General Question

jlm11f's avatar

Did Steve Jobs buy his way into a liver transplant? If so, is this acceptable?

Asked by jlm11f (12353points) June 26th, 2009

Jobs underwent a liver transplant a couple of months ago and as most us know, a person has to stay on a transplant list for a long time to recieve this organ. In addition, he got his transplant in Tennessee as opposed to Cali implying that he might have been playing the system.

For more info about this and how the transplant system in general, check out this article.

My questions are: Is it acceptable for someone to buy/manipulate the health care system like this? Does it matter if it is someone like Steve Jobs? Would it be okay to save him over an average income man? Would it be ethical to choose to save Barack Obama (just an example) over the same average income man? Where’s the line?

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41 Answers

whitenoise's avatar

Wow…. tough question. No-one should be able to manipulate the system like you suggested. In my mind every life should have an equal chance.

On the other hand… economics always play a part. To even make it to the list you have to be in a privileged position. (You need to be able pay for the procedures / be appropriately insured and have access to the health care system overall, ie live in the right country.) Unfairness is always there, but that should not stop the donor system from trying to help as many qualifying people in the fairest way possible, without looking at the depth of their pockets.

Now, if my children would need an organ to save their live, I personally would be very tempted to tweak the system and anything I can to get them the help they need. It would be up to the system then to remain honest.

pezz's avatar

Money will always fine a way to done anything!

rooeytoo's avatar

I think economics rules the world and that is the way it is. If you have enough money you can buy just about anyone or anything. Of course there are exceptions, you can’t buy intangibles.

Is it fair? Probably not, but who ever said life was fair?

Harp's avatar

I certainly can’t blame Jobs for doing all he legally could to get the transplant (and it doesn’t sound like he broke any rules), but it sounds like Congress has failed on multiple occasions to enact rules that would make the system more equitable. The more pervasive influence of money is on Capital Hill.

cookieman's avatar

Should it be an equal and fair system? Yes. Is it? Probably not and to expect otherwise is a bit naïve.

I agree with @Harp that you “can’t blame Jobs for doing all he legally could to get the transplant” – truth is, would any of us do any less if we had access to his resources?

jackfright's avatar

@Harp i agree here.

as to the question of whether it is “acceptable”, it depends. I suppose the popular answer would be “no”. if it were a more merit driven society, then the answer may be different. for example: is Bill Gates of more value to (other) human life than the common bum? OR do both stand absolutely equal?

Now in my opinion (which im sure will be unpopular), i would say Gates is of more value. Were i in the position to make the decision, i would save Gates over the bum.
Comparing Gates with a bum is a huge exaggeration of course, but it’s really just to illustrate my point.

There is no “line”, since the line (and equality) is really just a manmade concept. It’s wherever society decides to put it.

seekingwolf's avatar

I mean, using his resources and money to get a liver isn’t illegal. It just gives him an edge over the competition because of his money. It’s kind of sad because all human life has value, regardless of income.

In an ideal world, transplants could be given on a first-come-first-serve basis, but this isn’t utopia and I don’t expect that would happen. Those with the more money will get more opportunities and have better medical attention. Sad but true.

Had I been in his position, I would definitely fork over some money to get that liver. It’s silly not to utilize your resources, especially those that you have worked hard to earn. I don’t blame Jobs at all.

casheroo's avatar

I think when it comes down to it, you do what it takes to survive. He has the money aka the resources to survive, and he used them. Can’t fault him for that.

Organ donation is something that really bothers me. I can’t stand how it’s a business, even when they try to say it isn’t. That article say it costs $519,600 for a liver transplant but people like to pretend you don’t buy organs…with a pricetag like that, it sure sounds like you have to buy one. Whether it be with health insurance or cash. It’s disturbing. It shouldn’t cost that much. And the fact that there’s a shortage of organs always confuses me, as every single person I know is an organ donor. Well, y’all gotta die eventually! Why aren’t there more organs? Something is wrong with the big picture.

I plan on hopefully giving half my liver to my father eventually…when the time comes. I know we’re a blood type match, but I don’t know what else goes into it. He won’t be at the top of the list because of his condition, and it’s not fair.

robmandu's avatar

Fake Steve Jobs is mostly satire, but in this post, Daniel Lyons nails it.

@PnL, when you claim Jobs “played the system” and “bought his liver”, you’re questioning the ethics and professionalism not just of Jobs, but also of his doctors, the hospital, and the entire donor program administration. I’m surprised you even ask this.

He was officially “the sickest” person on the list. It’s not arbitrary. It’s medicine and science.

Yah, he has the ability to get on a private jet and get to Tennessee within 7–8 hours of notification of an available liver. But that’s really no different that a Tennessee resident who, being on the list, elects to go on a short trip, but must stay within a certain travel radius in order to return in time.

wundayatta's avatar

This question is similar to asking whether all people’s lives are equal. In the US, we try to guarantee that all are equal in the value of their lives, their freedom, and their ability to find happiness. So, perhaps we start equal at birth, but our equality changes over a life, as different people display different abilities, some of which, our society values more.

Over time, the reality is that people become less and less equal. In truth, some people are born with advantages. Wealth provides better education and better circumstances all around that lead to more intelligent and capable people, who are then in a much better position to acquire more wealth and other resources.

Society does value some lives a lot more than others. However, with respect to organs, since there is not a free market in organs, we try to make everyone equal with respect to access to a good where demand greatly outstrips supply.

The problem is that we can’t really mandate equality. Not very effectively. This means the best we can do is to try to make the proverbial playing field as level as possible. Those with more resources will always have an advantage, and so you could say that Jobs did buy his way into a liver transplant.

Given the way our society works, it seems that the overall opinion is that it is acceptable for people to buy themselves advantages. If we didn’t believe in this, we would redistribute wealth in a much more draconian way.

This means that the argument about buying livers is the same argument as the one about taxation and economic equality. Personally, I think we need to do more to level the playing field, but I don’t think we’ll ever have a perfectly level playing field, and I’m not sure that would be a good idea. The truth is that there is a market for the value of people, too. Some people, as measured by this “value of people” market, are more valuable than others.

Is society better off because some people are more valuable than others? Free marketeers would say, “yes.” Socialists might say, “yes, but…” I don’t know if anyone would say, “no.” Although, it probably depends on your position in society. If you are less well off than average, you might benefit from a more level distribution of resources.

Would you recognize that if you forced this redistribution to happen, that there would be fewer resources overall? No one would have an incentive to work hard, any more? Would you care that no one had an incentive to work hard any more? Would you be happy that you had more than you would have, even if there was less to have overall? Or would you recognize that even in an unequal economic atmosphere, you would have more than in a diminished economy that mandated economic and personal equality?

Depending on your answer to, and understanding of this question, you might say, “no” to the question of whether some people are more valuable than others. Personally, I do think some people are more valuable than others, and, as a result of that, I don not have a moral problem with Steve Jobs buying a liver. However, I am envious of his ability to do so, and wonder, if I were in that situation, would I be able to afford to do the same? If I were, would my family and I be willing to devote all our resources to making my life last a few years longer?

I would hope not. If I were in that situation, I would be very depressed, and I’d want to die, anyway. If I did get the transplant and my family was thrown into the poor house, I’d feel so guilty, I’d never get out of depression, and I’d never be of any use anyway. The truth is that my life is not worth five or six hundred thousand dollars—the amount of out-of-pocket cost you have for a liver transplant, if you aren’t insured. Not when that would decimate our net worth.

robmandu's avatar

I’m sorry, but this whole line of thinking brought up by this question really chaps my hide. All this talk about what’s equitable is gonna end up being what give us Universal Crappy Healthcare.

What would be more fair? How would you change the rules now to prevent someone like Jobs from “playing the system”?

Oh, I know, we can’t let people with private jets use them for travel to healthcare. That’s not fair to the rest of us stuck with cars. Oh wait, but what about poor folks with no cars? The rest of us are playing the system to their detriment. So… let’s just take public transportation then.

Or wait. Maybe we should not allow travel across state lines? What about the schmoe who lives in Kansas City, KS though? What if his new liver is in a Kansas City, MO hospital? Well, tough shit dude. Gotta be fair.

Or hell, how about this novel idea? What if the sickest person gets the organ? No matter their geographic distance, as long as they can get there in time, shouldn’t they legitimately get to have it?

Sheesh. Can’t believe this even has to be explained.

Harp's avatar

@robmandu That was one of the proposals that Congress shut down:

“In the late 1990s, the U.S. Department of Health and Human Services issued new regulations that would have given priority to the sickest patients, regardless of region. This would have eliminated the geographic disparities that make approval at multiple transplant centers advantageous, but Congress blocked the regulations…”

robmandu's avatar

@Harp, sounds like that prevents registration on multiple lists.

Jobs did his research, found out that TN has the lowest average turnaround (~48 days vs. ~300+ national average), and got his name on that one list.

Nothing wrong with that. Any one of us could do it, too.

The fact that any of us has the freedom to do it is what makes the current setup equitable already.

cheebdragon's avatar

“Money is good for bribing yourself through the inconveniences of life.”
~Gottfried Reinhardt

bythebay's avatar

If any one of us were in his position, would we/you not seek out the best possible position/options/alternatives for yourself or someone you love? Money isn’t the issue here. @robmandu is right, Jobs did his homework and it paid off.

And if money were the issue, and it were available to you; would you really say “no thanks, I’ll die…it’s only fair”?

robmandu's avatar

From CNBC, Jobs’ Doctor Speaks

[Dr. Eason] absolutely refuted the idea that Jobs received any special treatment because of his notoriety or wealth.

“Every patient has the same opportunity to be listed on the center which they choose,” Dr. Eason said. “Just as other patients may go out of their region for cancer care or other medical care, that’s the wonderful thing about America is that we have a choice in our healthcare and patients go to the place they choose to.”

Harp's avatar

@robmandu What the 1998 DHHS “Final Rule” was trying to do was take geography out of the equation in organ allocation decisions, which seems entirely reasonable. The disparity of availability among regions is caused entirely by the way the system is set up. Wouldn’t it be better to revise the system in a way that reduces this artificial disparity, rather than to rely on very sick people and their over-burdened families to figure out the work-arounds?

robmandu's avatar

@Harp, I kinda read it a little different. The coordination required to have one person on multiple listings isn’t supportable with the short, short timeframes at play with organ transplant (I think I read that the liver recipient must be in the hospital within 7 or 8 hours of initial notice).

The obvious solution then is to get rid of multiple lists… just have one national (global?) list. But who would create, maintain, administrate it? Well the government, of course. I personally am no fan of my organ’s few hours of viability relying on a government bureaucracy.

To me, it sounds like the current system worked out pretty well.

If I find myself or a loved one in such need, you better believe I’ll consider taking a similar approach, even if it means having a charter jet on standby.

We should be celebrating this amazing success. That such life-saving measures are even possible should be heralded. Instead, there’s a lot of interest in beating up the rich guy and finding failure in a system that actually worked!

Darwin's avatar

If someone close to you were dying and a cure was available, wouldn’t you do all that you could to get that cure? What Jobs did was do his homework. He used the system as it is set up to use, and followed the rules as they are written. How can we judge him badly for that?

If someone feels the system is inequitable, then they need to talk to their politicians to get them to vote “yes” on more restrictive rules for qualifying for transplants. In the meantime, you can attack someone simply because they followed the rules to their advantage.

One could also argue that Steve Jobs has contributed more to the world than the average income person, and will contribute even more in the future, including creating employment opportunities for many of those same average income people, so perhaps it is in society’s best interest that he live longer.

robmandu's avatar

Argh!

Steve Jobs isn’t “better” than anyone else. He should get the same quality care that we all get.

And we all should have access to the same options. In this example, we do. And he did.

And good grief, I hope, really hope, no one thinks that this particular case is an example to use for more restrictive transplant qualifications.

‘scuse me, I now really need to damage my liver a bit with some whiskey.

robmandu's avatar

Still amazed even that we’re talking about Tennessee as if it offers THE pre-eminent healthcare to the world’s elite, powerful, and super rich.

Not knocking Tennessee… but before this, who here, not from TN, could even name a single hospital there? It’s not the Mayo Clinic, or Cedar Sinai, or Duke.

No, Steve Jobs took advantage of the American healthcare system. The same one that you and I have equal access to. We should all be proud that it is what it is.

cak's avatar

Before my father died, we went through several years of dealing with multiple, life-threatening diseases. The final year, his liver was failing and so was a kidney. It wasn’t from being an alcoholic, either. You’d be amazed how many people ask that question.

When it came to the point of knowing it was going to require the transplant, we started reading things and seeing what we needed to know to “better his odds” – something I think all families want to do when they have a loved one in this position. Believe me, we were willing (my husband and I) to liquidate any of our assets to help out, along with their assets and insurance, to try to make things go faster. What list is the list for him to register on, became the question.

In the end, it didn’t matter, he was denied the opportunity and eventually passed away from a stroke. While I believe that it should be fair, I will honestly say that I would have sold the shirt from my back to secure my father a better chance. My husband and I were both ready to sell our businesses, along with property to help. It’s family, it’s someone you love. It’s what you do.

Jeruba's avatar

It doesn’t bother me that people who have extraordinary means at their disposal can use those means to gain advantages that the rest of us may not have, such as help in doing research, consulting specialists, having transportation advantages, etc. Some people have done what it takes to earn fortunes that others will never have. Equal value of life, equal opportunity in the workplace, and equality before the law do not translate into depriving those few of the right to use their fortunes as they choose. The rest of us still have access to those same benefits, even though we may not have the wherewithal to take the fullest possible advantage of them.

I think it would be wrong to deny extraordinary advantages to those who can afford them simply because there exist others who cannot. By that logic, we should all be on the street and living on subsistence diets because there are hungry and homeless people among us.

jackfright's avatar

@Jeruba great answer.

it reminds me a little of what a wealthy friend’s father once said to me- most people have the capacity to be extremely successful (financially) but choose not to make the sacrifices necessary to do so. wouldn’t a person who has worked harder or achieved more than the average also deserve more than the average? because otherwise, what incentive would there be to excel?

jfos's avatar

Survival of the fittest. Nowadays, money is just one of the components of social “fitness”.

Harp's avatar

The problem here, though, is that we’re not talking about whatever advantages wealth might afford you in improving your life; we’re talking about life itself. The fact that a rich person buys a Farrari has no impact, good or bad, on a poor carless man. Some goods and services exist only because there are wealthy people who can purchase them, so we can’t begrudge the wealthy those advantages. It’s not because the rich forego these things that they’ll become available to the poor.

The allocation of organs is very different. This is not a resource, like luxury cars, that expands in response to demand. Pouring money into the system won’t create more livers. In this scenario, each liver that is given to one person is a possible death sentence for another. In these circumstances, I don’t think wealth should be a deciding factor.

Again, the state of the current system is not the fault of Steve jobs, and he did nothing in the least bit wrong as far as I can see. But the allocation system, while not terrible, is not as equitable as it could be, and a principle reason is that the regions that enjoy the advantage are reluctant to give it up. That’s understandable, but it does create the conditions under which wealth could influence outcomes (whether or not it did in this instance).

robmandu's avatar

Steve Jobs “was the patient with the highest MELD score (Model for End-Stage Liver Disease) of his blood type and, therefore, the sickest patient on the waiting list at the time a donor organ became available.”—Methodist Healthcare

(emphasis mine)

Where’s the inequality?

Lightlyseared's avatar

Having worked in a Liver Transplant centre (NHS, in the UK) I have seen people receive an organ within hours of being listed (admittedly you have to be pretty damn sick).

Edit – it helped that they needed the liver on a wet friday night when lots of people get drunk and crash their cars

Harp's avatar

@robmandu Quite possibly no inequality in this case. And I’m very happy that it all worked out for him. But the potential for inequality is still inherent in the system, and that should be looked at.

robmandu's avatar

Continuous improvement processes should indeed be employed… and likely they already are. That’s par for the course.

Using this particular exacmple as a case to highlight the need for addressing perceived inequalities is opportunistic at best, slanderous/libelous at least, and if carried to the “logical” extreme, murderous for all of us (that is, Universal Crappy Healthcare™) at worst.

Harp's avatar

@robmandu I’ve not seen a single opinion here or elsewhere that casts Jobs as the bad guy in this case. I’m not sure where you’re picking that up from.

People have recognized the problems with the allocation system for decades. This isn’t a new debate. If the inequalities weren’t already well-known, no one would be paying attention to this particular case at all.

robmandu's avatar

@Harp, re-read the question posted, mon frér. It asks if he “bought his way” into the transplant. Of course that would be a slam at Jobs. And it also slams every person and organization who had a part in the transplantation process.

Furthermore, as noted in my first quip‘s link, the New York Times is out shaking the bushes on this with no evidence.

I understand that it’s not your intent. But make no mistake, the only reason this came up was because the Wall Street Journal scooped the Times, and when days later, the Times still couldn’t get a single source of credible info, they invented this entire claptrap just to create a scandal.

That scandal flies easily on the wings of class envy being fomented in the country now in conjunction with the hot topic of universal healthcare. And then here we are.

I find it fascinating to follow Apple news. It’s like a microcosm where the shortcomings of modern journalism, finance, markets, OS, design, et al come into stark relief.

Harp's avatar

@robmandu Having just read the NY Times article you’re talking about, I don’t see that it even hints at a scandal. As even your source points out, the article says in the third paragraph: “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.” It then goes on to point out the inequities in the system itself, which have been recognized for years and which no one denies. Where’s the invention?

YARNLADY's avatar

When the law of supply and demand comes into play, the one with the most money is always going to come out on top.

Please take this opportunity to fill out your donor card.

chyna's avatar

My sister in law was on the list for a liver transplant in North Carolina. She was number 1 on the list, but due to her having an uncommon blood type, she died before she could get one. There are many reasons, other than blood type, that a person could move up the list faster. I do not think Steve Jobs bought his liver. However, my brother would have done anything in his power, even grabbing a plane to a foreign country if he had to, to get his wife a liver.

casheroo's avatar

So how does UNOS work? You get on a master list? Or on a list for each state? He went to Tenn because it had a shorter list? I’m getting confused.

Mtl_zack's avatar

I’m writing an essay right now for my integrative seminar class about how transplant regulation reflects the society in which the process takes place.

If you’re in Canada, Northern Europe or Austria, then yes, this would be considered a horrible thing. But in the US, where there are very individualistic ideologies, and it is more competitive than elsewhere in regards to economics, it should be seen as more common.

Economics is a field where you study resources that are scarce and the methods that people use in order to satisfy their wants for those resources. Governing transplants is very embedded in economics. If I need a liver, and there are 20,000 other people who need one, and there are only 5 available, and I need that liver to survive, I would want to be one of those 5.

If Jobs did in fact bribe people to get the liver, it was because of economics. Think about it. A man with a big media crowd around him goes to get a transplant but he can’t get one. In order for this hospital (which was among the top 10 who do transplants in the US) to get a huge sum of money from this guy, they need an organ to operate with. If the man dies, the media will swarm and make negative comments about this hospital. If he lives and everything runs smoothly, the media loves the institution and it thrives, along with the doctors and administrators. Jobs is held in such high esteem so other people will trust a hospital that such a successful man has chosen. This could not have been possible without an organ to work with.

On another note, did people take into consideration that perhaps the organ was brought to the US from abroad? Transplant tourism is very common, although having an organ from abroad come to the US is more rare.

Another, very likely source of the organ is from a friend of his, or perhaps a dying person who had a matching organ whose family he paid off. It is very common that people give organs to friends or relatives, so maybe he paid a guy to be his friend, and when he died he took his liver. A simple business transaction.

Sorry for spelling/grammar mistakes, it’s 3:45 here yawn

Divalicious's avatar

My aunt passed away June 11th this year from pancreatic cancer. This cancer is very difficult to diagnose. Aunt Penny was diagnosed 3 weeks before her death, and the doctors estimated aggressive chemo might give her an extra week or two.

I don’t think Jobs played the system. It was probably a matter of luck (in getting diagnosed early), knowing his body (the symptoms aren’t very specific), and of course it helps to be rich enough to afford every conceivable test until your problem is found.

The window of opportunity to survive pancreatic cancer isn’t large. It has usually spread to other organs by the time symptoms appear. It seems this waiting list for donors would have a quick turnover, unfortunately.

jlm11f's avatar

Hey guys. Sorry for the late response, I am out of country and don’t check Fluther often. First off, I like the response this question got! Thank you all for putting so much thought and time into your answers. Second, I apologize since obviously I phrased this question horribly. To sum it up, @Harp understood what I was really trying to say and @robmandu picked up on the literal meaning (through no fault of his own of course). My question wasn’t meant to blame Jobs in any way or fashion. Whatever he did is perfectly legal and in addition, I have no qualms in stating that I would do the same if I had the resources he has. The question was meant to be non-biased but I can see now that it isn’t phrased that way. My personal opinion is more along the lines that the system itself is flawed and is in need of reform.

The additional question of whether one person’s life is more valuable than anothers brought up some interesting responses from all of you and I encourage the rest to chime in on that. I am short of time right now, so I unfortunately cannot get back to individual answers but hopefully will do that when I return to the States.

chyna's avatar

@PnL Where ever you are, I hope you are having a great time.

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