Network
Memphis, where Jobs got the transplant, is one of several U.S. meccas for liver patients who can afford to travel, doctors said. Flight records show Jobss personal jet flew at least six times this year from California, with one of the longest transplant lists in the U.S., to Memphis, where the wait is shorter.
Jobs, 54, got his transplant in part because regions can keep donated organs on a local list — even when there may be sicker patients not far away. His experience spotlights organ allocation practices that have been under fire for decades and will be discussed at a national public meeting the United Network for Organ Sharing in Richmond, Virginia, plans for later this year, doctors said.
“You could call it gaming the system, that may be true,” John Fung, chairman of transplant surgery at the Cleveland Clinic in Cleveland, said in a telephone interview. “But until we tackle the problem of what makes the system unfair, we cant criticize people who are trying to help themselves.”
Shorter Waits
About 17,000 Americans were on liver transplant waiting lists in 2008, and about 6,000 received them, according to the Scientific Registry of Transplant Recipients, a national database of transplant statistics based in Ann Arbor, Michigan. Patients go to transplant centers in Memphis, as well as in Jacksonville, Florida, because the wait is shorter than other parts of the U.S., said Elizabeth Pomfret, chairman of the department of transplantation at the Lahey Clinic Medical Center in Burlington, Massachusetts.
Memphis is part of Region 11 of the United Network for Organ Sharing, which administers the U.S. organ waiting list and allocation system. As of June 30, 2008, there were 4,120 patients on the list for livers in Region 5, which includes California, compared with 1,084 patients listed in Region 11, according to the registry of transplant recipients.
On the same date, there were 594 patients on the list at Stanford University Medical Center, 14 miles from Apple headquarters, compared with 98 at Methodist University Hospital in Memphis, where Jobs had his surgery.
Jobs received a liver transplant about two months ago, according to a person familiar with the matter. The median waiting time for a liver in Tennessee in 2008 was 135 days, according to the organ-sharing network. The organization hasnt been able to make the same waiting-time calculation for California since 1996 because less than half those waiting got tranpslants.
MELD Scores
Patients in the networks Region 11 receive livers before their health has deteriorated as much as in other districts, such as Californias Region 5, according to the registry of transplant recipients. The organ-sharing network divides the U.S. into 11 regions.
Under the organ-sharing networks rules, most livers are allocated locally using a system called model for end-stage liver disease, or MELD, that assigns scores to liver health and function. Patients with higher scores on the scale of 6 to 40 gain priority for receiving a liver.
Steve Dowling, a spokesman for Cupertino, California-based Apple, declined to comment on how Jobs qualified for a liver transplant, except to say, “Steve continues to look forward to returning to Apple at the end of June.” Jobs didnt respond to an e-mail seeking comment.
Geographic Divisions
Apple rose $2.58 to $142.44 on June 26 in Nasdaq Stock Market trading. The shares have gained 67 percent this year.
In Memphis, 8 percent of the waiting list patients progressed to a score higher than 30 before getting a transplant. In California, 25 percent of transplant recipients topped 30. The national average for transplant recipients above that score is 14.8 percent, according to the registry.
The geographic divisions mean a patient with just months to live can be denied a liver while a healthier person a few miles away gets a transplant because of lower demand in that area, said Russell Wiesner, a medical professor at the Mayo Clinic in Rochester, Minnesota, and former president of the United Network for Organ Sharing.
Some surgeons in low-demand areas back the system because it allows them to perform operations that cost about $350,000, including extensive post-surgical care, Wiesner said.
Organ System Criticism