Thursday, October 6, 2011

Damage to Program Reputation

Yesterday, Twitter was flying the Fail-Whale  (at intervals) due, in part, to Steve Jobs's death. Many of my friends were posting their condolences messages to FaceBook and/or Plus. I suppose it's all a nice tribute to someone whose singular vision helped shape an industry. But, at the same time, there's that part of me that was pissed by it all.

Don't get me wrong, I'm not denigrating the man's professional accomplishments. I'd be a fool to try to claim that he didn't have profound influences in a number of technical areas. My main beef is that, much like many people who had power derived from their mone and success, the man used that power to cheat. Worse, where he cheated helped to further damage an already problematic system - the organ donor program.

I've long had a problem with the whole organ donor program. The people who give their organs typically see nothing in return. The organ donor programs try to spin the whole thing as an enobling endeavor where a senseless death can be made meaningful.

Bullshit. While the families of the deceased are being fed this bullshit message, everyone else involved in the process are moving around piles of money. It's not like the doctors, nurses, hospitals (etc.) are working for free. It's not like donor recipients are getting the organs for free. And, worse, people with money and power are able to shove piles of money (or maybe just influence) and get themselves jumped ahead in line. 

The first memorable instance of this for me was when former PA governor Casey did it in 1993. Within a day of the need for a multi-organ transplant being determined, he "somehow" ended up at the head of the line for the procedure.

Jobs's instance wasn't quite so glaring. He actually set up temporary residence in state with favorable waitlist times. Thus, instead of waiting the best part of a year for a transplant, he only had to wait two months. By itself, this could just be chalked up to exercising one's money to move where the wait lists are shortest (Tennessee is a short-wait state for livers, for some reason). And, I could deal with that. However, Jobs's health history made him a sub-ideal candidate. With the organ transplant triage systems, people with a history of cancer - particularly a recent and/or active history - are generally given low to no priority on transplant waitlists.

Given the scarcity of available organs, it only makes sense: not only do you want an organ to go to someone with the best tissue-match, you want it to go to someone with the best, overall, prosspects for long-term survival. Cancer patients - particularly ones with recent and/or active history of the diease - generally aren't considered a good, long-term risk for an organ transplant. Judging by the time displacement between Jobs' transplant and his eventual death, he bore out this poor-risk rationale.

I can't help but think that, had Jobs not used his money to put himself someplace where he could jump the line, someone else might have gotten that liver. Further, "someone else" would likely have not been given special consideration in spite of a sub-ideal health history. The liver that died with Jobs might still be acting as a life-saver for someone else.

Yeah, that's a lot of mights. It's a lot of speculation. But, it just reinforces my whole distaste for the organ transplant system in the US. It contributes to my desire to not donate my organs were I eligible to do so. I mean, we have a system that essentially supports organ-selling where everyone but the organs' prior owners profits, but the donors' survivors see nothing of it but "nobility". Screw that. The "nobility" just strikes me as a very cynical method to get people to part with things for free that have a high, real-dollar value. And, at the end of the day, the people most likely to give out of charity are also the least likely to ever benefit from such charity (i.e., they aren't the class of people that will get preferential treatment due to social positioning).

For now, if anyone wants my organs, feel free to bid for them. If I pre-decease my "family", they're gonna be in a sub-ideal economic state. The least I can do for them is try to get them the last dollars my corpse can yield. And, if I can't do that, then there's no way I'm risking some monied line-jumper benefitting from my death. My organs die with me unless I'm able to put stipulations in place for who they may be "given" to (i.e., someone in the same or lower economic class and who have financial dependents that would face genuine hardship were they to die). Without those kinds of assurances on who can have them, no one can have them.

Yeah, that's selfish - I'm just making sure I'm not participating in a sham.

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