Steve Jobs & The Healthcare Memory Hole

First of all, my condolences to Steve Jobs’ friends and family. I’ve been a Mac user for nearly two decades; every day I’m thankful for his contribution to the technology landscape.

It’s scary to think someone could die of an awful disease like pancreatic cancer at the age of 56, which is far too young. That said, I could not hear the news of his passing without reflecting on the Tennessee connection: namely, that Jobs was able to use his wealth and resources to “game the system” when he received his 2009 liver transplant here:

Jobs couldn’t pay for an organ. Nor could he pay to cut the queue. But what someone with Jobs’ resources could do, according to liver transplant surgeons and ethicists, is to use money and mobility to improve the odds either by going to an area of the country where there are more organ donors, or by signing up at multiple transplant centers.

“It’s not for anybody but the rich. It’s called multiple-listing, a practice some would say is unethical,” said Arthur Caplan, co-chair of the United Nations Task Force on organ trafficking and chair of the department of medical ethics at University of Pennsylvania.

[…]

Paschke said UNOS requires transplant centers to encourage patients to do “multiple listings” at transplant centers in multiple geographic areas to increase the odds of being matched to a liver. The only catch, Paschke said, is that health insurance policies often cover only one medical evaluation to get on one transplant center list. Most people simply don’t have the money to pay for multiple extensive evaluations at far-flung locations.

“[Multiple listing] is not common. I think you have to have the means to do it and most centers are looking for patients that have a support system within the area,” said Dr. Michael Porayko, medical director of Liver Transplant at Vanderbilt University in Nashville, Tenn.

“So, most people don’t travel all around the country to get on a liver transplant list,” he said.

The fact that anyone with Steve Job’s level of wealth could use money to get a numerical advantage within the national system irks ethicists like Caplan. According to Caplan 3 to 5 percent of the names on organ waiting lists are “multiple listing,” including U.S.citizens and wealthy foreigners who moved to the United States for medical treatment.

Steve Jobs did what anyone in his position with his resources would do. I’m not faulting him for it. I’m just pointing out that a healthcare system which can be so easily gamed by those with vast wealth is not a functioning, equitable system. Steve Jobs lived another two and a half years; last year over 1,500 people died awaiting a liver.

It’s certainly something worth discussing.

10 Comments

Filed under health insurance, healthcare

10 responses to “Steve Jobs & The Healthcare Memory Hole

  1. deep cap

    A similarity I’ve noticed lately is in the adoption business. My brother has been trying to adopt for 10 years now with all sorts of problems both locally, nationally and internationally. Then last year a comparatively wealthy friend of mine was able to adopt in about 3 months, and the only thing that took too long was the time it took for recommendations to be returned.

    The difference between my brother and those friends of mine? $60,000.

    • Yeah that issue has come up with Madonna and Angelina Jolie and other celebrity adoptions. I have some friends who recenlty adopted and their process took several years.

      The world has always been tilted toward the wealthy and fabulous, I think what’s different now is people aren’t really shocked by it anymore. And that’s a shame.

  2. deep cap

    Oh, and of course, just as you, I don’t fault my friends for being able to do what my brother did. It’s just a real shame that with news about so many children needing homes that a good, hard-working guy like my brother can’t adopt unless he has a lot of cash to spend.

  3. greennotGreen

    ‘Bout time I visited your blog.

    I question the efficacy of transplanting a liver into a pancreatic cancer patient. The life expectancy for the particular kind of cancer Jobs had is 7-15 years, but was there really no other patient in the waiting whose only limit on life expectancy was their liver? If he was the best candidate, then I’m glad he got the extra time.

    • The ABC News piece I linked to partially addressed that issue. Apparently they changed how they do the waiting list:

      In years past a person needing a liver transplant from islet cell cancer would have to join a local waiting list with patients suffering liver failure from multiple reasons from alcohol abuse to hepatitis C. For years the liver recipient lists were managed by wait time and other factors such as age.

      But in 2002 a new metric called MELD, (Model for End Stage Liver Disease) was supposed to level the playing field and make the wait for an organ purely associated with biology.

      “It’s an objective score that is generated from patient’s blood test to better be able to rank people in the severity of their illness,” said Dr. Ari Cohen, a transplant surgeon with the Ochsner Health System in New Orleans.

      “The MELD score makes it purely objective, and it’s the same between centers,” he said.

      MELD scores range from 0 to a severe near-death score of 40. The sicker one gets, the higher the MELD score goes. At a MELD score of 15 or above, doctors begin to recommend a transplant.

      But once the MELD score was implemented a clear geographic difference among waiting lists began to appear, according to Dr. Michael Porayko, medical director of liver transplant at Vanderbilt University in Nashville, Tenn.

      “There are differences in wait times for livers,” said Porayko. “I know for instances at the Mayo Clinic down in Florida, there are so many donors they can transplant somebody at a MELD of 17, 18, 19.”

      I don’t know what medical ethicists have to say about allocating limited resources like organs to patients who are so severely ill they aren’t likely to live long. I guess there are no guarantees and someone who could be “cured” by an organ transplant could potentially be hit by a bus. But also, someone who is not that sick has longer to wait.

      It’s an interesting discussion.

      • Jim

        As a cancer patient, was Jobs a candidate to be an organ donor himself? For instance, was it possible to re-transplant the liver he received or would it have been damaged by the cancer?

      • greennotGreen

        I don’t see that MELD addresses the issue I raised. Giving Jobs a new liver did not treat his cancer unless his liver was the only repository of the cancer – which it obviously was not. Of course, maybe they didn’t know that at the time.

      • Jim, I guess that’s a question for his doctors but I would imagine his “new” liver would have been too damaged to be reused. But you know, they reuse all sorts of things — corneas, skin, etc.

        I remember when my mother, who was an organ donor, died, there was a big question about what of her organs were suitable for donation because she had been so ill. And she wasn’t a cancer patient, either. I think in the end we donated her corneas and that was it. I really don’t remember.

    • Good point, Green.

      I guess unless his family releases his medical records (and there’s no reason they would), we are just talking in hypotheticals.

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