Occasionally my mind wanders toward random things that are little distraction during my long daily commute. I listen to talk radio when I do not muse over the alpacas that I just passed. I heard leading bioethicist Dr. Art Caplan, presently on faculty at New York University, on NPR recently discussing a myriad of reasons why a patient may never become a candidate on the National Waiting List for a solid organ. End Stage Renal Disease is a public health crisis that is often unnoticed at the sake of more media- sexy comorbidities such as diabetes and high blood pressure. What is distressing is that there is a social vagueness that may occur in the allocation of the organs. We should certainly want the best return on the investment of that organ- a patient that will take care of it and not reject it. But how medicine may come to this conclusion of worth is not standardized.
When medical worthiness of an organ is decided arbitrarily, there is a problem. Even the slightest improvement in mortality rate for those awaiting organs is like well-positioned strides of a marathon runner. We have a long way to go. The path to an organ is arduous yet hopeful at the same time. The accomplishment of finishing the marathon is a welcomed event. The sweaty finish of a marathon runner is met in applause. The race that ends with a transplant signifies more time with your loved one but more weary marathons of ceaseless post-transplant care on the horizon. There are too few of those transplant celebrations for End Stage Renal patients.
There are good, even stellar dialysis centers who serve renal patients with the best clinical and emotional care possible. The dedication of the renal medical community is one to emulate. But dialysis is not a solution. It is a holding pattern until the receipt of that elusive kidney. While the intentions may be the right place, “worth” in receiving organs leaves far too many dialysis patients with a bum deal. Transplant centers, according to Caplan, can make a list of demands to make a patient worthy of organs. Many make perfect evidence- based sense and are backed by medical experts and policy makers. Some may even make financial sense. But does the inherent inconsistency of qualifications to the wait list make moral sense? People are dying at an average rate of 18 per day. Far too many fathers, mothers, friends, and foes are perishing.
How can a society be held to such a high moral standard? The statistics are working against us. The renal community is in for the long haul. However, with far too much frequency, tough decisions of life and death are made under duress and under the casing of outstripped demand.
NOTE: The Art Caplan transcript from the September 4, 2013 interview may be found at http://m.npr.org/news/Health/218811165?start=10. This is a reworking of “From cop cars and stalactites to kidneys and transplantation: thinking deeply” (Orgcomplexity Blog, 9-5-13)