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Cutting in line for organ transplants

Texas man's efforts to get liver undermine system

KRAMPITZ
Todd Krampitz, shown here in Houston Aug. 11 with his wife, Julie, received a liver after advertising on billboards and a Web site.
Pat Sullivan / AP
By Arthur Caplan, Ph.D.
COMMENTARY
msnbc.com
updated 12:34 p.m. ET Aug. 25, 2004

Earlier this year Todd Krampitz, a 32-year-old from Texas, was battling cancer. His liver, riddled with a huge tumor, was starting to fail. Then a courageous family that had tragically lost a loved one made the vitally important decision to donate a liver.

On Aug. 13, Krampitz received the organ and underwent transplant surgery. One might argue that the system worked and a young man’s life was saved. Except that in this case, the system did not work — the fact that Krampitz received a liver is unethical because he got his by cutting in line.

There is a very long list of people in the United States waiting for livers. The list is run by the United Network for Organ Sharing, a quasi-public agency based in Richmond, Va., that operates with a grant from the Department of Health and Human Services. The national list was created so that everyone who needs a life-saving organ has a fair chance of getting one.

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Circumventing the system
At the time Krampitz received his liver, there were more than 17,000 people on the list who also needed a liver transplant, some more desperately than he did. More than a thousand of those patients live in Krampitz’ home state of Texas.

Krampitz and his doctor knew about the national system for distributing organs, but Krampitz and his wife decided to circumvent the system. They posted ads on billboards around Houston, took out ads in newspapers and appeared on various national TV shows. Their primary goal was not to get Americans to donate more organs. Rather, it was to convince a family to donate a liver directly to Krampitz. And that's exactly what happened.

The fact that Krampitz could successfully acquire a liver through these means is wrong. While he has the right to try to do whatever he can to save his life, the whole point of the organ distribution system, which has been in place since 1986, is to give everyone in need of a transplant — not just those who can pay for ads and grab national media attention — an equal shot.

'A sad day for liver transplantation'
The system, which has worked well for almost 20 years, uses a complex set of formulas, including blood type, tissue type, size of donor, medical urgency and likelihood of survival, to distribute organs. Krampitz would not have gotten a liver using the current formula. He was not as near death as others were on the day of his operation. And, his cancer is so advanced that it may be impossible to make a transplant work for him.

At least one experienced Texas transplant surgeon declared that it was "a sad day for liver transplantation" when a person not at the top of the waiting list could hijack an organ.

No one, including me, wants to begrudge anyone the right to do what they need to do to save their lives. But in the case of organ transplantation, the organs needed to save lives come from all over America — from people from all kinds of backgrounds and financial means. We have a system in place that makes sure that these precious gifts are given out so that everyone who needs an organ has a fair chance at getting one.

Krampitz found a loophole in the system and used it. In the end, someone else who could not afford to take out ads died because Krampitz was not told to wait his turn.

In order to prevent this from happening again, Congress, Secretary of Health and Human Services Tommy Thompson and President Bush should act quickly to close that loophole so that individual self-interest cannot destroy the common good.

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