If I Only Had a Heart: Organ Transplants - Who's Getting Them and How

When it comes to organ transplants, there are laws that prevent people from buying their way up a list. It's illegal in America to buy organs. There is a federal law banning it. (This is perhaps why you've heard of the black market). So why does it seem that - the more money you have, the better your chances for receiving a transplant?

I read a few articles today answering this very question in regards to Steve Jobs (CEO of Apple - worth ~$5.7bil). Two months ago Steve received a new liver - making him one of the lucky 6,500 in America that will receive livers this year. The entire list of people waiting for livers is around 16,000. The Memphis hospital where Steve underwent transplant surgery claims that no rules were bent to assure his surgery. So how is it that some people, like Steve Jobs, seem to get transplants? Where is the money going?

Well, one way is by putting themselves on multiple lists. Each state has a list of people waiting for organs. Some lists are longer than others. The rule is - whoever is sickest, gets the organ. So, if you're someone with a lot of extra money, you are able to fly to multiple states and get yourself on a bunch of different lists to up your chances of receiving the transplant. This is legal to do. You can be on as many lists as you want.

So many of us could try to do the same thing - especially if you live in a place with easy access to other states. Right? It's not quite that easy. When you receive the call saying "you're up!" you must get to the hospital within 7-8 hours. This makes it tricky for those of us without access to a private jet or $3-5,000 kicking around to spend on a chartered plane. So you can see where having money comes in handy here. This is probably why Steve, a CA resident, had his surgery performed in TN. If you know you can get around the country with ease, why wouldn't you try to 'buy' better odds this way?

The United Network for Organ Sharing (UNOS) actually requires transplant centers to tell their candidates that they can be evaluated and listed at more than one center and that they can transfer their care from one center to the next without losing time. However, UNOs has considered banning or limiting multiple listings - but patients always protested, trying desperately to improve their odds. And I don't blame them. A spokesperson for UNOs says that it's basically up to the particular transplant program to accept someone that they know is already on another list.

Liver transplants, and all organ transplants, are very expensive on their own. I had no idea how expensive! A recent estimate puts liver transplant at $519,600! This price tag excludes 1/3 of Americans right off the bat due to poor/no health insurance. Only about 5% of liver transplants are paid for out-of-pocket. And insurance varies. Some insurance, for example, limits you to only one transplant center that the company itself owns. Before you get on a list, there are committees that actually evaluate candidates with access to their full medical and financial history. This is often where affluence comes into play. Those who have the best insurance and also pass the financial screening are able to shop around and pick the transplant center that is likely to put them high on their list.

The US Dept of Health and Human Services tried to make a rule where priority is given to sickest patients regardless of geographic locale, but it was blocked by Congress. Now the Institute of Medicine is left to consider it. However, the regulations they agreed upon were also turned down by Congress. In addition, smaller transplant centers are concerned that they will be receive fewer transplants and be put out of business. Larger centers want to keep things the way they are. This creates a big split in the transplant community according to territory. It's clearly a complicated system. What do you think about this?

Have you or someone you know been put on a waiting list for transplants? Should people be allowed on multiple lists? What do you think about the business-like aspects to these lists? Do you think this competition is ok or that the rules should be changed?

I worry that no matter what - people will always be able to 'buy' their way into better healthcare (whether it be access via planes or better doctors or affording better medication or technology). Without strict screenings on insurance and priority given to certain people - perhaps homeless alcoholics could be as likely to get a new liver as you or I. I'm not sure how I feel about this. Is one life worth saving more than another? Where does 'fairness' come into play? Do you think money will always have a hand in better treatment/quality of life?

Read this article and this article for more info on Steve Jobs and transplants.
Check out this blogpost on WEGO Health: Recycled Hearts.
Learn more about organ donation at:
Donate Life
Organ Donor.gov