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Steve Jobs Returns To Work As Questions Continue To Surround His Liver Transplant

Posted by Chrissie Cole
Monday, June 29, 2009 5:24 PM EST
Category: Major Medical
Tags: Protecting Your Family, Apple, Steve Jobs, Liver Transplant, Pancreatic Cancer


IMAGE SOURCE: Wikimedia Commons / Steve Jobs

Steve Jobs, Apple Inc.’s CEO has been at the forefront of tech and health news the last week as reports emerged that he traveled to an unidentified hospital in Tennessee for a liver transplant this March.

The news is also abuzz with questions about fairness. Certainly Jobs had the financial resources to travel and pay out of pocket for his medical care. He reportedly received his transplant in Memphis which has a significantly shorter waiting period of just 48 days compared to the national average waiting period of 306 days.

Patients go to transplant centers in Memphis, and in Jacksonville, Florida, because the waiting period is shorter than other parts of the U.S.

“You could say its gaming the system and that very well may be true,” John Fung, chairman of transplant surgery at Cleveland Clinic tells Bloomberg. “But until we address the problem of what makes the system unfair, we can’t condemn those people who are trying to help themselves.”

Gaming The System

To clarify “gaming” the system in this instance - Jobs couldn’t pay for an organ. Nor could he pay to cut ahead of those already waiting. But what someone with Jobs’ resources could do, according to liver transplant surgeons and ethicists, is use money and mobility to improve his odds by either going to an area of the country where there are more organ donors or by signing up with multiple transplant centers.

In 2008, there were 17,000 Americans waitingon a liver. Of which 6,000 received a transplant and 1,481 died waiting, according to a national database of transplant statistics maintained by the Scientific Registry of Transplant Recipients.

The Process

In the U.S., when a patient needs a liver, they must go to a hospital with a transplant center for an extensive medical, mental and financial consultation. If the patient is a good candidate, they will be added to transplant center’s waiting list.

When a liver becomes available, the nearest of 49 national Organ Procurement Organizations (OPO) 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.

Anne Paschke, spokesperson for the United Network of Organ Sharing (UNOS) explains, “The local area is not a state, it’s that donor service area of that OPO. For a liver, they look in the local and regional areas before looking nationally.

“Multiple listing is not common. The person must have the means to do so and most centers look for patients that have a support system in the area,” said said Dr. Michael Porayko, medical director of Liver Transplant at Vanderbilt University in Nashville, Tenn.

“So, most people don’t travel around the world to get on a liver transplant list,” he said.

Ethicists are bothered by the fact that anyone with Steve Job’s level of wealth could use money to get a numerical advantage within the national system. An estimated 3 to 5 percent of the names on organ waiting lists are “multiple listing,” including U.S. citizens and wealthy foreigners who move to the U.S. for medical treatment.

They also feel that multiple listing undermines the fairness of the listing.

Jobs and Apple have refused comment, but doctors say, based on what Jobs has revealed about his health makes this case that much more unusual.

In 2004, Jobs confirmed he was diagnosed with a pancreatic tumor known as an islet cell neuroendocrine tumor, which is less deadly than most pancreatic growths.

He underwent surgery in 2004 and then announced that he was cured. But in January, he was forced to take a leave of absence from Apple due to an undisclosed medical condition that was causing significant weight loss.

Physicians theorize the cause of the liver transplant was that the tumor metastasized to his liver – a likely place for the disease to spread. Yet, still, a liver transplant would not typically be the first intervention attempted.

“It’s definitely not a common indication for liver transplantation,” said Dr. Will Chapman, professor and chief of transplant surgery at Washington University, in reference to neuroendocrine tumors. Chapman, who was not involved in Jobs surgery, said the scenario accounts for less than 2 percent of liver transplants, but didn’t want to speculate.

MELD Scores

Under the organ-sharing network’s rules, most livers are allocated locally using a system called The Model for End-Stage Liver Disease (MELD) system, implemented in 2002 to prioritize patients waiting for a liver transplant.

MELD scores range from 6 (less ill) to 40 (gravely ill) and the individual score determines how urgently a patient needs a liver transplant within the next three months. The number is calculated using the most recent laboratory tests.

Steve Dowling, a spokesman for Apple, has declined to comment on how Jobs qualified for a liver transplant. And numerous emails to Jobs have remained unanswered. #

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