Everyday Ethics

Everyday Ethics


Steve Jobs Liver Transplant–Is That Ethical?

posted by hfields

STEVEJOBS.jpgUPDATE: Interesting NY Times article asking some of the same questions as my original post about Steve Jobs’ liver transplant. Check the NY Times piece out! Because of this article, and because of the many comments I received on my own, I’m putting up an updated version of my prior post today (below), but with some changes to reflect better information. Unfortunately, by putting up this new version, the old one was deleted, so some of the comments on it may no longer apply. Anyhow, enough disclaimers! Here goes:

I read on Gawker that the Wall Street Journal is reporting Steve Jobs had a liver transplant in Tennessee two months ago. After fudging and phumphering about his medical condition for months (even years) since being diagnosed with pancreatic cancer in 2004, this past winter he announced he had a ‘hormone imbalance’ and took a medical leave after he was observed to have dropped an alarming amount of weight.

I get why he’d want to keep his condition quiet. All apart from the natural desire of any regular citizen to have privacy during a serious medical event–and they don’t come more serious than pancreatic cancer–Jobs is the driving force behind one of the biggest tech companies in the known universe. Stock prices dive or skyrocket with the very beat of his pulse. His decision to keep the world guessing about his condition isn’t the source of my ethical ears pricking up.
No, what’s making me just the faintest bit queasy about this story is Jobs getting a liver transplant when he has a disease with such an incredibly high mortality rate. [Updated version--sorry, in my first version of this post, I failed to mention that Steve has the slower-growing and less lethal but still very serious form of pancreatic cancer, a neuroendocrine tumor.] I know a little about pancreatic cancer–my mother was diagnosed with it a year and a half ago. She has been doing remarkably well (thank god and a great doctor) but there’s always the specter of the disease’s return hovering over our family, as it [the adenocarcinoma kind] has something like a 95% recurrence rate. And when it recurs, well… the odds are astronomically bad. While the kind Jobs has isn’t as terrifying, the efficacy of liver transplant to cure it or prolong life is still a matter for debate among doctors.
 

So I have to wonder, if indeed the transplant is because of pancreatic cancer metastasizing (and that is by no means established yet, so this is all hypothetical for now), is Jobs taking a liver from someone who would have a better chance of surviving? [Is what I'm thinking a total conspiracy theory? A holdover paranoia from the case of Mickey Mantle?] And, did he cut to the head of the line because he’s rich and famous? The rich do have resources, such as being able to register for transplant lists in multiple locations, that most people simply don’t have.
For the purposes of this blog, let’s extrapolate from Jobs’ case, the details of which we can’t really know, to the larger issue of whether the rich get special medical treatment when it comes to organ transplantation, and whether that’s a violation of ethics. Do they get to jump the line? And would we do the same if we could?
Yikes, what a tricky question. I can only look at it through the lens of my own experience. If my mom’s cancer were to return, would I want her to get a transplant even at someone else’s expense? Well, I want her to live, as long and as healthily as is possible. But at the expense of another, someone whose odds are far better than hers? Yeah, if I were faced with the decision today, I’d have to say probably, since she’s my mom. I don’t think I’m the most objective observer on this question, so I went to the source. I asked my mom what she had to say about this.
Her answer was basically, “That’s what transplant review boards are for.” Sure, she said, she’d want to be on the transplant list, if her odds were decent. And she would have no way of knowing who else was next to receive a donated organ, whether their chances were any better or worse than hers. Unless she knew the guy behind her was meant to save the world, why not take her shot at life?
Yay, Mom. I love you so much, for your practicality, your wisdom, and your optimism. I need to see these things modeled in my life–they are a great power of example.
OK, enough mush. Back to ethics, and to Steve Jobs’ case.
Barring any unlikely conspiracy theories about Jobs getting unusual medical treatment because of his rock star status in the computer world, what’s left for me to feel uneasy about is only his having been able to register for the transplant in multiple regions because of his nearly unlimited financial resources. Ethically iffy, but not illegal.
My own conclusion is that I feel relieved, like my mom, that transplant lists are handled by those who know both the medical issues and the likely outcomes, and who have spent years of thought and study on these questions of medical ethics. We put our faith in them not to allow unfair treatment benefitting the elite, and we take comfort in the UNOS procedures that have been set out to keep things equitable. Yet I feel niggling concern that there are lingering inequities that stem from the wealth of people like Jobs, and a healthcare system that is dangerously unbalanced.
Do you agree?



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Markus

posted June 20, 2009 at 11:07 am


For someone with a personal connection to pancreatic cancer, you seem to know very little about it.
First, the type of cancer that he had was not the typical pancreatic cancer with a very low cure rate. He was one of the extremely lucky ones with islet cell PC, an extremely rare form that if caught at the stage he caught it, has an extremely good prognosis. He did not have adenocarcinoma, the kind that my mother had and your mother has.
Second, transplants are NEVER done for any cancer metastasis that I know of. Once a cancer spreads, that’s it, game over, they no longer try to cure you, they are just buying time.



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Susan C

posted June 20, 2009 at 11:12 am


Well, you have to consider that there are two types of pancreatic cancer and that Steve Jobs had the less lethal of the two types, an islet cell tumor. This type of pancreatic cancer has a much higher survival rate. So the ethical question may not be as great as you think.



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Charles Cosimano

posted June 20, 2009 at 11:27 am


There are times when ethical questions are really irrelevant. This would seem to be one of them.



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Hillary Fields

posted June 20, 2009 at 11:49 am


Markus:
1) I am sorry about your mom.
2) I’m using this case really as more of a hypothetical conversation opener than a comment on Jobs’ specific type of cancer. I’m obviously not privy to his personal medical records, though liver transplant does appear to be an unusual course of treatment for *any* form of pancreatic cancer, from what (admittedly) little I’ve read.
3) Re: “Once a cancer spreads, that’s it, game over…” I guess I was suggesting that while that’s generally the case, I wondered if Jobs might be getting special treatment–possibly useless treatment–and this was the cause of my ethical unease. Of course I can’t know that. My hope is that his doctors are following well-established medical ethical guidelines that are the same for all patients. And, I also hope his health continues to improve.
All the best,
Hillary



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L. Davis

posted June 20, 2009 at 11:58 am


It is my understanding that Jobs was told his pancreatic cancer was treatable initially, but chose alternative medicine for a time. It was then beyond much treatment. I, of course, don’t have first hand knowledge that this is true; but either way he waited. It is disturbing that his money and ‘status’ gave him special access to the transplant….. these things should have no part in health issues like this, but of course do.
A great example of what money buys in our medical centers was demonstrated to me in the fall magazine of Johns Hopkins Medicine Magazine when it announced that the United Arab Emirates (UAE) had endowned Hopkins with “a momentous contribution that catapulted the hopsital’s $1.2 billion redevelopment plant toward reality. …., the confetti is still flying.”
The article explained the special relationship that had been developed with the UAE since 1988 and their ‘international’ was described by the director as being , ‘known around the hospital—and the world—for its personalized attention to everything from appointment scheduling and financial planning to interpreting and arranging travel.” He said that when it comes to leaders such as the royal family, “the service expectations are above and beyond any standard . Our coordinators work day and night, weekends included, to manage and facilitate any possible need.”:
Large scale visits have been arranged for the royal family since 2005, when a royal arrived for surgery accomodied by an entourage of 70. All were accommodated by the hospitial and since then, , similar groups arrive annually for care involving all medical specialties. Preparations are begun long in advance for, at many times, 2 month stays…. The “private’ suites in the hospital are upgraded with new TVs and satellite channels, laptops, artwork, curtains and Oriental rugs. Additional help is hired, private nurses . Hospital staff from housekeeping to kitchen staff are given special instructions.
Does money buy health? You bet it does…. And Obamacare won’t change that one bit. At least now private citizens have the option of seeking healthcare at institutions like Hopkins, The Mayo Clinic and Harvard. You may not get the same attention, nor even the same healthcare, but at least now you can seek out top-notch Drs. at our medical schools. Government controlled healthcare will not allow that…. I guarantee it.



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desiree

posted June 20, 2009 at 12:38 pm


I’m sorry about your mother. But you do know that partial liver transplants are performed with a living donor. Both patient and donor can recover within weeks because the liver regenerates.



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bill

posted June 20, 2009 at 1:25 pm


I would bet it was a partial donation from a living relative or tissue match. In medicine, cancer patients of any type are not often transplanted. Here’s a bigger question- and I do not by any means have an answer for this one. Do certain individuals with greater political or business influence/achievement AND financial means, deserve better medical care. You can bet that any universal health care plan that the government pushes through will create just such a situation. Doubt it? Call 10 doctors in your town and tell them you have Medicare or Medicaid (state program for free care) and ask if they are accepting patients. Angry at physicians? Go to walmart and tell them you know the price of a loaf of bread is $1.60 but you are going to give them $1 instead. What do you think they will tell you. The whole situation is a mess. I am not confident in our government to get us out of this one. I just want cost controls on healthcare. Nothing free EVER to anyone. Really cheap is okay. just not FREE. I also don’t want to get punished for being able to have really good health insurance and access to physicians.



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Tommy

posted June 20, 2009 at 1:47 pm


In January, Bloomberg – see http://www.bloomberg.com/apps/news?pid=20601087&sid=aDmh9xsKBMe4 – was saying Steve Jobs was a candidate for a liver transplant.
If that was true and Jobs got onto the national registry, he just might have become a recipent based on being on a list.
However, if he got onto a private list earlier than his medical leave from his Apple announcement. That might have had a material effect on share values that their shareholders should have known about a long time ago.



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Scott

posted June 20, 2009 at 1:57 pm


Why shouldn’t the rich get better care than the poor? Steve Jobs has been more valuable to society as a whole as compared to the rest of us submitting comments.
Not everyone can own a Ferarri ! Public health care will give everyone a Yugo!
Obamacare sucks !



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Frank

posted June 20, 2009 at 2:09 pm


My prayers for your Mom.
1. Steve has a rare, curable form of this cancer.
2. The most likely surgery for it (Whipple technique) had been done for over 50 years and often has digestive side effects. (pancreas produces enzymes for digestion and a lot of organ may be taken out in surgery)
3. Liver can be damaged from digestive problems from above, in a few cases. So, no cancer in liver needs to be assumed.
4. Living transplant donors (for liver or kidney, for example) can designate recipient. (so, no list needed)
5. Being a billionaire helps, but is not necessary for all this to have transpired.
If this isn’t about Steve, then what “hypothetical” discussion are you trying to generate? And, in any case, do more research beforehand in the future.



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Your Name

posted June 20, 2009 at 2:34 pm


You are really making assumptions and jumping to conclusions. Many people have liver transplants and the donors are friends and relatives, since the liver regenerates itself. The donor would need to be a proper match to the patient and be thoroughly examined to make sure that their own health would not be jeopardized. This method of transplantation is becoming increasingly popular. It has nothing to do with the transplant “list” that you are referring to.



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Hillary Fields

posted June 20, 2009 at 2:35 pm


Hi Frank. Thanks for your prayers. My mom had a Whipple – one of the toughest surgeries there is. She takes digestive enzymes to help her compensate. You make a lot of good points (even in your rebuke), so thank you very much. Sorry if my argument wasn’t fully thought out or fully elucidated. I suppose my ‘hypothetical’ was about a) wealth and privilege potentially skipping certain people ahead of the line when it’s not fair and not generally medically accepted treatment. While perhaps this is not Jobs’ case per se, one might argue that people who have greater wealth are able to buy access to every last remote option to which others may not have access. I was also thinking b) how long and how far would you cling to life and accept a transplant if you had a dismal long-term prognosis? (Yes, I don’t know Jobs’s prognosis, but his situation made me think about transplant ethics in general.)



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Duh

posted June 20, 2009 at 2:37 pm


Sorry Frank, I am pretty sure that the author made it abundantly clear that this is a hypothetical situation here. Without getting into the fancy details you just posted, the main crux of the argument was “is it fair that a rich person gets to the head of the line with regards to transplants?”. I don’t think researching into the details of the liver, and digestive side effects of it has anything to do with the question of ethics here although I was thoroughly entertained by your listing. If it did happen, I don’t think its ethical but there are a lot of things that happen in medicine that aren’t ethical unfortunately.



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robert

posted June 20, 2009 at 3:24 pm


What the hell!!! Cancer is Cancer,Treatable or not. I was told My wife could not have a transplant and she was dying. I would have done anything at that point in our lives to save her, or at least think there was a chance…anything. But it was brushed off like we were lepers to even think we could get a transplant…..Ethics…..He aint no better than you and I…..



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CV

posted June 20, 2009 at 3:30 pm


“No, what’s making me just the faintest bit queasy about this story is Jobs getting a liver transplant when he has a disease with such an incredibly high mortality rate. I know a little about pancreatic cancer–my mother was diagnosed with it a year and a half ago. She has been doing remarkably well (thank god and a great doctor) but there’s always the specter of the disease’s return hovering over our family, as it has something like a 95% recurrence rate. And when it recurs, well… the odds are astronomically bad.
So I have to wonder, if indeed the transplant is because of pancreatic cancer metastasizing (and that is by no means established yet, so this is all hypothetical for now), is Jobs taking a liver from someone who would have a far better chance of surviving? And did he cut to the head of the line because he’s rich and famous?”

That comment is simply ignorant. I worked several years ago at a hospital with a kidney transplant program. Each and every prospective patient went through an extensive transplant review process to determine if the person was a viable candidate for organ transplant. Their individual wealth played no role in that, and some had been on more than one regional transplant list. You don’t buy organs here in the U.S.
Second, your statement that you “know a little about pancreatic cancer” means exactly that. It’s been widely reported that Steve Jobs did not suffer from a “normal” pancreatic cancer, but from a rare tumor called “islet cell cancer,” which generally has a much better prognosis according to comments I read on another blog from a physician who treats that type of cancer. That doctor who treats islet cell tumors said it is common for them to metastasize (seed) into the liver – but a liver transplant can cure patients in those instances.
If you’re going to debate ethics, start from the truth, not a false premise.



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S

posted June 20, 2009 at 3:41 pm


We really don’t know the specifics of his situation. Most pancreatic cancers (for instance, the one your mother probably had, Hillary) have a horrifically grim prognosis. I have never seen a liver transplant done as a salvage for someone with pancreatic adenocarcinoma. However, liver transplant are often done for other liver conditions — including liver cancers. So, I feel we can only speculate on his specific condition.
But the larger issue is does someone with more resources earn better access to care? Did Job get this because he is Steve Jobs? I think the sad fact is one’s social and economic status is completely intertwined with the care that someone gets. In the US, African-Americans have higher mortality stage for stage than other cancer patients. That’s just the fact. Some of it may be the biology, maybe in prostate cancer for instance. But certainly there’s a lot of systematic differences in the care different patient’s receive and their outcomes. Why? I don’t know. Is it income levels, the way patients are treated, the follow-up care they get, cultural attitudes toward disease, or the fact that the majority of patients on trials and studied have usually been white, who knows? I think we need to recognize and understand this, so that we help true our best to provide the best care to everyone.



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Bob

posted June 20, 2009 at 4:00 pm


Note: I am not an APPLE shareholder or investor
As a liver recipient who works in the world of organ-donation and who has helped hundreds of patients get liver transplants, Job’s transplant raises many questions.
After one is “cured” of cancer with treatment they must clear five years before getting a liver transplant to insure their cancer is not going to reoccur and metastasize. So that’s question # 1, when was he considered clear of CA and when did the five years begin. If he was given a new liver prior to the five years, he got preferential treatment over other dying patients.
Was his liver transplant necessitated due to liver cancer? Likely since he had no symptoms I saw of ESLD from hepatitis C or other maladies that would have made him jaundice, etc. and necessitated a very long wait on the waiting list. With liver cancer, one gets boosted up on the list and one is transplanted much sooner. If so, possibly metastatic from the pancreatic cancer and it’s highly questionable that he should have received a liver transplant at all, a liver that perhaps should have gone to another more deserving patient.
What was his MELD score at transplant? http://www.unos.org/SharedContentDocuments/MELD_PELD(1).pdf
If he had stayed in California his MELD would have to be very high to get a liver—there are too many patients and too many transplant centers vying for livers you have to be almost dead to get one. In Tennessee the MELD-at-transplant scores for each blood type are much lower so Jobs, with his wealth which is not available to other patients obviously, flew to a region where he could be transplanted sooner, indeed, in many cases years sooner than in California. You can see the MELD-at-transplant scores in all states and organ procurement regions here: http://fairfoundation.org/OPO_MELD_scores.htm
He’s got pancreatic issues, then the company insisted his thinner appearance was due to a common bug, then a treatable hormone imbalance, then he doesn’t, now he’s had a liver transplant??—two months ago?? The degree of secrecy and lack of disclosure by such a prominent financial CEO is staggering. The fact that it was kept secret for two months shows incredible efforts by the tx team and hospital to give him preferential treatment. It has been written, In this case, it is unclear whether the surgery is material [to need to disclose] because Mr. Jobs was already on leave.” Regardless of the legal tap-dancing here, the head of APPLE needs a liver tx and does not let investors know?? Unbelievable.
In all the patients I have helped I have never, ever had one who was not willing to share their medical history with other patients, not only to be helped with advice but also with the goal of helping other patients who are dying with ESLD—giving them information and HOPE. Jobs clearly has not extended that benefit to other dying patients.
The point here is that there are red flags that could point to favoritism on the waiting list. Why is that so important? We have an organ donor crisis in this country because of the deep failure of relying solely on altruism : every 59 minutes-yes, 59, a patient on the waiting list, or one who was on the list but got so sick they had to remove him, dies. The waiting list continues to rise every day—today at 102,101. Another 355,000 are on renal dialysis and not even listed yet due to the shortage of organs. We can’t have preferential treatment for Japanese mobsters at UCLA or for Steve Jobs in Tennessee. http://fairfoundation.org/organdonation/waiting_list_death_rate.htm
Perhaps when reporters interview Jobs, they can ask him to help other dying patients by publicly and financially supporting trial projects of new organ-donor policies. http://fairfoundation.org/organdonation/contactcongressfororgandonation.htm
By doing this he can atone for the preferential treatment he has received not available to other dying patients.



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Ap

posted June 20, 2009 at 4:01 pm


I have a friend who died while on the waiting list for a liver transplant. I have little or no doubt that Steve Jobs’ billions made all the difference in the world. And I sure don’t believe that his fortune makes him a more valuable person on this planet than my friend was.
I wonder what his position on health care reform in the U.S.? Any chance he’ll step to the bat for single payer so that ALL Americans might have the same access to care as himself?
I know my friend would have.
No, it’s NOT ethical. Thank you for writing this piece.



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Your Name

posted June 20, 2009 at 4:35 pm


Steve Jobs has an neuroendocrine islet cell cancer, NOT pancreatic adenocarcinoma. These two cancers are very different and have different prognosis and treatment options.



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Sander

posted June 20, 2009 at 4:48 pm


Apart from the correctness of your assumptions (see the other comments) I thought you were going for the conclusion: since Steve Jobs IS such an important person (“Unless she knew the guy behind her was meant to save the world…”), making millions of people happy with his ipods and iphones, you’d agree to let him go first. It’s a bit of a weak piece you wrote, ending with the easy way out to let the specialists decide.



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KES

posted June 20, 2009 at 5:46 pm


S – “Their individual wealth played no role in that, and some had been on more than one regional transplant list. You don’t buy organs here in the U.S.” and “If you’re going to debate ethics, start from the truth, not a false premise.”
Sorry to have to break it to you, but the way that organs are shared in the US is not necessarily as equitable as you would like to think. As you already state, organ distribution is first determined by region, and then by need. Obviously if someone has the resources to get their name listed in several regions (have $$$, will travel), their name will come up before someone who only has resources to get listed in their home region (assuming the same severity of disease). There are also a number of neuroendocrine islet cell tumors, and while they may have lower morbidity and mortality than pancreatic adenocarcinoma, you are probably misinterpreting the meaning of the word “cure” when applied to this or any other cancer. You do not have all the facts and admittedly not an expert in this field so please be more polite in the presentation of your opinion (and not “truth”).
Anyway…
A discussion on the ethics of organ sharing protocols in the US is completely appropriate. One thing that could be considered is changing the organ donation list from “opt-in” to “opt-out.” Have you checked your own driver’s license? Is the organ donation box checked and the sticker affixed? Have you told your family that you wish to donate? There are tons of people that would be willing to accept an organ, but far fewer willing to donate under the same circumstances. While the criteria used to determine potential donors would stay the same, this simple change would greatly increase the availability of organs.
Don’t want to donate? Then go through the process of opting out. But if you opt out, should you be eligible to receive an organ if you need one? This is an important question. Would it be ethical to accept an organ if you or your family are are unwilling to donate organs when indicated? Many families are willing to donate the organs of their loved one despite the overwhelming sense of great personal loss, but I have seen many more patients or patient’s families that want everything done, but will absolutely not consider organ donation when clearly indicated.
When looking at the statistics of organ procurement and organ transplantation, there are clearly dichotomies. Certain regions have persistently lower organ procurement rates but higher transplantation rates (the citizens in this region donate less, but have a higher need and receive more organs from other regions). Would it be ethical to restrict organ procurement and transplantation to recipients within the same region? Regions that have an excess would then potentially be wasting organs that could go to a donor with a higher need or a better match in a different region, while “punishing” patients in regions for lower procurement rates. How do you decide the boundaries of each region? Can you move (or rent/buy property in a different region) to increase your odds?
Who pays for all this? The costs associated with organ transplant is astronomical. Medicare and Medicaid will assist with the costs associated with kidney transplants, due to grandfathering of dialysis and kidney transplantation. What about all the other organs? Is it ethical than only dialysis and kidney transplant are covered by government programs? Are you “entitled” to an organ if you have no money? If so are you then “entitled” to a lifetime of followup care and anti-rejection meds? Who pays for the equipment, the meds, the drugs, the time of all the specialists involved? While you wait on the kidney transplant list are you “entitled” to “free” dialysis?
If you need a liver transplant due to cirrhosis from alcohol abuse or hepatitis from drug use, should you be removed from the list for continuing to drink or abuse drugs? What about smoking? Is smoking still a “right?” Smoking increases morbidity and mortality in all transplant patients, even for non-lung transplant. Do you have a right to not take your anti-rejection meds? If so, do you have a “right” to further medical care, when the time and resources of all those involved can be better spent on compliant patients that view their transplant as a “gift” and not a “right?”
What if you were in a tragic accident and needed blood, how much should you be able to get? Should you be allowed to get all blood the hospital or blood bank has? Should the hospital or blood bank be allowed to ration the amount of blood? Have you donated lately?
Is it reasonable to ration health care? As you can see you can extrapolate this to medicine/health care in general, at which point it becomes a much more “interesting” discussion. How does society pay for something that everyone wants but few can afford?



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T Peich

posted June 20, 2009 at 5:52 pm


I totally agree with CV. If you are going to discuss “hypotheticals” then why not actually write an intelligent post based with some knowledge about organ transplantation process. There are many, many moral/ethical dilemmas that are up for public debate re: medical ethics please get a clue.
Don’t you think you should know the facts about the process of getting an organ, before you blog about the ethics of it? You ignorantly ponder “ethical” issues that would not even exist in real life if your assumptions of Jobs medical diagnosis/prognosis are correct. You wrote some idiotic medical assumptions that are also not based on fact/truth. Do your research. You wrote a truly stupid post, so expect to get a lot of flack for it.



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CV

posted June 20, 2009 at 6:40 pm


Sorry to have to break it to you, but the way that organs are shared in the US is not necessarily as equitable as you would like to think. As you already state, organ distribution is first determined by region, and then by need. Obviously if someone has the resources to get their name listed in several regions (have $$$, will travel), their name will come up before someone who only has resources to get listed in their home region (assuming the same severity of disease)…
I’ve attached the url for a page on the Web site of the United Network for Organ Sharing (UNOS). Check it out. I’ve pasted in some of it below, and hopefully, by boldfacing works. But let me just summarize. Donors are listed in their regional organ donor area, as well as in a national database. When an organ becomes available, it is offered to the best-matched recipient in that regional area. If there are no good matches in the closest regional area, it then is available nationally.
I will agree with anyone that the best overall healthcare in America is available mostly to those who can afford it. I fervently hope Congress and all the parties involved can produce a good healthcare reform bill. But the organ transplant process is apart from that.
UNOS-The Organ Placement Process
When organs are donated, a complex process begins. The procuring organization accesses the national transplant computer system, UNetsm, through the Internet, or contacts the UNOS Organ Center directly. In either situation, information about the donor is entered into UNetsm and a donor/recipient match is run for each donated organ.
The resulting match list of potential recipients is ranked according to objective medical criteria (i.e. blood type, tissue type, size of the organ, medical urgency of the patient as well as time already spent on the waiting list and distance between donor and recipient). Each organ has its own specific criteria.
Using the match of potential recipients, the local organ procurement coordinator or an organ placement specialist contacts the transplant center of the highest ranked patient, based on policy criteria, and offers the organ. If the organ is turned down, the next potential recipient’s transplant center on the match list is contacted. Calls are made to multiple recipients’ transplant centers in succession to expedite the organ placement process until the organ is placed. Once the organ is accepted for a patient, transportation arrangements are made and the transplant surgery is scheduled.



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blissfulsadness

posted June 20, 2009 at 6:59 pm


Oh dear! While I understand this is a hot-button issue, I think some of you rather rude commenters should take it down a notch. This is not a front page New York Times story. It’s a daily blog. It’s a blog that people relate to because it addresses the questions we all have on a daily basis. I know more about certain things than I do this, but I’ve still made judgments (because I’m human) without having all the facts. I do that a lot, in fact, because I’m a normal human being. I also question a lot of things. I think this is an honest question for any one to pose to him/herself or in a forum like this. Perhaps responding in a different way would be more productive and something we could all learn from. None of this is to say, though, that I agree with the post. I’m still unsure how I feel about it, although I’m inclined to say it was OK. Then again, no one has ever commended me on my high-level of ethics.



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Ramus

posted June 21, 2009 at 6:47 am


I am sorry for your loss. But in terms of social value, Steve Jobs’s value to our society is enormous. If you want to maximize the benefit to society, certainly there should be some priority for a person like him… He generates tens of thousands of jobs, has generated billions of dollars for the economy, and the profit of one idea of his, when donated can change research for cures in one field… He is a big time philantropist so hope for that…
Wouldn’t you save this guy? Sometimes as a society we want a pretense equality when not all things are equal. This is a certainty… One Steve JObs = hundreds of thousands of us… Of course, I would want my mom to be first (it is my emotional need!!!), but looking from the prism of ethical



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Bill

posted June 21, 2009 at 10:21 am


You don’t seem to know anything about the type of pancreatic cancer Jobs had. A very weak foundation for your discussion.



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Kenneth Youner MD

posted June 21, 2009 at 11:29 am


As a 6 year cancer survivor (stage 4 kidney) and medical director of Action to CUre Kidney Cancer (run by and for kidney cancer survivors) I feel that before you discuss the ethics you must know more information. IF this transplant is being done with known pancreatic cancer still active than it is very questionable. I have metastatic kidney cancer in my lungs. Right now I am under treatment and remain very active. However if my lung disease increases-there is absolutely no role for a lung transplant. I think that would be unethical and not medically indicated.A major point in the ethics of organ transplantation is the availability of donor organs. The smaller the donor pool, the more important ethical transplantation becomes. Thinking on the same line, if SJ’s liver transplant is being done because there is active cancer in his liver, and the number of donor liver are limited, than this brings up serious questions about the ethics. However without full knowledge of the clinical situation it is very difficult to say. SJ’s probably went to Tennessee because the transplantation wait list is smaller.



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carly

posted June 21, 2009 at 12:42 pm


Glad he received his transplant but have to question if he did not receive preferential treatment. There is a related post at http://iamsoannoyed.com/?p=1887



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What a dumb article

posted June 21, 2009 at 2:19 pm


Steve didn’t have a “high mortality” type of pancreatic cancer, so the author is a fool in not researching what he wrote. Steve has offered more to world society than anyone in the last 100 years… the personal computer, the web, pixar animated films, ipod, iphone… each of which is more contribution than 100 million men.
so now that we know he is back to health, that is all that matters, may he live to age 95.



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Bruce Hord

posted June 21, 2009 at 3:34 pm


1.) “Tennessee isn’t known as a magnet for liver transplants. But wait times (for transplants) do appear to be considerably shorter than elsewhere in the country. In 2006, the median number of days from joining the liver waiting list to transplant was 306 nationally. In Tennessee, it was 48 days.”
2.) Those who travel out of state must be evaluated at the new hospital, but there is no prohibition to being on the wait list at more than one transplant center.”
Both of these are direct quotes from a recent article by Laura Meckler of the Wall Street Journal entitled: “Jobs’s Transplant Highlights Differing Wait Times”.
Most of you would agree that Mr. Jobs is a reasonably intelligent man, who has excellent healthcare advisors. He simply took information available to everyone
and USED IT. Nothing illegal or unethical or underhanded.
I would refer you to this website for a lot more on organ donation:
http://www.lifesharers.org/faq.asp



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Barbara Saunders

posted June 21, 2009 at 5:44 pm


Here’s the first problem with this “ethical question.” We don’t know the medical story behind it. Pancreatic cancer spread to the liver is one thing. Pancreatic cancer in remission with liver troubles subsequent to chemo is another. Liver problems caused by some other physiological troubles related more generally to being ill is yet another.
The second is that a person’s overall situation is a consideration in granting transplants. The age of the patient, the likelihood that they will be able to keep affording ongoing medical support, the level of social support they have. Being a billionaire (incidental to being a celebrity) affects those other factors.



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Your Name

posted June 22, 2009 at 6:30 am


The one thing really unethical here, is your unsubstantiated (as you say yourself)insinuation that there may be anything wrong with the transplantations. “Death and life are in the power of the tongue”.
One should be careful.



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med ethics

posted July 2, 2009 at 2:58 am


to the “idiot” who thinks that SJ deserves the transplant because “has offered more to world society than anyone in the last 100 years”…… that is NEVER grounds to give transplant. even if it was Mother Theresa with a cancer that spread from pancreas to liver, that AUTOMATICALLY disqualifies you from transplantation.
i hope that SJ’s liver was needed for a reason OTHER than metastatic spread. because transplanting someone with metastatic tumors is beyond unethical.



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Marian

posted July 2, 2009 at 1:31 pm


I find it impossible to be objective about this issue because my godson has Down Syndrome, and I am well aware that if, heaven forbid, he ever needs an organ transplant, he will be AUTOMATICALLY refused because of his disability.



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Dale

posted July 5, 2009 at 10:11 pm


Being the recipient of a liver transplant last fall, I can attest to the SEVERELY restricted protocols for UNOS (United Network for Organ Sharing). ALL transplants must go through this national agency. All considerations are made by a disinterested board, with complete anonymity. Those reviewing a patient know only their age, patient record number and chart of medical history. When UNOS facilitated Steve Jobs’ transplant, they had no idea whether he was a billionaire or a homeless bum. It’s so easy, and cheap, to take issue when someone famous receives treatment. It is YOU that is exploiting his fame, not he.



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da bishop

posted October 10, 2009 at 3:08 am


Umm, say obama needs treatment for XX. Does he get priority? Yup. His work benefits the masses. Obama is surrounded by guys trained to die to protect him, that’s how valuable a head of state’s life is considered to be. They’ll jump in front of bullets etc, people are expected to sacrifice their lives to protect his.
By the same virtue, people like Steve Jobs do indeed benefit the masses, he’s done a lot for the computer world, and there’s nobody who looks like an easy replacement.
However, there’s lots of people like arms dealers and dishonest profitable business owners who have a *lot* of money, and that giving them an unfair advantage over people in terms of their healthcare.
I do believe that there are some people whose roles in the world are indeed special, and that they’re worth prioritising.
Politicians, Scientists and CEOs of huge companies *should* indeed be these special people whose talents dedication and insight help all of the people of the world.
In the case of George Bush Sr, or the Head of Smithfield Pork… I ain’t jumping in front of bullets to protect those guys. I’ll even go so far as to say that I’d even consider bringing some extra bullets of my own… what they’ve done is *that* terrible, that unethical.
Is it ethical to prioritise people? Depends how ethical they are.



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Rachel E

posted December 7, 2011 at 6:29 pm


More than the people that are for the situation are against it. “The fact that anyone with Steve Job’s level of wealth could use money to get a numerical advantage within the national system irks ethicists like Caplan. According to Caplan 3 to 5 percent of the names on organ waiting lists are “multiple listing,” including U.S.citizens and wealthy foreigners who moved to the United States for medical treatment. “Obviously the supply of organs is controlled as a public resource by UNOS,” said Caplan. “Multiple listing undermines the fairness of the listing, in my opinion.” (Cox) Jobs was a very wealthy and successful person but was it worth to lose his reputation over trying to beat death. There are thousands of people that can’t even get on a list because of medical insurance, money, or just being denied. Instead of using his money to get himself a new liver he could have use it to help others who couldn’t even get on a list.
Over all this situation is up in the air but I am totally against it for many reasons. I have experienced going through the hard ships of transplants. My father was diagnosed with cardiomyopathy in the summer of 2002. We were walking to the store for groceries and then he suddenly fell to the ground. I did not know what to do so I cried and screamed on the top of my lungs for help. That year he had two heart attacks, a pace maker put in and a artificial heart inserted to is left ventricle. The Heart Mate was the artificial heart that ended up making my dad very sick because it was producing a fungus in his heart. Then they gave him a new Heart Mate and then the next week he was paged for a heart transplant. Then on September 15th 2005 after his transplant, I thought my life would change forever, when indeed it did. At 7:37 P.M. the doctor pronounced my dad brain dead. I realize that a heart transplant has different components then a liver transplant but my dad’s blood type was AB negative and he had a one in a thousand chance of get a heart. The doctor told us not to even expect one. My family was broke from medical bills and we didn’t even have gas to get my dad to Denver for treatment. I think having money is advantage but there are people that survive and fight on their own to beat their diseases. I was always told to live your life as if there was no tomorrow. I think Steve Jobs was a great inventor but what he did to get ahead gave me as customer less respect for him.

Cox, Lauren. “Apple CEO Steve Jobs’ Liver Transplant Stirs Health Care Debate – ABC News.” ABCNews.com: Daily News, Breaking News and Video Broadcasts – ABC News. 23 June 2009. Web. 10 Nov. 2011. .



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pancreatic cancer

posted September 24, 2013 at 12:24 pm


Great site. Lots of helpful info here. I am sending it tto several buuddies ans also sharing in delicious.
And certainly, thank you to your effort!



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