Thursday, January 20, 2011

Would people accept a market in organs?

Here's a guy riled up about how the liver-transplant Steve Apple-and-Pixar Jobs got a couple of years ago after having had pancreatic cancer may have been "wasted" if his recent health leave is due to his cancer returning. The reason he got the liver, according to this guy and his sources, was that the had the financial resources to "shop around" in the different state health systems.

Makes me curious how a purely market driven system would work. On the one hand, the fact that such "gaming" is EXTREMELY expensive now may make each individual case stand out more. In a market system, seeing a rich guy get his organ first would be an everyday occurence. On the other hand, if rich people could always buy their way to the front of the line, there would likely be many more cases of organs going to people who for other medical reasons may be poor recipients. If you have the cash and you're willing to gamble - here's your organ, even if the chances of success are low.

Maybe there would be supply-side reactions - people signing up for donation-under-specified-criteria? Or maybe the market revenue at stake would become a force for changing the default donation rules (which has enormous impact on donation rates - with roughly 20% changing from the default we can choose having 80% donation rates or 20% if I remember "Nudge" correctly)? Such factors would also make "gaming" and "medically suboptimal transplants" less salient. And I guess we should never underestimate the ability market players have for making things less transparent - whether it involves hiding how blood-stenched Coltan from Congo is in your cell-phone, how some financial sector legislation gets designed to benefit the financial sector, or how factory farming of hogs, turkeys and chickens is... well, evil (read Safran Foers new book on eating animals)

Amplify’d from

Two years ago, Jobs gamed the transplant allocation system to get a liver that could have saved somebody else. At the time, skeptics doubted that he should have received the organ, since he'd been treated for pancreatic cancer—in fact, he may have sought the liver because of the cancer—and the likelihood of the cancer's recurrence made him a bad bet for putting the liver to best use. If his health is now failing because of the cancer, that suspicion may be vindicated.

Jobs lives in Northern California, but he got his liver in Tennessee. Why? Different parts of the country have different waiting lists, and the wait in Northern California was three times longer than the wait in Tennessee. In fact, the median wait in the Tennessee area where Jobs snagged his liver was around 15 percent of the national average. Jobs confirmed last year that this is why he went to Tennessee: "My doctors here advised me to enroll in a transplant program in Memphis, Tennessee, where the supply/demand ratio of livers is more favorable than it is in California here."* Legally, you're allowed to get on multiple waiting lists around the country. That's how you game the system.

So why doesn't everybody do this? Because they can't. First you have to show up for an extensive in-person evaluation. Then you have to be available for a transplant in the area within hours of an organ becoming available. And while one jurisdiction might accept you as a charity case, if you want to play the field you'll have to prove you can pay for the transplant yourself. You also get priority points for being able to guarantee follow-up medical care, since this assures transplant allocators that the organ will be well cared for. Ordinary people can't compete with billionaires at meeting these tests. They can't go to multiple states for evaluations. They don't have private jets. Their insurance doesn't cover multiple evaluations and may not cover much of the half-million dollar transplant, much less the follow-up care.

there were roughly 16,000 people on the national liver waiting list when Jobs got a liver. He was one of 1,581 people who got livers in the United States in the first quarter of [2009]. Almost none of those people had any form of cancer. In fact, if Jobs' tumor has spread from his pancreas into his liver as is likely, some transplant surgeons say that they would not recommend a liver transplant because there is no data that shows a transplant will stop or even slow the spread of the cancer. This raises the question: Is this the best use of a liver?


No comments:

Post a Comment