A Third of Patients On Transplant List Are Not Eligible - washingtonpost.com

A Third of Patients On Transplant List Are Not Eligible - washingtonpost.com:

"The list of patients waiting for organ transplants, which is widely used to promote organ donations, includes thousands who are ineligible for the operations, according to statistics kept by the national network that manages the allocation of organs.

More than a third of the nearly 98,000 patients on the list at any one time are classified as 'inactive,' meaning they could not be given an organ if it became available because they are too sick, or not sick enough, or for some other, often unexplained, reason." ...

[C]ritics note that a significant number of patients have been inactive for more than two years and may never become eligible.

"The wait list is dishonest," said Donna L. Luebke, a nurse who said she was rebuked by UNOS officials when she complained about the list near the end of the three years she served on the organization's board of directors. "The public deserves to know the true numbers."

The revelation comes at a time when advocates of organ donation have come under fire for using increasingly aggressive strategies to obtain organs, justifying their efforts by citing the long and steadily growing waiting list. ..."If the number is not accurate, that's giving people the false impression that the situation is more serious than it is. It's deceptive."...

"It does help the political cause to push for legislation and policies to increase donor rates to use the bigger numbers," [Bioethicist Arthur] Caplan said. "It's not the accurate and truthful thing to be doing."

Advocates are also pushing a controversial strategy for obtaining organs from patients who are not yet brain-dead, known as donation after cardiac death, or DCD.

"The push for DCD is based solely on the idea that we have a huge disparity of organs," said Gail Van Norman, an anesthesiologist and bioethicist at the University of Washington.

"But if 30 percent of the names are the list are inactive, the data isn't a true reflection."

Prosecuting a transplant surgeon for an excess of zeal--and some dubious practices

An interesting case is currently unfolding in California, involving the prosecution of a transplant surgeon for inappropriate treatment of the patient from whom the desired organs were to be procured. I've been asked for comment. One never knows in these circumstances what will or will not be included in a journalistic piece, so let me set forth my comment in full here:


While organ transplantation currently enjoys a very good press, it was not always so. The field has been shadowed by a number of public suspicions and concerns since its inception (and even before, reflected in works of science fiction and horror--back to Frankenstein). A particularly salient concern, even today, is that physicians eager to "harvest" organs to save lives will disregard the interests of potential donors (really, organ "sources", since relatively few give personal permission) and/or exert inappropriate pressure on family members. There has been a particular horror that organs will be taken from the bodies of still living patients, causing their death, to serve the "superior" interests of potential recipients. The criminal law regards the removal (with or without permission) of a vital organ from a still living patient, causing that patient's death, as a homicide, and various procedures have been established to protect against the reality, and the perception, that transplant surgeons, and other medical personnel, "operate" with a conflict of interest of this sort. For precisely this reason, transplantation protocols, and many state laws and regulations governing them, insist that one team perform the transplantation, and another team, devoted solely to the interests of the patient from whom the organs are to be removed, attend to that patient, oversee the dying patient's care, and declare that patient's death. These procedures, if meticulously followed, serve to protect the entire transplantation enterprise from suspicions of abuse.

Recent protocols for so-called "donation after cardiac death" draw a very fine line between orchestrating the removal of life-sustaining measures and superintending the donor's dying process and the removal of organs for transplantation purposes. In this setting, it is especially important that the medical institution and professional teams be well prepared and trained to follow carefully worked-out protocols, both for the protection and proper care of the donor and to assure public confidence in the integrity of the process. Some experts (including myself and fellow bioethicists Renee Fox and Judith Swazey) have been wary of moving in this direction, fearing that the zealousness to procure organs (understandable, given their life-saving potential) will cause physicians and procurement teams to overstep appropriate boundaries intended to protect patient and process. Donation after cardiac death leaves a very narrow margin of error in this domain, and it is rather clear in this case that relevant lines were crossed. Whether that is best regarded as a matter for criminal prosecution or for civil penalties and professional discipline will depend on particular facts of the individual case, and I am in no position to speak to the facts of this particular case. From what has been written, though, it would appear that this is a textbook case of how not to do things, and a potent reminder of the powerful temptations to stretch, and perhaps break, the rules in the quest for life-saving organs. Ironically, in this case, no useful organs were procured, and public confidence in the integrity of organ procurement methods was significantly undermined.

Some bioethicists have argued that society should become even more zealous in its pursuit of organs, lessening requirements for consent, providing monetary incentives for donation, and even doing away with the so-called "dead donor rule", which prohibits harvesting vital organs from still-living patients, thus directly causing their deaths. I think this case provides a sobering reminder of some of the risks of ever more aggressive means of procuring organs for transplantation purposes.

Human organ transplant mediators nabbed on suspicion of tax evasion

Haaretz : By Eti Aflalo

Three suspects, including one lawyer, were arrested Tuesday on suspicion of dodging tax on income from mediating human organ transplants.

Tel Aviv Magistrate's Court Judge Mordechai Peled on Tuesday approved a Tax Authority request to arrest Yaron Yudokin, the manager of two companies that mediated human organ transplants and provided related services, among other things. Yudokin's alleged activities were based in China and the Philippines.

Hard to imagine that traders in human organs, of all people, might cheat on their taxes. What will the Chinese think?

Repo: The Genetic Opera

Variety.com :

After spending most of the year living a soap opera, Paris Hilton will be part of a real opera this fall.

Hilton has joined Alexa Vega and Paul Sorvino in the cast of 'Repo! The Genetic Opera,' a full-blown musical thriller co-financed by 'Saw' makers Twisted Pictures and Lionsgate."...

Hilton will sing in a futuristic thriller framed around musical numbers that range from opera to rock. The setting is 2056, when a plague nearly destroys the human race and survival is dependent upon being able to finance a pricey organ transplant.

Hilton plays a daughter of the organ transplant magnate (Sorvino) who is the villain of the piece.

"This movie has become my life," said Bousman. "I have auditioned at least 30 actresses for this role -- Paris came in and owned it. She is this role."

See, I told you terrible things would happen if we commercialized a trade in organs for transplantation.

Thanks to blog.bioethics.net for the pickup--Variety is not on my usual rounds.

Impressive leadership

From Inside Higher Ed :

The president of the University of South Dakota, James Abbott, donated his kidney Monday to the university’s chief diversity officer, Bruce King, in operations at the Mayo Clinic, The Argus Leader reported. Both men are reported in good condition, but it is too early to tell if King’s body will accept the kidney for the long term. After Abbott first learned of King’s need, he volunteered to donate, and was rejected because of high blood pressure. The university president then adopted a new exercise program to lower his blood pressure and qualify to make the donation.

Improving public understanding of transplantation?

Dutch kidney-donor reality show a hoax
Supposed donor was actually healthy actress; contestants were in on it
The Associated Press
Updated: 4:35 p.m. CT June 1, 2007

AMSTERDAM - A television show in which a woman would donate a kidney to a contestant was revealed as a hoax Friday, with presenters saying they were trying to pressure the government into reforming organ donation laws.

Shortly before the controversial program was to air, Patrick Lodiers of the “Big Donor Show” said the woman was not actually dying of a brain tumor and the entire exercise was intended to put pressure on the government and raise awareness of the need for organs.

The three prospective recipients were real patients in need of transplants and had been in on the hoax, the show said.

The program concept had received widespread criticism for being tasteless and unethical.

But Lodiers said that it was “reality that was shocking” because around 200 people die annually in the Netherlands while waiting for a kidney, and the average waiting time is more than four years. Under Dutch rules, donors must be friends, or preferably, family of the recipient. Meeting on a TV show wouldn’t qualify.

“I thought it was brilliant, really,” said Caroline Klingers, a kidney patient who was watching the show at a kidney treatment center in Bussum, Netherlands.

“I know these transplant doctors, and I thought they’ll never go and actually do it. But it’s good for the publicity and there are no losers.”

During the show, 25 kidney patients were vetted by “Lisa,” and most were quickly dismissed for being too old, too young, smokers, ex-smokers or unemployed. Contestants gave moving pleas for why they should receive the organ.

“It really hurt watching that,” said Tim Duyst, whose wife is awaiting a transplant and cannot work. “You’re dismissed in a wave of the hand.”

Viewers were called on to express an opinion or vote for their favorite candidate by SMS text message for 47 cents.

The show was produced by Endemol, which created “Big Brother” in 1999.

The Royal Netherlands Medical Association, known by its Dutch acronym KNM, had urged its members not to participate and questioned whether the program might just be a publicity stunt.

“Given the large medical, psychological, and legal uncertainties around this case, the KNMG considers the chance extremely small that it will ever come to an organ transplant,” it said.

All seven of the country’s transplant centers had said they not cooperating with the program, KNMG spokeswoman Saskia van der Ree.

Earlier in the week, the Cabinet declined suggestions from lawmakers to ban the program, saying that would amount to censorship.

New Machine Keeps 'Heart in a Box' Beating

blog.bioethics.net: Art Caplan on MSNBC:

Now there's a machine that can do what Poe imagined - preserve a beating heart in isolation. And while this might seem to be the yuckiest idea to come down the pike in a long time, it really represents a bold and fascinating advance in trying to save the lives of people with failing hearts.

The 'heart in a box' machine, known as the Organ Care System, is made by TransMedics Inc., of Andover, Mass. Doctors in Pittsburgh recently announced that they used the machine to keep hearts beating for hours on their own after being removed from cadavers. Three patients, a 47-year-old man and two women in their 50s, received these hearts and all seem to be doing very well.

The machine will be tested further in the coming year at five transplant centers in the U.S. - the University of Pittsburgh Medical Center, Brigham and Women's Hospital in Boston, UCLA Medical Center in Los Angeles, the University of Chicago Hospitals' Cardiac Center and the Cleveland Clinic. The researchers want to be sure that hearts transplanted out of the box really work as well as those preserved by current methods.