HOT BUTTON: Response To “Wealthiest – Not Sickest – Patients May Have Edge In Organ Transplants”

I saw this Science Daily news article in my Twitter feed after arriving back home after a cancelled Social Security Disability testing appointment today.  I was already a bit miffed because I should have gotten a call or notice it was cancelled but didn’t.   However, when I came across this article I was really ambivalent about it.  I know this is a known issue. I am not naive to the ethical issues it raises at all, but I’m not sure this is completely true.  At least in how this discussion is framed.

In fact, I have yet to dig into the great resource “Replacement Parts: The Ethics of Procuring & Replacing Organs in Humans”.  It covers this subject & so many others.  I’m sure once I make it through, I’ll have more to comment on.  It’s edited by one of my favorite bioethicists, Arthur Caplan (along with James J. McCartney & Daniel Reid).  Part 5 Chapter 34, addresses Multiple Listing in Kidney Transplantation. I’m sure much common ground will be found in multiple listings of other organs as well.

That said, I do see the point of this article.  It is based on a study by Columbia physician Raymond Givens & his team.  More information can be found from this press release from the American Heart Association.  I do see clearly the issue they are trying to address.  I agree that disparities in healthcare can only be addressed if they are acknowledged & talked about.  But it also needs to be a balanced discussion. This is hard in the realm of transplant because there are not only bioethics involved but personal ethics & decision-making based on each individual candidate’s unique situation.

I also think this overlooks another issue in general that may be a barrier to multiple listing access, & that is insurance access.  While they mention private insurance for the wealthy, they still don’t take in account that there are still a few careers out there who offer very good group health insurance plans to their employees (even though those days are dying fast). These employees may not always be in the wealthy class, especially those in mid-level jobs.   How do I know this?  Because I am one of them.

I also, as proven with my recent fundraising efforts, am extremely resourceful. Moreso than I ever realized & for that I’m thankful.  I do not come from a rich family.  I do not have many wealthy friends.

The only reason I haven’t dual listed yet is because I am not currently listed yet at my original center (although I will most likely be soon). I would only consider dual listing after discussing it with my team at my current center. I would only dual list upon their recommendation & if they felt it was in my best interest.

I could technically dual list on my own, but I am not comfortable with my closest dual listing options since I know where they are. I don’t feel they are as strong an option as my current center. I would only consider dual listing for myself if I had been given an extraordinarily long wait time. Also if my transplant team was concerned that I might get too sick to list during that wait timeframe.

I can’t argue with the facts & truths they point out in this article.  To a degree it’s true.  But it only paints one side of the picture. There’s more to dual listing than just finances alone.  It’s a major decision with multiple factors involved.  Also they do not account for another key factor in even listing kidney patients, & that’s the inconsistencies of referrals from dialysis centers. (I do think they need to explore that & how much that contributes to many ethical issues.  The later the referral, the more pressure put on the candidate which may affect their entire outlook rather than if they were referred appropriately, consistently, & at the proper stage of illness.)

I do wholeheartedly agree, however; with the second to the last paragraph in the article in principle. Yet, there are organizations & means of offsetting those expenses for the public. That fact is not addressed in the article. These resources can effectively narrow that gap & make it possible for others who may not be wealthy to find a way to dual list. Yet, many of those candidates have to dig for these resources themselves.  So, that too, is a disparity. More resources need to be put out in front at the start of the entire process (starting at evaluation), in either financing or social work discussions for openly & clearly discussing options for candidates with financial hurdles.

In theory, I get the point.  But the way this article frames the issue it’s extremely one-sided & simplistic.  One’s choice to dual list first starts with weighing whether there is a viable option for a dual listing at all.  Then whether that center is just as strong or stronger than the original center.  Then if the candidate can physically meet dual listing obligations.  Finances are only one piece of the puzzle & may not be the sole driver in the decision. In fact, for some people, regardless of class, these other factors might come into play first, before finances even enter the equation.



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