the most wealthy to afford.”
The late Jobs, according to the report, was far from being the only member of the upper crust to “game” the transplant system. This was revealed in a new study discussed this week at the annual American Heart Association meeting in Orlando, Florida. Researchers analyzed statistics from UNOS, checking wait times for close to half a million patients from 2000 to 2013. 12 percent of kidney transplants were on multiple lists, same with 6 percent of liver patients, 3.4 percent of lung patients, and 2 percent of heart patients. These were typically wealthier patients with insurance, and also had higher transplant rates and lower mortality rates while on the wait list. Patients with Medicaid insurance, on the other hand, typically don’t have the option to get on more than one list, or to be listed in another state with a better chance of a transplant.
One key reason why the wealthy has been able to take advantage of multiple lists is the prohibitive cost involved in getting approved for a transplant at any specific center. This also takes up a lot of time, and patients need to go through a battery of tests and be interviewed multiple times, with at least six specialists handling the interviews. Hospitals also have their own specific protocols, and many hospitals require regular check-ins every two weeks to six months to ensure that patients remain on the transplant lists and don’t lose their slot.
Study lead Raymond Givens of the Columbia University Medical Center said that the upper crust does indeed have an edge through multiple listings, while those who need the transplants the most often don’t have as good a chance to get them. “It undermines a bedrock principle of organ transplantation — which is that the sickest people should be transplanted first,” he said. “We firmly believe the multiple listing policy needs to be reconsidered.”
Others have had similar complaints with the current organ transplant system, but believe the issue has more to do with the widely varying wait times from center to center. Wait times may be as short as six months in certain regions, or as long as two or more years in others.