This article showed up on NPR a few days ago: Who Decides Whether This 26-Year Old Woman Gets a Lung Transplant.
Without going into detail, the writer talks about attempts by transplant physicians to manipulate the wait list to obtain an organ for their patient as soon as possible.
“I care more about my patients than I care about patients in another city,” says Dr. William Carey, a liver specialist at the Cleveland Clinic. “And it clearly is in the interest of my patient to get transplanted however I can make that happen.”
That quote alone explains why OPTN has been unable to eliminate geographical hording, or the more macabre ‘death by geography’. The US is divided into 11 OPTN regions. These regions were meant to be administrative (which was probably necessary in the 1980s when the system was established) but have become a means of allocating organs as well. Every deceased donor organ that becomes available is first offered to patients within that transplant center then to the region, and finally to the rest of the country. It’s well known this violates the rule of ‘fair and equitable allocation’ but far too many physicians and centers benefit from the status quo, so changes have not been made.
But the most important quote of the entire article occurs at the end* where a would-be lung transplant recipient’s doctor says in regards to using whatever means necessary to procure a needed organ:
“That patient is everything,” Budev says. “And that’s why I think we can’t be trusted [not to manipulate the system].”
So, if we accept the notion that the would-be recipient is the patient, where does that leave anyone who presents as a possible living organ donor?
Is this small quote from a Cleveland Clinic physician the reason OPTN membership keeps rejecting national standards of living donor care?
Is this obvious prioritizing of the would-be recipient over everyone else (including other would-be recipients) why the transplant industry went from skeptical of solicitation in 2002 to actually teaching folks how to solicit five years later?
Is this why we keep seeing press releases from transplant centers’ marketing departments on highly flawed studies that ‘claim’ to reinforce the safety of living donation?
I’ve come to accept, over the past three years, that some of the conclusions drawn by those of us who research and pay attention to the transplant industry can come across as conspiracy theories. But this sort of admission, that locating and obtaining a organ transplant for MY patient is reason enough to lie, steal and cheat – even if it means other folks end up dead – well, that’s a pretty frightening confirmation.
It’s unfortunate the rest of the world will miss its import.
*gold star for the writer in realizing what a ‘gotcha!’ moment this is.