I spent this morning researching the mechanics of America’s vast organ transplantation guidelines. They are currently the topic of discussion by the American Heart Association at one of their annual junkets. I was unable to find the costs associated with the various organ transplants that were not four years or more in age, and in a world where a single Hepatitis B treatment pill can cost a month’s honest wages, that is an ominous harbinger. What I was able to ascertain is the fact that a heart transplant in 2011 cost an average of $977,000,000.
Transplant doctors are supposed to use the concept that the most critically ill should be at the top of the transplant lists, but often, they do not. The major organ transplant clearinghouse, the Organ Procurement and Transplantation Network which is funded by the U.S. government’s Department of Health and Human Services has admitted that those with the most money and insurance at their disposal are the most likely to survive the wait and be rewarded with a new heart (or other organ).
So then I asked myself a simple question: “Am I worth one million dollars or more?” Granted, all humans have worth — except for a few highly-placed Turkish government officials. We are the sum of our intellect, our inner selves, our personal histories, our familial surroundings and our understanding of the world in which we live. If we are fortunate, we have a wide circle of friends to whom we can turn if needed, and we likewise reciprocate, as needed. We have had a proper education which exposed us to culture, the arts, the humanities and even to culinary endeavors. We know if a carton of milk has gone bad in the refrigerator by its smell. We never listen to politicians telling us what is best for us. In a word, we have institutional and observational knowledge that is as valuable as that which we learn in books. But how much is it all worth?
Several months ago, I had a conversation with my beloved Maccabi doctor about the fact that I need a new (or slightly used heart) to replace the one I got at birth which is failing and bringing with it some very unpleasant side effects. I expressed my concern that someone my age was “not worthy” of an organ replacement — the U.S. maximum age is 70 years. I posited to him that someone half my age would benefit more from a transplant than I would. I asked him: “What if the actual organ recipient discovered a cure for cancer? Would that not mean their life was more important than mine?” My doctor re-iterated that hearts and other organs for transplant go to those with the most need. He then asked me: “What if the actual recipient is a real asshole? I would rather you got the the heart than some jerk!” Then I thought of Dick Cheney.
This is not to say that I do not know some people who are worth one million dollars and even more. I know three gentlemen that fall in this category. Their contributions to our society is why I say this about them. If I asked them whether they thought they were worth one million dollars or more, they would mostly likely laugh at me. But I stand by my assessment of their talents and skills.
My question may be more rhetorical than answerable. But why should anyone have to ask it in the first place? Why does a replacement organ coming from a deceased person cost $80,000 or more? A $1,000 flight to most medical centers in major cities in the U.S. sounds a tad high, but $80,000? Who puts the price tags on such things? The system is rigged in favor of those who never have to ask how much something costs. Steve Jobs got a new liver when his original one got cancer. He died, anyway. It used to be that anyone with cancer was not considered a good candidate for transplant for the obvious reason that cancers return and the new organ would be diseased before too long. Baseball legend Mickey Mantle got a new liver when he pickled the one he had with alcohol. Some of the wealthiest families in the world have begun sporting new organs, which would not be uncommon except for the fact that one such recipient is close to 100 years old and he has had two hearts so far. Clearly, fairness is not the standard by which one either gets or does not get a new organ. Perhaps the Steve Jobses of the world should have to pay the equivalent of one of their own surgeries to a stranger. Think of it as a “Superfund” for the poor who will certainly die without interventional organ transplants.
For all its faults and failings, the Israeli health care system cannot be beat for one simple reason: I never saw a medical bill in my 12 years of living there. In Israel’s society, all citizens are entitled to appropriate health care and although they have yet to get around to performing actual heart transplants–I suspect due to their associated costs; they do perform every other kind of major organ transplant. In America, winning the lottery seems more an appropriate wish than having a skilled enough surgeon to pull you through a complicated operation.