Silence breeds suspicion about many things, as Steve Jobs knows

News about Steve Jobs' health has begun to follow a certain pattern: silence, rumor, confirmation of rumor, questions about the original silence.

Now the questions have moved beyond the usual ones about the impact on Apple.

Today's Bloomberg story begins: "Steve Jobs, Apple Inc.’s chief executive officer, got a liver transplant quickly because of a U.S. system that favors patients with the means to rush to geographic areas where there is less competition for organs."

The Associated Press notes: "A celebrity like Apple CEO Steve Jobs scores a rare organ transplant and the world wonders: Did he game the system?"

Here's what the United Network for Organ Sharing says in response: "Recent news regarding liver transplantation has raised public questions regarding how donated livers are allocated and potential variation in transplant waiting times. ... Liver waiting time is greatly influenced by a formula that assigns priority for organ offers based on the candidate's risk of dying within three months without a transplant. For candidates 12 or older, this formula is called a MELD score."

The blog Respectful Insolence offers an explanation of this score and an overview of the current questions, controversy and second-guessing. The author concludes by suggesting that, regardless of what people think of the Jobs case, perhaps a wider discussion is in order:

"Part of the reason for the questions and criticisms of how Jobs managed to use his wealth and power to improve his odds as much as is legally possible is that there are such regional disparities in wait times. If there were not, neither Jobs nor anyone else would feel as compelled to do something like move to Memphis temporarily in order to take advantage of Tennessee's shorter wait lists for liver transplant."

Open acknowledgment tends to limit suspicion.

 -- Tami Dennis

Photo: Steve Jobs, who had been undergoing treatment for pancreatic cancer. Credit: Associated Press

Comments

[Dave Undis]

There's one question that nobody seems to be asking about Steve Jobs and his liver transplant: is Steve Jobs a registered organ donor?

It's not fair to give an organ to a non-donor as long as there is a donor who needs it. But about 50% of the organs transplanted in the United States go to people who haven't agreed to donate their own organs when they die. It's no wonder there's such a large organ shortage. If organs were allocated first to organ donors, more people would agree to donate and fewer people would die waiting for transplants.

Anyone who would like to donate their organs to other organ donors can join LifeSharers at www.lifesharers.org or by calling 1-888-ORGAN88. Membership is free. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.

[kevin]

What is the purpose of money if you can't use it to save your life?

[BIlly]

I think there'd be greater consequences if Steve Jobs died. Not only for the thousands of people Apple directly employs, but also the thousands of people employed by contractors who build Apple's products worldwide, as well as the millions of stockholders who rely on Steve Jobs to keep Apple profitable. In this economy, we can't afford to loose him. Let the man have a liver and live.

[Hana]

Not everyone can be an organ donor, especially if one has a chronic disease such as pancreatic cancer, in Jobs' case. Organ donors need to be healthy so that their organs can be used without restriction.

[Philvs]

Mr. Undis' remarks need to be challenge on several levels. First, he has no way of knowing how many transplant recipient were registered donor at the time of their transplants. He uses the same voodoo math everytime he comments on a story about donation and transplantation. His remarks are always the same, and his figures are unsubstantiated.

Second, Mr. Undis' absurd idea proposes two waiting lists: one for organ donors and one for those who, for whatever reason, have not actually registered. He believes more people will register for fear that they will end up on the wrong list should they ever need an organ transplant. So far, in more than six years of trying, he has managed to sign up a little more than 12,000 Americans in his "organ club". Those of us who work in the legitimate donation/transplantation system have registered more than 82,000,000
Americans as donors. And they have registered for the right reason...because they want to help someone in need.

If he were really concerned about increasing donation, he would encourage Americans to go to www.donatelife.net and find out how to register as a donor in their own state.

As for Mr. Jobs' liver transplant, it is fair to question the policy of multiple listing, because their is significant disagreement about the fairness of the practice, but under the current policy he has done nothing illegal or unethical.

Those of us who work everyday to save lives through transplantation are glad that he's alive and well...not because he is Steve Jobs, CEO of Apple, but because he is a fellow human being who was dying of liver failure.

Phil Van Stavern
LifeShare of Oklahoma

[Thomas Mone]

A couple of comments; First, as Mr. Undis knows, the Donate Life California Registry is a confidential registry of people who choose to be organ donors and is now the largest registry in the country with 5 million registrants. Whether Mr. Jobs is a registered donor is his personal information until accessed at time of death. Further, as noted by others, recent and active cancer is a rule-out for organ donation so is Mr. Undis' perspective that Mr. Jobs should not have received a transplant...even if it allows him to survive long enough to be able to be a donor?

Second and more importantly, MELD is a valuable tool to ensure that those who are in most immediate need of liver transplant receive one. The challenge of liver allocation today is not MELD, but rather how broadly livers are shared. Today first-level sharing is local areas, but these can vary from areas covering hundreds of thousands of miles to just a few hundred miles...and therein is the problem. The biology of cellular breakdown limits livers to roughly 9 hours time between recovery and transplant....too little to allow routine cross country flights to find the sickest patient. But livers could and should be allocated across broader "zones" that ensure the sickest in a zone benefit first. Maybe then Mr. Jobs would not have to leave California where the MELD at transplant is the very high 35-40 for Memphis, Tennessee where MELD at transplant averages closer to 20, or roughly half as emergent as in California. As long as California has 20% of the national transplant waiting lists but only 10% of the national deaths and possible deceased donors, such imbalances will persist and this requires changes to the allocation rules to focus on the needs of waiting recipients.