Toad in the Hole

March 19, 2007

The Unglamorous Facts

Acknowledged as true, but there's no rubber bracelet for this aspect:

Money is a strong factor in who gets an organ.

Although organs cannot be sold or bought, money plays a role in how this country rations scarce transplant resources. Money does not determine who gets a transplant at a particular hospital, but it does determine who is referred for consideration and gains admission to a transplant center.

Access to transplantation is a function of access to good primary care and the right kind of insurance, which is heavily dependent on personal finances.

To gain access to the waiting list for organs, a patient must demonstrate the ability to pay transplant-associated costs. A kidney transplant costs $35,000 on average, a heart transplant $60-100,000 and a liver transplant $150-200,000 in the first post-operative year.
Many insurance companies and government programs do not cover the costs of some types of transplantations, particularly newer therapies such as lung, pancreas or multiple organ transplants.
Since transplantation depends on public altruism to make organs available, it is an especially untenable public policy to ask everyone to donate but to give organs only to those who can pay.

... Medicaid programs in some states do not pay for some types of transplants. The uninsured and underinsured are sometimes forced to resort to public begging to be considered as recipients.

Quoted from
Organ Procurement and Transplantation: Ethical and Practical Issues
Arthur Caplan, Ph.D., LDI Senior Fellow, Trustee Professor of Bioethics and Director, Center for Bioethics, University of Pennsylvania School of Medicine
Volume 2, Number 5; September 1995

Posted at March 19, 2007 05:52 AM


I think we should make ribbons out of dollar bills, or with some kind of novelty money-print fabric.

Posted by: Sara at March 19, 2007 05:21 PM

The facts become even less glamorous, if you can believe it.

There are international, sordid organ-trafficking businesses which trick poor people into "donating" organs, then sell them at premium prices. The demand is so much higher than the supply that the price is out of reach for most of us working folk but the middle men are making a LOT of money.

Posted by: Sally at March 19, 2007 08:38 PM

You know, I passed the "INternational Admissions Office" at Jackson Memorial in Miami several times before I got to speculating about just what it was for.

Posted by: Ron at March 19, 2007 09:09 PM

I have 20 years experience in working with the Florida District 9 Medical Examiner's Office in Orlando Florida. I have personally encouraged next-of-kin to donate "any and all organs and tissues" in order to "save lives or enhance the quality of life" for the recipient of their donation. My understanding of the donation process was short-sighted to say the least.

I am embarrassed by my role in this sordid marketing of human life, and sad beyond repair that my sister had to die to expose it to me. It is difficult to rally when you know your loved one is gone. But if I can spare anyone this tragic experience, I have a difficult job ahead of me, but I am up for the challenge.

I love you Jeanne!

Posted by: Ellen Sullivan at March 19, 2007 11:56 PM

(((( ellen )))) (((( ron )))) and (((( julie )))) i'm so sorry. there can't be a good way to lose your sister too young, but this was a particularly awful way.

ellen, i hope you are not kicking yourself too hard, because there are so many people who could be helped by organ donations. talking to next of kin is the work of angels [i believe in secular angels] -- there can hardly be a more difficult talk to have with grieving family, but donation is also such a generous gift, one that can both comfort the bereaved and bring hope to another family in anguish.

the problem isn't with donors, except that for one reason or another, there aren't enough donors yet. a health care system that mainly aids the rich and healthy, though -- that's a real problem. it isn't usually as stark as this, but jeanne's story [so far as i've heard] seems to be one vivid illustration of why for-profit insurance-driven health care is bad public policy. not sure how to get all that changed, just that it has to change.

Posted by: kathy a at March 20, 2007 12:59 AM

kathy, thanks for the kind comments. i agree that for-profit health care is the root of much evil. i am not beating myself up so much as newly awakened to the issue that did not begin and end with donation, and i never gave it much afterthought. if only we could have rallied sooner or something. but then Jeanne didn't let on she was so sick until the very end. it was a double-edged sword I am afraid.

as far as not being sure how to get things changed, amen sister. following the last two supposed elections, i am not sure it really matters......but vote....and pay attention to these issues. this country has victimized folks like us for long enough.

Posted by: Ellen Sullivan at March 23, 2007 01:50 AM

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