Insurance doesnt cover transplants now because the availablility of organs is artificially reduced.
In the future, I would not choose a health care insurance provider who did NOT provide organs in their plan, and I doubt many others would either. Those insurers who do not provide organs, will quickly go bankrupt soon after organs are legalized.
Why do you think the price of organs will be “high” as you seem to imply?
Dont you know that we may face a huge oversupply!!!???, there may be tens of millions of people who will want to register their bodies for transplant/organ donation the first day that they can get at least ten grand cash tax free?
Besides the regular insurrers "pools’, where by you can register with blue cross to give and receive organs for free, there will also spring up many independent
“associations”, that anyone can join, which may have a common bond of some kind, like musicians, ex-marines, baptists, hospitals, high schools, college alumnai associations, etc, where all people of a baptist church, sign up their bodies, and in turn get all the organs they want for free.
Dont forget too, that all of these "pools’, or associations, or medical insurance companies who build gigantic networks of available organs, will be freely trading with one another. For example, if a baptist church member in Colorado Springs needed a kidney, and the local blue cross had one extra in stock, but needed a lung in Idaho, then the baptist association would trade with blue cross, and the patients would never know the difference.
All this drama, expense, and waste of “flying” out a kidney somewhere, will be quite rare once the organ trnasplant system is up and running nationwide.
People who cannot “afford” organs once they become legally available, will get them free, just as they now get all other medical treatment free. Everyone can afford “free” organs!!!
Why is that hard to understand? YOu cant get much cheaper than free.
I am not advocating any changes to our welfare system, and think you are again gettting off the point!! and on a tangent. Welfare, medicare, medicaid, etc have nothing to do with the subject of allowing doctors to obtain organs for transplant.
Under the current system which nearly prohibits organ transfers, hardly anyone can get an organ transplant, whether you are rich or poor.
Under a system which made organs lega, both the poor and the rich could get organ transplants.
This is the “partial liver” transplant technique I was referring to in one of my previous posts. Until stem cell research permits physicians access to custom grown organs with an exact genetic match to the recipient, partial transplants represent one of the few “living donor” routes available (besides kidney donation). If the current administration would cease to impede stem cell research many, if not most, of the issues being debated in this thread would become irrelevant.
The article you mention escaped my notice. While I shall not demand any cite, it would certainly be appreciated. I would like to verify that the individuals involved were charged with complicity in the murder of the individual(s) they deprived of timely medical care. Such breaches of ethics must be prosecuted vigorously and receive maximum penalties.
Susanann, some of your ideas are both novel and of exceptional merit. While I strongly disagree with your free-market approach to organ and tissue sales, I think your “pool” idea has a lot of value. I see absolutely nothing wrong with group consolidation of donors depending upon personal orientation, profession or other pursuits. I also heartily concur with your model of free exchange among these groups for “credits.” This will enable precise matches to be made outside of given organizations (snicker) in order that no donations go to waste. I’d like to add that your persistence in this thread is well appreciated. While your original position at first seemed somewhat dubious, I can only admire how you have developed your idea into a substantial solution to the donation dilemma.
For reasons mentioned above, there is the immense potential for either abuse or creation of disparity if a free-market monetary approach is taken. By combining “presumed consent” policies, divestiture of final disposition by relatives and compulsory reciprocal donation by transplant recipients there could evolve a much more productive structure to solve the gigantic deficit currently being experienced.
This thread has managed to highlight existing concepts and elicit numerous other ideas that could all provide vital improvements to our existing system. I congratulate all of you and request that everyone keep posting with more arguments and enhancements to this topic.
While I see your point about seemingly non-deserving people being denied organs Zenster, I would be very reluctant to implement any kind of system that would refuse organs to people based on past behavior. Who would be in charge of deciding, and how could it be proven that the patient needs an organ as a direct result of that behavior? What if the smoker, for example, also worked at a factory where he came into contact with asbestos? What if he started at age 9 and became addicted, but tried to quit and failed?
I don’t know how such a system could be enforced, and it gets into ethical territory that I don’t think Dr.'s should have to enter. It is their job to provide care, not make judgements over who deserves that care. They would be vulnerable to criticism from the surviving family and possibly lawsuits where he /she would have to prove the patient should have been denied. IMO, it gets into the same kind of territory as the hypothetical staff who lets a donor die to give the organ to a supposedly more deserving person - not something I want to encourage.
It is very frustrating when someone who is seemingly unworthy gets an organ, thus denying a more pleasant candidate, but I think picking and choosing can only lead to trouble.
Asbestosis is easily distinguished from tobacco induced lung damage. The expressed tumors would most likely be readily differentiated. As mentioned above, it might be better to have a panel of doctors make the decision instead of individual physicians. As an example, I give you the case of David Crosby. It is difficult to imagine that his notoriety and wealth did not play a significant role in the speedy liver transplant that he received. This, despite incredible amounts of self-inflicted abuse to his own body. The common diseases of self-injecting addicts include highly specific fungal infections of the heart valves. These are pretty much only obtained from bacteria being driven through the dermal membrane (skin) at unsterilized injection sites. I most certainly have no compunctions about denying transplants to inmates serving life sentences without possibility of parole. In order to maintain a degree of fairness, denial of prisoner transplants might have to require convictions based upon uncoerced confessions or highly conclusive DNA evidence.
While I understand your point and share some of your concerns, addicts and convicts most often arrive at their state through entirely voluntary behavior. Standard law already denies convicted felons some rights (bearing arms and voting) so it is not a giant leap to deny them transplants as well. I am not attempting to indiscriminately apply this ban to the entire inmate population, only heinous criminals without possibility of parole. Fortunately, as mentioned before, stem cell research can alleviate many of these dilemmas. Although I would still have difficulty in justifying the enormous expense of providing (admittedly, somewhat rare) transplants to the prison population. Again, many prisoners work rather hard at getting into prison and it is difficult to find much sympathy for them.
I agree that the issue of addicts is more difficult to define. However, I believe there already exists some form of protocol that permits doctors to exclude certain individuals with a history of routinely self-inflicted physiological insult from qualifying for a transplant. Perhaps some posters in this thread who are from the medical community might be able to verify this for us.
Zenster;
Am not trying to deliberately duck your request for cite…am instead frantically searching thru newspaper clippings for cross reference…will get back to you.
As for your most recent statement:
In an ideal world, Velma would be correct. The question of who is most worthy is a sticky moral one, which most doctors, if they are worth the MD, do not even attempt to address. What you did prior to walking (or being wheeled) through that door is not their concern.
Unfortunately, what everyone seems to remember most about organ donations and transplants is what you yourself brought up: the media circus surrounding David Crosby’s new liver.
Sigh…organ transplant programs are staffed with some of the most caring, giving people it has ever been my pleasure and honor to meet. They are too often faced with staff and budget cuts, and live from hand to mouth; private donations not really covering the cost, insurance payments (by the way, insurance plans DO pay for organ transplants, it’s your employer that doesn’t cover the option. That’s an entire thread all on its own) are quite low, and grants end up re-allocated to other struggling areas of the hospital/facility/administration. That what is foremost in everyone’s mind when the words “organ transplant” are mentioned is the deplorable case of Mr. Crosby is not only sad, but an injustice to those programs.
Some medical criteria for organ transplant are:
Age of recipient
Likelihood of survival after transplant (will the new organ even change anything?)
Compatibility of the donor organ v. Probability of rejection by new host
previous therapies (what have we tried so far?)…
the list goes on.
As will my search for your cite request.
I agree that development of stem cell research should continue. I believe it is our best hope at new and perfected therapies, and will not stop lobbying for it. Something that seems to have escaped notice is that T-cells are also abundant in placenta. Which ends up killing no one, and continues the research. But, I suppose that would mean anti-choice advocates would have nothing left to complain about.
I understand and agree with the intent behind the idea - to make sure the most deserving candidates are the ones to receive the organs. In cases that are obvious and extreme it might seem like an easy choice, but it opens a door to what I feel is an unacceptable idea - that a Dr. has the power to deny medical care based on how she feels about the morality and choices of a patient. That is a dangerous road to start down. There are extreme cases like the ones you mentioned where it could probably be proven fairly easily that the patient directly brought an illness upon himself, but most would be difficult. I also would not know where to draw the line - should we not give other types of care to hopeless or non-deserving cases? We are wasting resources and money better spent on those more deserving. I would hate to think that someday a Dr. could deny me or someone in my family medical care because of the way I lived my life.
That said, I would certainly be upset if it were my family member who was in line for a liver that went to an alcoholic. I don’t know how to fix that without opening the floodgates, though. Would every recipient on the waiting list have to undergo a background check of sorts? Or would it be up to a Dr. to call attention to the most outrageous cases?
Maureen, please don’t knock yourself trying to look up the cite. I’m just hoping that the ambulance crew faced manslaughter charges at the very least. What a revolting situation.
Velma, I’ll repeat that this is why I suggested a panel of medical experts might make the determinations. A single physician or surgeon would have too much responsibility and such power could easily be abused. I agree that my proposal opens up a slippery slope, but I do believe we are already there.
As you can see from Maureen’s post, there are already numerous criteria governing the qualification of a transplant recipient. Perhaps a point system could be established whereby incarceration reduces your overall likelyhood of qualification without excluding you completely. Such a weighted equation would be a simple matter and would preclude prejudice upon the part of any surgeon or panel.
Simple palpation for a hardened liver or a quick MRI could easily detect long term alcoholism related damage (cirrhosis) in a liver transplant candidate. PET scans would probably work if neither of the others did. I just feel there needs to be consequences for those wanting to rely upon the largess of others while rendering themselves unable to donate their own organs due to dereliction.
Insurance companies do cover transplants, particularly ones like kidney or bone marrow that are no longer considered experimental.
In the US, if your health plan comes from your employer you do not choose your health plan, your employer does. If the company you work for decides that they want to reduce premiums by eliminating certain types of coverage - like organ transplants, for instance - don’t blame the insurance company. Blame the decision makers where you work - THEY made the choice.
The cost isn’t just in the organ - transplants require intensive medical care, round-the-clock nursing, pharmaceuticals, operating rooms, surgeons… you have to pay for the machinery, the people, the drugs, the cleaning staff that sterilizes everything that needs sterilziing. Making more organs available isn’t going to do jack for those costs, which are already high.
Uh… right… but you can’t just rip a liver lobe out of someone and slap it into any random stranger. You have to match various characteristics of the immune system. It has to be the right size. It has to be healthy.
There are a LOT of people who simply can NOT be organ donors because they have a long-term viral infection (HIV, Hepatitis, etc.). What if someone registers, then they catch hepatitis - they may not need a transplant, but they can no longer provide one. Do they give the money back? If you’re 80 it’s doubtful your organs could be transplanted - even with a healthy lifestyle organs only last so long.
And, as I have mentioned before, if your working with organs that must be obtained from dead donors, it’s not enough to die, you have to die under the right circumstances. That usually means head trauma. That’s not nearly the most common cause of death. MOST people die of things that make their organs useless for donation.
So, most of the money paid out under your proprosed “free market” system will not, in fact, purchase organs. Is that any way to do business?
OK… you get organs for free (this is your capatilistic system…?) but how do pay for the hospital room, nursing care, surgeons, support services, machinery, drugs…
In stock?
Let’s clear something up. Human organs are not like a slab of cow’s liver you can throw in your freezer. They only last a set amount of time - measured in hours - and there is, at present, no way to extend that.
The organ with the longest “shelf life” is whole blood - and that’s a mere 30 days. With exception of certain things like skin and bone which can be frozen, most transplanted parts must be kept above freezing and will only last a very finite length of time.
With present technology you will never, ever, be able to say “Yes, we have a heart in stock”. If it can’t be used immediately it simply can’t be used. Nevermind the problem of matching immune factors.
If you have an organ usable for transplant you MUST get it into someone within a matter of hours after removal from the donor or the organ will die. It’s that simple. Which is why, sometimes, the recipient is a puzzle - they put the liver into a former alcoholic instead of a deserving Rhodes Scholar? Well, if the scholar’s blood type is different than the donor’s the liver can’t be used. If there’s no other compatible recipient close enough to benefit… yes, the former alcoholic may well get the liver. It’s better than letting it go to waste, isn’t it?
Yes, there most certainly IS “drama and expense” in flying organs about the country - but it’s NOT a waste. It is, in fact, the only way we have to avoid those organs going to waste, to give them to the most compatible recipient where they have the greatest chance of survival. They are flown in small planes to help keep the cost down, and that can fly into small airports either closer to medical centers or at least avoiding the crush of hub airports, sometimes thereafter switched to helicoptors to get them even closer to their destination. Such flights are given priority over all other air traffic to avoid delays. There is simply no faster means of transporting donated organs (if there was, it would be used) and, when an organ only survives 12-16 hours (at most!) unattached to a human body, and some of those hours are needed to sew it into its new home… Tell me, how ELSE would you get the lung from Idaho to Colorado Springs in time to do any good to the recipient?
Broomstick, thank you for clarifying what some people may not be aware of. Personal friends of mine were involved in “angel flights” until their untimely death in a plane crash. Those helipads at major hospitals aren’t just for air ambulances.
I suppose I need to admit that if many people are unaware of the irreversible nature of brain death, then there will many others who do not realize what intensely constricting circumstances surround organ donation and successful transplantation.
Perhaps, it is even more tragic that something so arcane as stem cell research is going to be even less understood when it comes to public recognition. Our nation should be up in arms about the administration’s foot dragging when it comes to this vital new technology. All of those who demonstrated against the Iraq war should be on the streets raising a ruckus about the delays and roadblocks being encountered by scientists developing this crucial and lifegiving technology.
I’ve been one of the people charged with making the choice, and the insurance company did not give us the option of having transplant coverage or contraceptive coverage. The agents claimed these two items were not currently offered. I guess they could have been lying, though I can’t figure out why they would.
It also depends on which company you’re dealing with. Some offer more than others, some offer more options than others.
There are some complicated factors involved in underwriting health insurance, including the sheer number of people on the policy - the more people, the greater the risk pool and the lower premium that can be offered.
This is not to excuse the bad apples in health insurance - and there certainly are some. But it’s way too simplistic to lay the blame just at the insurance companies. The truth is, lawyers, doctors, hospitals, drug companies, and yes, even patients play a role in causing many of the problems with health care we see today in the United States. But that’s a discussion for a different thread.