Too soon?

Two years ago, Jobs gamed the transplant allocation system to get a liver that could have saved somebody else. At the time, skeptics doubted that he should have received the organ, since he’d been treated for pancreatic cancer—in fact, he may have sought the liver because of the cancer—and the likelihood of the cancer’s recurrence made him a bad bet for putting the liver to best use. If his health is now failing because of the cancer, that suspicion may be vindicated.

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Jobs lives in Northern California, but he got his liver in Tennessee. Why? Different parts of the country have different waiting lists, and the wait in Northern California was three times longer than the wait in Tennessee. In fact, the median wait in the Tennessee area where Jobs snagged his liver was around 15 percent of the national average. Jobs confirmed last year that this is why he went to Tennessee: “My doctors here advised me to enroll in a transplant program in Memphis, Tennessee, where the supply/demand ratio of livers is more favorable than it is in California here.”* Legally, you’re allowed to get on multiple waiting lists around the country. That’s how you game the system.

So why doesn’t everybody do this? Because they can’t. First you have to show up for an extensive in-person evaluation. Then you have to be available for a transplant in the area within hours of an organ becoming available. And while one jurisdiction might accept you as a charity case, if you want to play the field you’ll have to prove you can pay for the transplant yourself. You also get priority points for being able to guarantee follow-up medical care, since this assures transplant allocators that the organ will be well cared for. Ordinary people can’t compete with billionaires at meeting these tests. They can’t go to multiple states for evaluations. They don’t have private jets. Their insurance doesn’t cover multiple evaluations and may not cover much of the half-million dollar transplant, much less the follow-up care.

Or the case for an organ market? Wealthy people like Jobs are already effectively using their wealth to obtain organs. May as well reward the donee (or in this case, the donee’s estate).