I have read a lot of misinformation lately about Steve Jobs regarding his 2009 liver transplant.  Even at the time it was make public a couple of years ago, that misinformation was coming out.  A lot of people are saying that Steve Jobs received a liver transplant by bypassing the waiting list.  I will tell you that it is impossible because the rules are so strict.  A transplant center can be put on probation or even be shut down by UNOS (United Network for Organ Sharing) for doing such things.  UNOS is the government contractor who manages organ allocation and enforces regulations.  There is no way a transplant center will risk its future just to transplant a known person.  I am sure they kept good documentation of what they did just in case complaints like these would come back.

Reasons for his Fast Liver Transplant

Steve Jobs just did what a lot of Americans would do if they had the money; they would pick the hospital that gives them the best chance to be transplanted quickly.  This is why he went to Methodist University Hospital in Memphis, Tn.  This hospital performs about 120 liver transplants a year which is way more than the average hospital.  They also have a really good outcome: 90% of their patients are alive after a year with the national average being of 84%.  The main reasons he choose that transplant center is because of their short median wait time of 2 months.  This is really short.  The average wait time for a hospital in California for a liver transplant is 5 years!!  It really makes sense now why he went to Tennessee and it did not take time.  All the information I am giving you is available to the public.  The organ transplantation world is so regulated and monitored that there are tons of transplant statistics available.

Wait List

I forgot to mention that a transplant recipient can be on the wait list of more than one transplant center as long as the patient meets the criteria.  Usually, transplant hospitals want their patients to live within 2 to 3 hours of the hospital.  Let’s pretend Steve Jobs had a private jet, I guess he did, he could have lived in a central location, be on several hospitals wait list and be on stand bye to fly when he gets the call for his liver transplant.  That would have been theoretically possible but hard to manage.

Nothing Wrong

Basically anybody could have done what Steve Jobs did as long as you can afford it.  People are shopping for transplant centers every day in this country for diverse reasons.  Patients from overseas are even coming to the states to be transplanted.  Steve Jobs did nothing wrong, he could just afford what a lot of people couldn’t but would do.

This is no joke.  Britain’s health system is strongly considering offering free funerals to organ donors as a way to increase their donation rate.  More than 18 million people are registered donors but only 1,000 do so every year.  This is the lowest organ donation rate of Europe and half the US’s.  No maximum amount was set for funeral expenses.

That is an original way of promoting organ donation but is not without any controversy.   John Harris, a bioethics professor at the University of Manchester, described the free funerals offer as “macabre” and said more people would sign up to donate if offered more direct incentives, such as cash.

This is the world we live in, money rules, so I believe people would be more responsive to organ donation with cash than a free incentive.  The question that needs a debate would be how much an organ is worth?

Pig Cornea

According to a group a scientists from Pittsburgh University, pigs are to be used sooner than later for human organ transplantation. In fact they are planning to start using the cornea from genetically modified pigs into human with poor eye sights. As you may already know, pig valve is already being used in human with much success for years. In order to have the organ accepted by the human body, the pig protein galactosyltranferase (you don’t need to remember that 🙂 ) has to be removed so the corneas are not rejected.

How about Lung, Liver and Heart?

Solid organ transplantation from pigs (heart, lungs, liver) is several years away to be ready thought. Many issues have occurred, such as bleeding, clotting and organ failure during and after surgery. Scientists have transplanted pig organs in non-human primates for research but within months at the most, all organs had failed. There is also a major concern of transmitting animal viruses into an immune deficient human body which could cause a pandemic at the worst.

Controversy?

Another hurdle that scientists need to account for is groups for animal rights. These people will surely come out in force if pigs are used in mass for organ transplantation one day. In the mean time, scientists expect to be ready by the end of 2013 for corneal transplantation from pigs to human. We’ll see.

It is not recommended for a renal transplant patient to become pregnant after transplantation but it can be done successfully as long as the future mom is aware of the risks.  According to a study published in the American Journal of Transplantation, pregnancy after kidney transplant is associated to higher live birth rate, lower miscarriage but more complications than the general US population.  I would have never thought that kidney transplant patient could have babies with relatively good outcome.

Dark Side of the Story

Despite having relatively good outcome with pregnancy, renal transplant patients should discuss the risks with their nephrologists.  It is not all kidney transplant physician who will support their patients idea to have a baby.   They also need to find an OB/GYN willing to take high-risk pregnancy patients because the follow up will need to be tight.  Despite having more babies delivered by percentage than the general population, the complication rate is much higher.  These complications need to be addressed before the pregnancy to improve outcome.

Preeclampsia Risk

There is 6 times more chance for preeclampsia (high blood pressure and protein in urine) in women with history of kidney transplant.  Some of the risk factors of preeclampsia that are related to a post renal transplant patient are kidney disease and vitamin D deficiency.  This condition can lead to eclampsia if left untreated and can be fatal for both mom and baby.

Gestational Diabetes

Another complication that is not as bad but still need to be considered is gestational diabetes.  The chance of having this complication is double the rate of a pregnant woman with no history of renal transplant.  Because most transplant patients take prednisone as immune suppressant, diabetes rate is higher to begin with.  Like all transplant patients know, prednisone is well known to increase blood sugar level.  The complications for this kind of diabetes (it mostly affects baby)are: excessive birth weight, jaundice, respiratory distress, higher risk of diabetes type 2 later in life.

C-Sections

More than half of the renal transplant patients having babies have them through a C-section versus one third of all pregnant women.  Any surgery after organ transplant has more risk than for anybody else.  C-section brings its share of complications such as infection, blood clot in legs, bleeding.  If a transplant patient is taking rapamune, it will have to be stopped ahead of time because that drugs delay wound healing.  Anytime there is a change in a successful immune suppression regimen there are risks for rejections. The decision on how to have the baby should be discussed with the physicians ahead of time so the risks and benefits are well understood.

Pregnancy after organ transplantation should always be discussed with your transplant physician before the baby is conceived.  Having a baby is a lifelong commitment and that should always be kept in mind.