Steve Jobs received a new liver, and the ethics surrounding his transplant

Orac, a general surgeon who blogs at Respectful Insolence, writes the most comprehensive entry I’ve seen thus far on Apple’s Steve Jobs’ liver transplant.

Steve Jobs received a new liver, and the ethics surrounding his transplant For those interested in the medicine behind the transplant, go and read his post in its entirety. I’d like to highlight some of the potentially questionable ethics surrounding the case.

For one, there is the question why Mr. Jobs, who lived in California, had his transplant done at a Tennessee hospital. As reported by The Wall Street Journal, it was because the waiting list in that state was 46 days, far lower than the national average of 306 days.

Orac asks how many others in need of a transplant would have had to means to travel to a state with shortest waiting time, and although “what Jobs did is not illegal . . .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.”

Furthermore, the question whether a liver transplant should have been done at all is somewhat debatable. Mr. Jobs had a slow growing pancreatic neuroendocrine tumor that apparently had spread to the liver. The data surrounding the efficacy of a liver transplant in these cases is scarce, and the studies cite a cure rate ranging from 33 to 80 percent. And considering his previous history, where he had received a Whipple procedure, Orac notes that since “Jobs’ medical condition was far worse than he had let on, and his prognosis is far more tenuous than is being advertised . . . it’s arguable whether [the liver transplant] should be done in these cases, given the scarcity of organs and the questionable results.”

Of course, this speculation is entirely based on the Journal’s reporting, which was bereft of named sources. This entry by John Gruber further analyzes the reporting itself, and speculates on some of the uglier aspects of the story, including the thinking in some areas that, “there is no other way to read this than as an implication that Steve Jobs may have gotten a liver that should have gone to someone else.”

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  • An American Surgeon

    As far as I know, interstate commerce(eg. out of state liver transplants) is still a Constitutional right. Ethics appear to be situational in our health care system. There are numerous examples where prisoners and illegal immigrants have received liver tranplants ahead of law-abiding citizens, simply because they had better insurance coverage or their rights would have been violated. The ethics all depend upon the person affected.

  • Karl

    Kev, lot more complicated than it looks, IMHO.

    First, yes, illegals have gotten better treatment than legals. Like this case –

    http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/07/13/BAGTDQVMMG1.DTL&type=health

    And the LATimes story about the Japanese mobsters who got preferential treatment in LA.

    Second — specific factors. Rich DeVos, the Amway billionaire, got a heart transplant in the UK. He has a very rare blood type, according to “The Grand Rapids Press.” The opportunity arose, and he took it.

    In the end — the president gets an MD, 24×7 (and still, Bill Clinton had heart problems). Those of us, not married to MDs, do not have that privilege. Life goes on.

  • http://uncdiss.wordpress.com Tye

    My step-father is going to travel to Turkey this fall to receive his liver transplant. He has decent insurance (through a Texas teachers insurance fund) and has complied with all of the physician’s and transplant board’s requests. He has suffered through 2 years of weaning himself off of his pain medication that the physicians have pumped him full of for the last 15 years only to be told to wait again and again. The physicians at Baylor have given him around 9-12 months to live so I took it into my hands to find an organ.

    I hated having to go outside the US care system but it just wasn’t adequate, I don’t know where the organ is coming from or how effective the surgery will be, but it will 100% be more effective than him sitting at home and waiting for his liver to fail. It is a sad problem, and one that has many complicated issues and ethical considerations, unfortunately many families don’t have the time to wait for those considerations to be pondered.

  • Karl

    BETTER THAN ‘JON&kATE+8″

    More on Steve Jobs, in “Forbes” –

    http://www.forbes.com/2009/06/20/steve-jobs-executive-health-technology-transplant.html?feed=rss_popstories

    Apple has to issue a statement on this. If they don’t — stockholders should sell, immediately. It is about full, fair and timely disclosure. As opposed to “the Chicago Way.”

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  • Doc Stone

    The powerful will always buy better medical care for themselves. There is absolutely nothing that can be done to prevent this fact of life. It is, after all, on of the reasons they are driven to succeed. Otherwise, what is the point? Even the most radical egalitarian revolution intended to prevent this fact of life will only change who the powerful are–instead of being powerful because of the wealth they generate selling a superior product to willing powers, the new powerful are the revolutionaries themselves whose power is usually based on coercion, murder, and terror. The commisars in soviet societies get better medical care than everyone else.

    This is just a fact of life and anyone who is unduly disturbed by it needs to goes to envy eradication camp. It is, after all, a sin.

  • http://www.kipesquire.net KipEsquire

    “…the uglier aspects of the story…”

    By which we mean: That there are not now, nor will there ever be, enough livers for everybody? That no matter how much money, especially other people’s money, is thrown at the problem? That choices have to be made, and that health care resources have to be rationed — just like every other good and service throughout the rest of the economy. That the only real question is who gets to make the choices, for whom, and by what standard?

    I guess economics is not only the dismal science, but also the ugly science too.

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  • Maddy Malone, RN

    The registry for donor organs is nationwide. Anyone can receive an organ from a donor in another state, if there’s a good match. Steve Jobs was well enough to travel, whereas some recipients aren’t, or won’t because their doctor doesn’t have privileges at the donor’s hospital, or the patient’s doctor won’t relinquish care of his patient to another physican (he’ll lose money).
    Who can say the liver Jobs received was supposed to/should have gone to someone else/in Tennessee? You make it sound like he stole it out from another man’s nose because he’s wealthy. That happens on TV.
    Perhaps there was no one else who matched perfectly. Hospitals aren’t interested in keeping brain-dead people alive forever, waiting for a recipient to come along. Families of donors don’t like to have hospitals keep their deceased loved ones on life support in case there’s a good match with a recipient somewhere 1.) who has just decided to sign up, or 2.) who can afford the transplant, or 3.) whose insurance company (if he has one) agrees to pay for his flight, etc….
    There’s so many factors I can’t even touch on that determine who gets a donor’s organ. My point is that these decisions go on every day involving people who may be rich but not famous, so nobody hears about them. You think Jobs flying to Tennessee for a transplant indicates he is selfish, and deprived someone more deserving.
    The real problem is with families who don’t donate and let their relative’s liver go to waste, thereby depriving a potential recipient. THAT’s selfish.
    PS: No need to sell your stock, since Apple is doing Very well WITHOUT Steve Jobs at the helm.

  • S Randhawa (Med Student)

    IMHO the is pop journalism on fringes of the issues which concerns people and the health care system most. The focus shouldn’t be on why or whether it was right for him to take this decision or get this transplant- That’s a contentious issue and one where both sides of the story have strong arguments. The point is, why a country in which people would have spent $ 2.5 trillion dollars on health care in 2009 has such stark differences in the average days for liver transplant and how it can be narrowed across the board( I guess there would be a lotta loopholes around it). The problem with transplants again is the subjective preference of who needs it more. Until the day comes when you have fixed guidelines for transplantation priority- say a point system or something to that effect which looks at those in need objectively taking the various individual patient factors into account; till then people can go on and on about who should have done what and who shouldn’t have.
    Personally, if your doc recommends something that he feels would make you better and you can afford it – would you go into the ethics of it as a patient ?

  • Amy

    We are very righteous until our own suffers. Then, we would skip the line if we could.
    Be honest, do you treat the smelly uninsured alcoholic with the same enthusiasm as you would treat the 18 yo teenager with newly diagnosed lymphoma ? In your mind, you judge. When you judge, you stop considering those people as equals.

  • CHenry

    Is there actually proof Jobs “skipped the line?” It sounds as if Jobs had his staff find out all the options, including where the line was shortest, and took a place in that line.

  • Healthcare Observer

    ‘illegals have gotten better treatment than legals. Like this case – http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/07/13/BAGTDQVMMG1.DTL&type=health

    The little girl is a US citizen.