June 26, 2009

Apple chief’s transplant sparks debate

Apple chief’s transplant sparks debate

Apple CEO Steve Jobs' recent liver transplant dominated headlines this week.

While Jobs was not a patient at Vanderbilt, the question of whether patients are able to improve their chances of more quickly receiving a liver transplant soon became the focus of discussion.

According to Vanderbilt Transplant Center experts, the answer is yes. The practice is called multiple listing, registering at two or more transplant centers, with the chance of having greater access to more donors in a particular region of the country.

The costs associated with multiple listing make it an option most patients can’t take advantage of.

“The current system does not restrict patients from being listed at several different programs around the country,” said Michael Porayko, M.D., medical director for the liver transplant program at Vanderbilt. “It is an acceptable practice, but not everyone has the means or resources to travel outside their regional centers.”

The practice of multiple listing, which is a policy approved by the Organ Procurement and Transplantation Network (OPTN), can lead to shorter waiting times for transplantation, depending on the region and the center.

Wait times differ from center to center for a variety of reasons, including numbers of patients listed, efficiency of organ procurement in a region as well as patient and donor selection criteria.

Liver transplant patients are listed based on MELD (adult) or PELD (pediatric) scores, which measure severity and are predictors of patient mortality.

At Vanderbilt, patients accepted as candidates for liver or lung transplantation are discouraged from listing at multiple centers to avoid confusion in care between teams of physicians, while the heart and kidney transplantation programs allow multiple listing.

“It is part of our compliance process to talk to patients about multiple listing,” said Ed Zavala, administrator at the Vanderbilt Transplant Center. “But we don't encourage multiple listing because we want to ensure good patient management while they are waiting for an organ. Having more than one physician providing direction is often confusing for the patient.”

For the most part, said Porayko, the system works well and is meant to be transparent and fair so that it best serves the patient.