Tuesday, August 11, 2009

More Health Care Choices

In my last post, I asked readers to prioritize candidates for an organ transplant. In the comments was the suggestion that the "first in line" get the organ -- that's the only fair way.

OK, what's "first"? Can you buy your way to the top? Will that mean that doctors put people on the list the minute they have organ failure so in case they need the transplant, they will have moved up the list? Should the organ from a 25-year-old be put in an 80-year-old?

UNOS is working on this ethical dilemma that requires the wisdom of Solomon. Here is what they are considering for kidney transplants. These factors would work together to come up with a score:
  1. Life years from transplant: estimated survival for the recipient versus dialysis -- that is, how well and for how long will the donor organ be used?
  2. Dialysis time: time spent on dialysis already -- that is, who has been waiting longer, and how do we make a just decision?
  3. Donor profile index: measures the quality of the donated organ; that is, which organ is best for which candidate?
Currently, there is a huge computer database that crunches all the numbers and uses a number of factors to score patient characteristics and come up with a priority list. Hospitals agree to send any donated organs to the highest person on the list (for each organ), considering the travel time -- so the organ is not at risk by a long travel time. Sicker people move up the list, until they are so sick that they would likely not survive surgery. Then there is also body size, blood type and tissue typing to consider -- the patients that match are listed in priority order, the recipient's medical team is notified, and has one hour to accept the organ or pass it to the next person in line.

There are so many factors that go into the formula, it is very difficult to game the system.

Does anybody have a better idea? I think this is a good start at allocating resources when there is simply not enough of everything to go around. No death panels.

Must reads:
Colin McEnroe about end-of-life care for his mother
Don't talk to me about death panels
Alliance for Health Care Reform
Comparison of proposals


Mark said...

Those who agree to me organ donors themselves should be first in line. It makes perfect sense. Those committed to helping others should themselves be helped first.

Check out http://www.lifesharers.org to learn more about directed organ donation. If it is good enough for Natalie Cole, it is good enough for you and me.

Nopartisan said...

The formula outlined seems to be pretty good. There has to be priority based on medical need and realistic expectation of a sucessful outcome. The choices presented the other day however were based on who and what you were, and any system like that would be morally bankrupt.

West Haven Bob said...

The specific point I raised about "First in, first out" referred to the date/time one entered the list.

I would put no other allowances or provisions; when one tries to make "qualitative" distinctions - as logical as this might seem - one is setting up the spectre of the so-called "death panels".

Additionally, a strict date/time system can remove all possibilities of "bumping".