This article is from the Organ Transplant FAQ, by email@example.com (Michael Holloway) with numerous contributions by others.
Is there a possibility that well-connected persons---e.g., Mickey Mantle,
Gov. Casey of PA, or wealthy foreigners---might get to the top of a list
preferentially rather than by medical indications alone?
The short answer is : NO.
I take your question to mean "is there a realistic possibility that being
connected affects organ allocation. Of course, the answer to any question
that asks if there is "absolutely any possibility that".... is always,
yes it is possible. Is it possible that both sides of the conflict in
former Yugoslavia will kiss and make up? Well, yes it is possible, but
realistically it won't happen. Is it possible that connections make a
difference in organ allocation? As I said, anything is possible.
Realistically, it does not happen. In the United States it is illegal to
"engage in the commerce of human organs". The organ allocation system is
organized nationally by the United Network for Organ Sharing (UNOS)
charged with the equitable distribution of organs. Factors considered are
time waiting, tissue and blood type matching, size matching, and severity
of illness. The schemes for allocation are different for different
The case of Mickey Mantle has been covered extensively in the media.
*There is absolutely no evidence that he was not the most ill person in
his region of the country on the day he got his liver transplant.*
According to the allocation system for livers, he has priority over
people waiting longer, just as if he had been waiting longer than others
but they were more ill, they would have priority over him.
The case of Governor Casey was a special situation: he needed both a
heart and a liver. At the time his transplant occurred, there was no
national policy governing multi-organ transplants. The policy governing
multiple organ transplants in the area where he was transplanted placed
these patients at the top of the list. So when he was listed, he was
automatically first. Many multiple organ transplants had been performed
on patients previously. These cases did not make the headlines because
the patients were not famous, but they too were elevated to the top of
the list by virtue of the fact that they required multiple organs. Now
that multi-organ transplants are more common, a national policy covering
multi-organ recipients is in force.
Wealthy foreigners can come to this country and be placed on the
transplant lists if they meet medical criteria, just as they can donate
organs if they are killed while in this country. The priority on the list
is no different for foreigners, they take their place in line with
everyone else. To prevent the influx of non-US citizens from using too
many organs while US citizens are dying, UNOS has a policy that a
transplant center should not do more than 10% of their transplants on
non-citizens. In fact, most centers do far fewer than 10% of their
transplant on foreigners. So foreigners have no way to buy their way to
the top of the list.
We in the world of organ transplantation are very sensitive to the
fairness issue. Organ transplantation is perceived by some as something
that only saves the lives of wealthy old people. The reality couldn't be
farther from the truth. The goal of organ allocation couldn't be more
altruistic: provide organs as fairly as possible for as many as possible
before the patients die. The patients that are more ill have priority
over the ones that aren't as sick.
Unfortunately the perception of inequality keeps some people from
donating their organs. This is tragic. The disease that result in the
need for transplantation recognize no racial economic or geographic
barriers. The allocation scheme is as fair as humans have been able to
make it. Nevertheless, over 3000 people died last year because of a
shortage of life saving organs.
Give the gift of life: be an organ donor.
Jeff Punch MD, Transplant Surgery, University of Michigan