Tuesday, June 23, 2009

The interesting aspects of Steve Job’s alleged liver transplant

A surgeon expresses the thoughts on the mind of every physician who’s heard that Steve Jobs received a liver transplant (per WSJ) for a metastatic neuroendocrine tumor …

What's wrong with Steve Jobs, revisited : Respectful Insolence

… How many people are capable of getting themselves listed for transplant in a state nearly 2,000 miles away from their home? When a liver becomes available, there isn't much time to get to the hospital. That means a person seeking a transplant in another state either has to stay in that state for as long as it takes to get an organ or be within a distance to be able to fly there within a very short period of time. Moreover, organs eligibility and availability are determined by the United Network for Organ Sharing, which maintains the donor lists. When an donor is identified, regional and state organizations (in my home state, for example, Gift of Life, where one of my relatives works), obtain consent, arrange for organ harvest, and decide, based on fairly strict criteria published by UNOS regarding medical need and practical matters like how long it will take to get the organs out and to the hospitals where they are needed, which people on the waiting list for the state will receive each of the organs harvested. If this story is true, what Jobs did is not illegal, but it sure does leave an unpleasant stench of the rich and powerful taking advantage of regional differences in organ availability, perhaps at the expense of a lifelong Tennessee resident who needs a liver…

… Worse, the indication is somewhat shaky. For one thing, as was pointed out in the article, neuroendocrine tumors are generally very slow growing and take a long time to metastasize. One of the more "common" subtypes of the rare neuroendocrine tumor in particular, a carcinoid of the appendix or the rectum, is particularly prone to metastasize to the liver and is notorious for causing carcinoid syndrome, which is due to serotonin secretion by these tumors and causes flushing, diarrhea and other unpleasant symptoms…

In the United States organs are gifts from the dead to strangers. Most of the donors are not wealthy. In this country we don’t, yet, seem to have much of a commercial market in organs – though the organ trade is growing in much of the world (the sale of sperm and eggs, by contrast, is a very active US market, sure to be increasingly global).

The story of Jobs liver transplant has two interesting aspects. Both demonstrate what power can achieve.

One aspect is that it was kept pretty much out of the media, though clearly thousands must have known the details. In this regard it resembles the seven month media silence about the imprisonment of a senior NYT journalist in Taliban-occupied Pakistan . The modern world is better at keeping secrets than many imagine.

The second aspect is that it shows that we need to talk more about organ distribution. The rich will always have access to more health care options – though, as in this case, it may lead them to make medically sub-optimal choices. On the other hand, organs are a gift from people who are usually not themselves powerful. Given two equally appropriate candidates, one powerful and one not, I’d rather my liver go to the less privileged. It’s my way of spitting in the face of a fundamentally unjust universe.

We should be talking about the organ trade.

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