Steve Jobs' Reported Liver Transplant Stirs Debate

"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.

"Obviously the supply of organs is controlled as a public resource by UNOS," said Caplan. "Multiple listing undermines the fairness of the listing, in my opinion."

While Jobs and Apple have refused to speak about the matter, doctors say what Jobs has publicly revealed about his health makes his case more unusual in the organ donation system.

Changing the Way People Get Liver Donations

Jobs stated in 2004 that he was diagnosed with an uncommon islet cell neuroendocrine tumor in the pancreas. Doctors say under some circumstances the islet cell tumors cancer can metastasize to the liver, thus necessitating the need for a transplant. However, Apple has not commented on whether Jobs' cancer ever metastasized.

"Islet cell tumors are an unusual but an accepted indication for liver transplantation when the primary tumor has been addressed and the metastatic disease is limited to the liver," said Dr. Michael Millis, chief of transplantation at the University of Chicago Medical Center.

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.

An Objective Way To Make Liver Recipient Lists?

"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."

At Vanderbilt the average MELD score at time of transplant ranks around 24. But on the East and West Coasts, Porayko said the average transplant is done with a person who has a MELD score of 30.

But the original MELD score isn't always used to gauge a patient's needs if the disease that's causing the liver failure won't show symptoms in the MELD blood tests. In the rare case of someone with islet cell cancer, for example, the patient would be reviewed by a regional board that would then assign an "artificial" equivalent MELD score, said Cohen.

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