What should we make of Arizona's new law for rationing organ transplants?

Health and medicine explained.
Dec. 6 2010 1:41 PM

Cutting Human Lives

What should we make of Arizona's new law for rationing organ transplants?

Is organ rationing fair? Click image to expand.
Is organ rationing fair?

On Oct. 1, cash-strapped Arizona ended state-financed payments for certain organ transplants. The decision, as the New York Times put it last week, "amounts to a death sentence for some patients."

Francisco Felix might be one of them. The 32-year-old truck driver with four children will die without a new liver. According to the Times story, doctors at Banner Good Samaritan Medical Center had a matched liver for Felix several weeks ago and were ready to proceed. News of the budget cuts forced them to scrap the surgery.

Graciously, Arizona has allowed Felix to stay on the waiting list, but if another suitable organ is found, he must somehow raise the hundreds of thousands of dollars to pay for the procedure or pray that some billionaire like, say, Steve Jobs comes along to help.

I mention Jobs because the Apple CEO had his own encounter with transplantation in 2009, when he received a new liver. His story became a parable of class privilege and the inequities of the nation's transplant system. Jobs relocated from his home in California to Tennessee, where there is much less competition for vital organs.

It's perfectly legal to use one's wealth to improve the odds of getting transplanted—and thousands of other Americans who are waiting for life-saving livers, kidneys, or lungs would do the same. But unlike Jobs, few patients can afford to move to another state to improve their chances. Nor can they afford to register (again legally) at multiple transplant centers—each charging a fee of about $600—and then visit each one for preliminary tests before jetting, at a moment's notice, to the first one at which an organ becomes available.

Economic rationing of transplants occurs in other ways, too. Hospitals routinely reject candidates for new organs or bone marrow if they have no insurance or if their coverage will not guarantee payment for the anti-rejection medications that a patient must take for the rest of his life.


Jobs didn't have to worry about medical coverage for the procedure the way Francisco Felix must. Rather, his obstacle was the long-standing and worsening organ shortage. This state of affairs makes transplantation the most overtly rationed procedure in American medicine. There is a list, you know whether you are on that list, and you have some rough idea of your place in the queue. Seventeen people die every day because they could not survive the wait for a kidney, liver, heart, or lungs.

The Arizona law purports to be a different sort of rationing—one based on prognosis, rather than the availability of organs. According to Gov. Jan Brewer, liver transplants are inessential. "The state only has so much money, and we can only provide so many optional kinds of care," she told the Associated Press last month. "And those were one of the options that we had taken the liberty to discard, to dismiss." State Medicaid officials, the Times reported, said they recommended discontinuing some transplants only after assessing the success rates for previous patients. (I assume this is what Gov. Brewer meant when she used the unfortunate word optional.)

In certain instances, this sort of reasoning makes sense. Given limited resources—of organs as well as money—there's no logic in encouraging procedures with minimal or mitigated effects. For example, why give a precious liver to someone who won't quit heavy drinking or to a homeless individual whose circumstances make him unlikely to follow the anti-rejection regimen? And what about age? Arguably, a quality kidney from a young donor should go to a 40-year-old whose life would be prolonged by decades rather than a 70-year-old who would probably die with unused miles on his transplant.



The Self-Made Man

The story of America’s most pliable, pernicious, irrepressible myth.

Does Your Child Have Sluggish Cognitive Tempo? Or Is That Just a Disorder Made Up to Scare You?

Mitt Romney May Be Weighing a 2016 Run. That Would Be a Big Mistake.

Amazing Photos From Hong Kong’s Umbrella Revolution

Rehtaeh Parsons Was the Most Famous Victim in Canada. Now, Journalists Can’t Even Say Her Name.


See Me

Transparent is the fall’s only great new show.


Lena Dunham, the Book

More shtick than honesty in Not That Kind of Girl.

What a Juicy New Book About Diane Sawyer and Katie Couric Fails to Tell Us About the TV News Business

Rehtaeh Parsons Was the Most Famous Victim in Canada. Now, Journalists Can’t Even Say Her Name.

  News & Politics
Damned Spot
Sept. 30 2014 9:00 AM Now Stare. Don’t Stop. The perfect political wife’s loving gaze in campaign ads.
Sept. 30 2014 10:44 AM Bull---- Market America is overlooking a plentiful renewable resource: animal manure.
Atlas Obscura
Sept. 30 2014 10:10 AM A Lovable Murderer and Heroic Villain: The Story of Australia's Most Iconic Outlaw
  Double X
Sept. 29 2014 11:43 PM Lena Dunham, the Book More shtick than honesty in Not That Kind of Girl.
  Slate Plus
Behind the Scenes
Sept. 30 2014 10:59 AM “For People, Food Is Heaven” Boer Deng on the story behind her piece “How to Order Chinese Food.”
Brow Beat
Sept. 30 2014 10:48 AM One of Last Year’s Best Animated Shorts Is Finally Online for Free
Future Tense
Sept. 30 2014 7:36 AM Almost Humane What sci-fi can teach us about our treatment of prisoners of war.
  Health & Science
Bad Astronomy
Sept. 30 2014 7:30 AM What Lurks Beneath the Methane Lakes of Titan?
Sports Nut
Sept. 28 2014 8:30 PM NFL Players Die Young. Or Maybe They Live Long Lives. Why it’s so hard to pin down the effects of football on players’ lives.