Reports that Apple CEO Steve Jobs traveled to an unidentified hospital in Tennessee for a liver transplant this March have sparked a debate over whether the wealthy are able to use their resources to game the national organ donation system.
Representatives from Cupertino, Calif.-based Apple declined to answer specific questions from ABCNews.com or confirm the Wall Street Journal report that Jobs, 54, received a liver transplant. However, Apple released this statement: "Steve continues to look forward to returning to Apple at the end of June and there is nothing further to say."
But if Jobs did indeed get a transplant at one of the three designated liver transplant centers in Tennessee (Le Bonheur Children's Medical Center in Memphis, Vanderbilt University Medical Center in Nashville and Methodist University Hospital in Memphis) experts agree that he would have cut his waiting time for an organ.
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.
When a person needs a liver in the United States, the patient must go to a hospital with a transplant center for an extensive medical, mental and financial consultation. Then if he or she is determined a good candidate, the patient will be put on that transplant center's waiting list.
When a liver becomes available, the nearest of the 49 national Organ Procurement Organizations (OPO) will run a database search and algorithm to match the liver to people on all the transplant centers within that OPO's designated local and regional area.
"The local area is not a state, it's that donor service area of that OPO," explained Anne Paschke, spokesperson for the United Network of Organ Sharing (UNOS). "For a liver they're going to look in the local and regional areas before they look nationally."
According to the Organ Procurement and Transplantation Network, 15,771 people are currently waiting for a liver in the United States. Last year, 1,481 people died waiting for a donor liver, almost all of which come from the recently deceased. The national average waiting time for a transplant is about a year, but it can average as little as a few months at some centers, organ experts said.
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.