Saletan on the ethics of wealth and transplants

I'm a physician. I bet most physicians have been thinking about this over the past two years as Steve Jobs' health deteriorated ...

Steve Jobs liver transplant: Organ donation is the best way to honor him. - William Saletan - Slate Magazine

... there’s something you can do to help people such as Jobs. You can supply replacement parts for the machines that keep them alive. You can sign up as an organ donor...

... To get the liver, Jobs went to Tennessee, because the waiting list in Northern California was too long. There weren’t enough livers to go around. Lots of other people in Northern California needed livers but couldn’t get them, because they didn’t have the kind of money or savvy Jobs did. They couldn’t afford to fly around the country, go through extensive evaluations at multiple transplant centers, and guarantee their availability within an hour for the next liver that became available...

... Earlier this year, when Jobs took a leave from Apple because of deteriorating health, I asked whether he should have received his transplant in the first place. As bioethicist Arthur Caplan has noted, almost none of the 1,500 people who received liver transplants in the U.S. when Jobs did, in the first quarter of 2009, had cancer. That’s because there’s no evidence that transplants stop metastatic cancer. The much more likely scenario is that the cancer continues to spread and soon kills the patient, destroying a liver that could have kept someone else alive for many years. Among liver recipients, cancer patients have the worst survival rate. While more than 70 percent of liver recipients in Jobs’ age bracket are still alive and functioning five years later, Jobs lasted only half that long.

In theory wealth and genius are not part of the criteria for liver transplant. In theory, even goodness isn't part of the criteria.

In reality, money makes a huge difference with most things in life. Nobody has ever said Jobs was saintly. Most people with money and/or fame or both would have done what Jobs did. It would have been good if he'd left some money for less privileged people in need of new parts, but that wasn't his style.

Even though Jobs only did what was normal for the powerful, The Tennessee transplant center did worse than most. They do deserve some hard questions.