Most of you who've come to know us through blogland don't know that Shelby was almost on the heart transplant list three years ago.
The buildup to being put on the list involved a lot of meetings with individuals — transplantees and Stanford Medical Center employees — and a lot of time in support groups. The thing that always struck me was how caring yet incredibly serious everybody involved in the program was. Employees knew they were the facilitators of a sacred trust, taking the results of one family's selfless decision to donate — often made during the pain of unexpected death — and using that literally give someone else a second chance at life. Recipients and their families were incredibly grateful for and mindful of the second chance they'd received, taking all kinds of time to visit with us, answer our questions, and help us with the process.
At the same time, we learned how the organ procurement process worked — how the system was set up to be fair and give everyone the best chance. UNOS, the United Network for Organ Sharing, maintains regional (because organs can't travel very far) waiting lists for each type of organ. The lists are prioritized by the severity of your illness, the time you've spent waiting, and your physical characteristics (your blood type, body size, and some other genetic markers). Nothing else matters; fraud and outside influence are infintesimally rare. When an organ becomes available, UNOS works down the list, contacting the medical teams of eligible candidates until somebody is found who's ready for transplantation.
Which is why this week's news coming out of LA leaves me both flabbergasted and angry. Doctors in the liver transplant program at St. Vincent Hospital gave a transplant to a Saudi Arabian man who was number fifty-two on the waiting list, likely because of reasons of money or influence (the Saudi Arabian government paid full freight for the transplant) — and then proceeded to falsify paperwork to cover up what they'd done, callously putting other lives at risk in the process. (LA Times Article #1, Article #2)
Here's what they did: St. Vincent had a patient — "Patient A" — who was at the top of Southern California's liver transplant list. UNOS notified St. Vincent doctors that they had a matching liver for Patient A. Unfortunately, Patient A was out of town. The doctors at St. Vincent should have told UNOS that Patient A was unavailable, so that the liver could have been offered to number two on the list, a patient at UCLA. Instead, they took the liver, transplanting it into Mr. Fifty Two, a man with similar genetic characteristics to Patient A. After that, they told UNOS that Patient A had received the transplant (and that Mr. Fifty Two had given up seeking transplatation in the US, moving to Europe instead), effectively dropping Patient A off of the waiting list. Subsequent paperwork — follow-up reports, labelling of tissue samples, etc. — was altered to replace Mr. Fifty Two's name with that of Patient A. The transplant took place in 2003; the fraud was only discovered this year after a UNOS audit.
The Times says that St. Vincent "has terminated the program's relationship with the doctors", and that their transplant program has been temporarily suspended. But that's not enough. Not only did these doctors directly endanger the lives of two people — Patient A and the patient from UCLA — they've indirectly harmed hundreds or thousands of future transplantees, who'll have to wait that much longer for a transplant because this story puts a kernel of doubt into peoples' minds, making them turn away from signing that form or putting the "donor" sticker on their driver's license. I heard that they give transplants to foreigners and people who pay the most money! These doctors don't deserve to fade off to some other corner of medicine and still maintain a comfortable lifestyle; they need to lose their jobs, lose their licenses, and go to jail.
[Also see: UNOS's Myths About Organ Donation.]
Posted by Kevin at September 29, 2005 09:21 AM