How did Steve Jobs, Apple's virtually indispensable CEO, get a liver so relatively quickly when other patients ofttimes must wait significantly longer times?
AP Photo/Paul Sakuma, file
Steve Jobs in October 2008.
AP Photo/Paul Sakuma, file
That question was raised, and attempts made at answers, by several New York Times reporters in an enlightening piece today. Their conclusions: being extremely wealthy would obviously have been a big plus since it allows a would-be recipient to travel to and wait for a potential cadaver liver when and where it appeared. Also, Jobs' place on a transplant list or lists would have been determined by how sick he was.
In Mr. Jobs's case, doctors say there was no need, and little opportunity, to cheat the system. Under current procedures, any transplant center ranks potential liver recipients on its waiting list, with the highest rankings based on how sick the patients are and how long they have been that sick. Jumping ahead of a sicker patient is not allowed.
And yet, there are ways to work the system to one's advantage. Waiting times for a liver vary in different parts of the country, and people who can afford to travel are free to go to a city or state with the shortest wait and bide their time until they have reached the top of the list, a donor dies and an organ becomes available. Indeed, some patients rent apartments or stay in hotels near a hospital and wait for the phone to ring. It may not seem fair, but it is not illegal.
It is even conceivable that someone could go to the time and expense of registering for the waiting lists of several transplant centers around the country.
"If you had access to a jet and had six hours to get anywhere in the country, you'd have a wide choice of programs," said Dr. Michael Porayko, the medical director of liver transplants at Vanderbilt University, one of the Tennessee centers that has said it did not treat Mr. Jobs.
Mr. Jobs's transplant, but not the location of the hospital or the details of his treatment, has been confirmed by people briefed on the matter by current and former Apple board members. Mr. Jobs has declined to comment.
Another fascinating aspect of the story is the question of how a new liver would relates to pancreatic cancer since the relationship isn't immediately apparent.
The medical sources quoted for the story say the necessity of a liver transplant suggests that Jobs' cancer had spread to the liver.
Often, though, when tumors spread to the liver, surgeons can treat them by removing just part of the liver. The fact that Mr. Jobs needed a transplant suggests that he might have had diffuse disease throughout his liver, something that does not bode well, Dr. Goldberg said.
"The prognosis for somebody with metastatic liver disease is not nearly as good as for somebody who has disease confined to the pancreas," Dr. Goldberg said.
"I think this confirms the speculation that there was more going on than had been previously acknowledged," he said, "but it still doesn't really tell us where things are likely to go from here."
Dr. Goldberg said no large-scale, controlled studies had been done on the benefits of transplants for this type of cancer.
"It's controversial whether transplant is a helpful approach," he said.
Of course all of this is speculation, albeit highly educated speculation.
But since Jobs has tightly controlled his medical information, which is certainly his right but nonetheless leaves people seeking any possible information because of the his and his company's high profiles, speculation is about all we're left with.