医師の一分

アクセスカウンタ

zoom RSS スティーブ・ジョブズはお金で肝臓移植を早く買った?/米国医療事情 移植医療

<<   作成日時 : 2009/06/26 00:09   >>

ブログ気持玉 0 / トラックバック 0 / コメント 0

スティーブ・ジョブズはお金で肝臓移植を早く買った?
 アップル共同設立者スティーブ・ジョブズはテネシーでの移植手術から回復。彼の外科手術は優待についての問題を提起。現在のシステムは他よりずっと短い待ち時間の地域を結果として生じている。肝臓移植待ちリスト16,000人;毎年、3分の1だけが肝臓を得る。
 今週、スティーブ・ジョブズ(CEOでアップル共同設立者)が2ヶ月前肝臓移植を受けたと報告された。移植について奇妙な問題点がある。北カリフォルニアのジョブズの家から約2,000マイルのテネシーの病院で移植は行われたのはなぜか?
 なぜ、人々が臓器移植を得ることが十分な資産によって時々より容易であるかとともに、答えは臓器移植システムの複雑な事情に光を当てる。ジョブズの推定資産は57億ドルである。
 肝臓は不足している。6月末現在、移植待ちリストには16,000人があり、毎年このリストの上位約1/3だけが受けられる。しかし、しばしばセレブの場合にはリストの上位にあがり、人々は優待手術が行われていると思っている。こうした特別扱いの噂は1995年野球選手ミッキーマントルの肝臓移植の後に流れた。
 真実はより複雑である。実際、米国では法律上、臓器を買うことはできない。しかし、肝臓移植を受けるのは大学に入ることに似ている。待機リストに載った時、そこから降りるチャンスは個人的な都合、病気の重症度やドナーとのマッチングに依存する。しかし、先ず第一にリストの第1位に上るには、ほとんどの人が持っていない資源とノウハウが必要とされる
(書きかけ)
 最新の推計では、肝臓移植には519,600ドル必要であり、保険で十分な補償が得られないので1/3の人は受けられない。実際、自腹で払えるのはたった5%の人に過ぎないという。さらに保険は評価プロセスの間にも重要であり続ける。待機リスト追加を決定する委員会は患者の医療と金融経歴にアクセスできる。リストに入る際に莫大な選別がかかる。いくつかの移植センターでは支払い能力は受け入れのための前提条件となっている。結果的に、財政的に肝臓移植に「事前承認された」裕福な人々が新たな臓器を受けられるチャンスの最も高い移植センターを物色して回ることができる
------------------------------
メンフィスの病院がジョブズの肝移植実施を公表
 メンフィスのメソジスト大病院移植研究所のイーソン博士は、「ドナー器官が入手可能になった時に、彼がキャンセル待ちリストの上の最も病気の重い患者であったので、彼は肝臓移植を受けた」と言った。「ジョブズ氏の経過は順調である」。プライバシーのためとして手術時期は公表しなかったが、ウォールストリート・ジャーナルは、それが2ヶ月前であったと報告している。
画像

-------------------
スティーブ・ジョブズがテネシーで肝臓移植か/米国医療事情 マルチプル・リスティング 移植医療
http://kurie.at.webry.info/200906/article_34.html
無保険者は臓器提供者になれても臓器移植は受けにくい/米国医療事情
http://kurie.at.webry.info/200812/article_1.html
---------------------------------------------------
Did Steve Jobs' money buy him a faster liver transplant?
http://edition.cnn.com/2009/HEALTH/06/24/liver.transplant.priority.lists/index.html
* Story Highlights
* Apple cofounder Steve Jobs is recovering from transplant surgery in Tennessee
* His surgery raises questions about preferential treatment
* Current system results in regions with much shorter wait times than others
* 16,000 people on the liver waiting list; in any one year only one-third get liver

June 24, 2009 -- Updated 1529 GMT (2329 HKT)

* Next Article in Health ?

By Ray Hainer
Decrease font Decrease font
Enlarge font Enlarge font
Health

This week it was reported that Steve Jobs, the CEO and cofounder of Apple, underwent a liver transplant two months ago. One detail concerning Jobs's transplant seemed odd: The surgery took place at a hospital in Tennessee, some 2,000 miles from Jobs' home in northern California. Why Tennessee?
Steve Jobs (pictured in October 2008) has been on a health-related leave of absence since January 2009.

Steve Jobs (pictured in October 2008) has been on a health-related leave of absence since January 2009.

The answer sheds light on the intricacies of the organ transplant system, as well as why it's sometimes easier for people with significant financial resources to get an organ transplant. (Jobs' estimated net worth: $5.7 billion.)

Livers are a scarce resource. In any given year, only about one-third of the people on the national transplant waiting list receive one, and as of late June, more than 16,000 people were on the list.

Yet it sometimes seems that celebrities in need end up at the front of the line when they need a transplants, and people often assume they get preferential treatment. (Rumors about special treatment circulated after baseball player Mickey Mantle's liver transplant in 1995, for example.) Health.com: The real gift of life: How medical donations help

The truth is more complicated. No one can actually buy an organ in the United States (legally, that is). But getting a liver transplant, it turns out, is a lot like getting into college. Once you're on the waiting list, your chances of getting off it depend largely on your personal circumstances -- how sick you are and whether you are a good donor match. But getting on the list in the first place -- or on more than one list, as the case may be -- requires resources and know-how that most people don't have.

Can some people 'cut the line'?

There are 127 centers in the U.S. that perform liver transplants. If you need an organ transplant, your doctor will refer you to one of these centers, where you will be evaluated, given a score based on the severity of illness, and placed on the center's waiting list, if you are indeed a candidate for transplant.

The center's waiting list feeds into a national database managed by the United Network for Organ Sharing (UNOS), a nonprofit organization that contracts with the federal government to manage the nation's organ transplant system.

UNOS works with 58 organ procurement organizations (OPOs) that coordinate organ distribution in their region of the country. When an organ becomes available, the OPO in that region searches the UNOS database for a local match using blood type (and other biological considerations), the patient's severity score, and the time spent on the waiting list. If a match can't be made within that region, the organization expands its search to neighboring regions.
Don't Miss

* Steve Jobs recovering after liver transplant
* Steve Jobs: The sickest patient on the waiting list

The problem -- or the advantage for some patients -- is that not all OPOs are created equal. Some regions contain nearly 15 times as many people as others, and their waiting list times vary widely. Patients in the smaller OPOs tend to be less sick and experience shorter wait times before getting an organ. In the Tennessee OPO where Jobs received his transplant, the median wait for a liver between 2002 and 2007 was just over four months. The national average was just over a year, and in some OPOs it was more than three years.

Though there is always the possibility of preferential treatment once a patient is on a waiting list -- UNOS conducts periodic audits of transplant centers for exactly this reason -- it is unlikely that someone like Steve Jobs can "cut the line" of the transplant waiting list. Health.com: Three sisters find kidney donor for dad using craigslist

The reason that some people might be able to get transplants more quickly is that they're standing in more lines. Nothing prevents someone from being evaluated and listed at multiple transplant centers. As long as a patient has the wherewithal to fly around the country -- and be available at the drop of a hat if a liver becomes available (this is where the private jet comes in handy) -- a patient can, in theory, be evaluated by all the transplant centers in the country.

"The system works at two levels," explains Arthur Caplan, Ph.D., the chair of the department of medical ethics at the University of Pennsylvania. "One, who gets in to a center. Two, who gets transplanted off a particular center's list when an organ becomes available. Most of the attention goes to stage two, but the biggest ethical challenges are really at stage one."

Jobs underwent surgery for pancreatic cancer in 2004. (He reportedly had a type that grows more slowly -- and has a better prognosis -- than others.) He was said to have recovered, but last year he appeared in public looking thin and sick. He took a leave of absence in January and underwent a liver transplant a few months later. However, it's not clear how long he was on the transplant waiting list, or whether he was on the waiting list for a center other than the one in Tennessee.

Insurance matters too

Since 2003, UNOS has required that transplant centers inform all candidates that they can be evaluated and listed at more than one center, and that they can also transfer their care from one center to another without losing the time they have accrued on the waiting list. However, not everyone can afford to fly around the country and be evaluated at more than one transplant center. In fact, many people can't afford a liver transplant, period.

According to the most recent estimates, the cost of a liver transplant is $519,600 -- a price tag that excludes roughly one-third of Americans because they don't have sufficient insurance (or any insurance), Caplan estimates. According to data collected for UNOS, only about 5 percent of liver transplants are paid for out of pocket. Health.com: Where the money goes: A breast cancer donation guide

"What your insurance covers is very different from everyone else's," says Anne Paschke, a spokesperson for UNOS. Some insurance companies won't cover evaluations at multiple transplant centers, Paschke explains, and in at least one case, an insurance company has restricted its coverage to a single transplant center that the company itself owned.

Moreover, your insurance continues to be important during the evaluation process. The decision to accept a transplant candidate takes place before UNOS enters the picture, and the committees that determine whether a patient is added to the transplant center's waiting list have access to a patient's full medical and financial history.

"There's a huge triage involved in getting in," says Caplan. "If you're a homeless alcoholic sleeping on the streets of L.A., and you're going toe-to-toe with Steve Jobs, you're going to lose."

For most people, the ability to pay is a precondition for acceptance at more than one transplant center. Wealthy people who are, in effect, financially "pre-approved" for a liver transplant, can shop around and identify the transplant centers that will give them the best chance of receiving a new organ.

Reforming the system

Despite the apparent problems with the transplant system, past efforts at reform have generally failed. Health.com: Could painkillers be hurting your heart?

In the late 1990s, the U.S. Department of Health and Human Services issued new regulations that would have given priority to the sickest patients, regardless of region. This would have eliminated the geographic disparities that make approval at multiple transplant centers advantageous, but Congress blocked the regulations and instead asked the Institute of Medicine, an advisory organization that belongs to the National Academy of Sciences, to consider the issue.

The IOM's proposal was less far-reaching, but it did recommend standardizing the size of the organ donor pool for the sickest patients. Congress failed to implement this measure as well, however.

Some transplant centers advocated the shift away from the OPO system, but others vigorously lobbied Congress to oppose the new policy. The smaller transplant centers were concerned that in a national organ allocation system, they would receive fewer transplants and be driven out of business. The larger transplant centers, meanwhile, wanted to maintain the size and geographical reach of the OPOs in their areas.
Health Library

* MayoClinic.com: Organ donation -- Don't let these 10 myths confuse you

"There was a huge split in the transplant community," says Paschke. "It was very territorial at the time, and there was a lot of maneuvering going on. There were a lot of business interests on the part of the transplant centers."

UNOS itself has been split on the issue of multiple listing. The organization's board of directors has voted on whether to restrict multiple listing three times in the past 15 years; the first vote resulted in a tie, and in the others the proposal was rejected by a divided vote.

The inequity revealed in the liver transplant process is symptomatic of the larger inequalities in the American health-care system, says Caplan, who also cochairs a United Nations task force on organ trafficking. In countries such as Canada or Switzerland that have national health-care systems, a patient's finances don't influence access to organs to the same extent, he says.

"Money doesn't play such a big role in entry into the system," he says. "Steve Jobs' transplant is relevant to why we need some health reform."

-------------------------------------------------------
Memphis hospital confirms Jobs liver transplant
http://www.washingtonpost.com/wp-dyn/content/article/2009/06/23/AR2009062303722.html
By JANET BLAKE
The Associated Press
Wednesday, June 24, 2009; 12:07 AM

LOUISVILLE, Ky. -- Apple co-founder and CEO Steve Jobs has an "excellent prognosis" after receiving a liver transplant at a Tennessee hospital, a doctor confirmed Tuesday.

"He received a liver transplant because he was ... the sickest patient on the waiting list at the time a donor organ became available," said Dr. James D. Eason, chief of transplantation at Methodist University Hospital Transplant Institute in Memphis. "Mr. Jobs is now recovering well and has an excellent prognosis."

Eason said in a news release posted on the hospital's Web site that when Jobs received the transplant, he was in end-stage liver disease.

Eason did not reveal when the operation took place, citing patient privacy. However, The Wall Street Journal reported it was two months ago.

Apple did not confirm the WSJ report, and has said only that Jobs is looking forward to returning to Apple - which he started in 1976 - at the end of June.

Eason said the hospital could not reveal further information on the specifics of the transplant.

"That's all that we are giving out at this time," hospital spokeswoman Ruth Ann Hale told The Associated Press.

Wall Street has grappled with the implications of Jobs' illness since August 2004, when investors learned the CEO had kept a cancer diagnosis secret until after he underwent surgery. The company's past silence on matters of Jobs' health made shareholders jittery when he appeared increasingly, even alarmingly, thin last year.

Investors sent the stock tumbling 5 percent to its lowest point in a year on a rumor last October that Jobs had suffered a heart attack.

Then shares slipped 2 percent in December when Apple said that Jobs would not speak as usual the next month at the annual Macworld conference, then bounced up 4 percent on Jan. 5 when Jobs explained his weight loss as a treatable hormone imbalance. They sank 7 percent a week later after Apple said he would be taking six months off because his medical problems were more complex than he initially thought.

Since then, Wall Street's whiplash has had time to heal, especially because Apple's stock has weathered the recession better than those of most of its competitors.

Cupertino, California-based Apple put Tim Cook, its chief operating officer, at the helm during Jobs' absence.

---

On the Net:

http://www.methodisthealth.org

----------------------------------------------------

http://www.methodisthealth.org/static/methodist/doc/Jobs-media-statement.pdf
Ruth Ann Hale, APR
Director, Media & Community Relations
(901) 516-0600
haler@methodisthealth.org
June 23, 2009
For Immediate Release
I am pleased to confirm today, with the patient's permission, that Steve Jobs received a liver transplant at Methodist University Hospital Transplant Institute in partnership with the University of Tennessee Health Science Center in Memphis.
Mr. Jobs underwent a complete transplant evaluation and was listed for transplantation for an approved indication in accordance with the Transplant Institute policies and United Network for Organ Sharing (UNOS) policies. He received a liver transplant because he was the patient with the highest MELD score (Model for End-Stage Liver Disease) of his blood type and, therefore, the sickest patient on the waiting list at the time a donor organ became available.
Mr. Jobs is now recovering well and has an excellent prognosis.
The Methodist University Hospital/University of Tennessee Health Science Center Transplant Institute performed 120 liver transplants in 2008 making it one of the ten largest liver transplant centers in the United States. We provide transplants to patients regardless of race, sex, age, financial status, or place of residence. Our one-year patient and graft survival rates are among the best in the nation and were a dominant reason in Mr. Jobs's choice of transplant centers.
We respect and protect every patient's private health information and cannot reveal any further information on the specifics of Mr. Jobs's case.
James D. Eason, M.D.
Program Director, Methodist University Hospital Transplant Institute Professor of Surgery, Chief of Transplantation, University of Tennessee Health Science Center

テーマ

関連テーマ 一覧


月別リンク

ブログ気持玉

クリックして気持ちを伝えよう!
ログインしてクリックすれば、自分のブログへのリンクが付きます。
→ログインへ

トラックバック(0件)

タイトル (本文) ブログ名/日時

トラックバック用URL help


自分のブログにトラックバック記事作成(会員用) help

タイトル
本 文

コメント(0件)

内 容 ニックネーム/日時

コメントする help

ニックネーム
本 文
スティーブ・ジョブズはお金で肝臓移植を早く買った?/米国医療事情 移植医療 医師の一分/BIGLOBEウェブリブログ
文字サイズ:       閉じる