Next Gen Journal

By Celia Wright

The human liver (Public Domain)

It seems like the idea of organ donation has been everywhere recently. From Will Smith’s Seven Pounds to Denzel Washington’s John Q, many have been educated about the process and necessity of national organ distribution. Some are left wondering, however, if one could “cheat the system” or “cut in line” to receive an organ faster.  It’s a considerably unethical concept; the question was recently brought to light after Steve Jobs, the CEO and cofounder of Apple, received a liver transplant after waiting for only 48 days. The national average, meanwhile, is 306 days. Yet Jobs did nothing illegal; he simply studied the system and found a loophole.

The United Network for Organ Sharing (UNOS) manages distribution via 58 Organ Procurement Organizations (OPOs). Each OPO, assigned a region of the country, ranks patients in accordance with the severity of their sickness and the time they have been that sick, with patients holding the “highest rankings” receiving organs first. Due to disparities in organ demand between regions, however, the duration of time waited per patient varies. Therefore, a wealthier patient could conceivably apply in multiple regions and then either relocate or use a private jet to rapidly travel to a far-away site to receive an organ. That’s exactly what Jobs, who received his transplanted liver in Tennessee, did.

While this action is legal, it is not separated from ethical concerns. Many low-income Americans simply could not afford to relocate in order to receive an organ more quickly; barely any could use a private jet to travel rapidly from location to location. Less-than-wealthy Americans have other disadvantages as well. The estimated price of a liver transplant alone is $519,600, leaving 1/3 of the population without sufficient insurance to pay for the procedure. Therefore, while money doesn’t guarantee successful procural of an organ, it certainly gives patients more options along the way.

Steve Jobs self-financed and self-initiated his treatment, and under current conditions, he is entitled to do so. As Jeremy Shane, an observer of health issues, said, “Jobs is a billionaire, earning his money fair and square; why shouldn’t he be willing to spend millions on his own survival?” Still, ethical lines are fogged when one considers the scarcity of organs and the notion that an organ received by someone with great wealth could’ve just as well been received by someone equally desperate, but with fewer resources. The real problem lies within the system itself, which legally allows application to multiple centers, giving the wealthy and influential a huge advantage.

In the past, Congress has been called upon to eliminate some of the disparities in the organ distribution system. In the 1990s, a reform was attempted that would give priority to the sickest patients nationwide, regardless of their OPO region. However, Congress blocked the regulations and asked the Institute of Medicine (IOM) to consider the issue. While the IOM’s proposal was less far-reaching, it did give recommendations for reform (such as standardizing the size of the organ donor pool for the sickest patients’ benefit) that Congress also failed to implement.

With empathy for every patient, Congress needs to reconsider these proposals to create a system that is fair for everyone, regardless of wealth and other resources that don’t pertain directly to a person’s health or the quality of life they deserve. The first proposal would have eliminated the ethical conundrum being puzzled over by health experts and would guarantee equal care for all. Although people like Steve Jobs have truly earned their wealth, others shouldn’t be denied an equal opportunity at life.

Using Canada and Switzerland (where wealth bears no influence whatsoever in organ procural) as examples, we can solve many issues residing within the organ distribution process. With empathy for all Americans currently on waiting lists, Congress can work to seal up existing loopholes within the organ distribution system and ensure equality of opportunity for all.  Until then, many will continue to speculate every time a celebrity receives an organ quickly, wondering how it could possibly be done- and why they couldn’t do it themselves.

Celia Wright is an NGJ Contributor and a student at Avon Lake High School in Avon Lake, Ohio.

The opinions expressed in this article are solely those of the author