It is a reliable part of political hyperbole for an issue to be called a matter of life or death.
Sometimes, it just happens to be true.
That’s the case with the controversy about the organ transplant waiver requested by Methodist LeBonheur Healthcare.
It has many of the earmarks of a political campaign with overheated rhetoric, intense lobbying, and fact-altering attacks. While we can appreciate the tenacity and the determination shown by the Mid-South Transplant Foundation to block the waiver because they see their business future on the line, it’s hard for us to argue with the logic in favor of the waiver being requested by Methodist Healthcare.
It’s pretty hard to ignore the raw numbers. Methodist Healthcare did 260 transplants last year and it says Mid-South Transplant Foundation provided 62. That’s why, more than anything, it feels that as Methodist Healthcare grew to the fifth largest liver transplant center and it simply outgrew the Mid-South organization.
Methodist Healthcare is looking to draw organs in the future from Tennessee Donor Services which has a wider area for procurement of organs. With the waiver, Methodist Healthcare would have a pool of almost six million donors, compared to about two million if it remains with the local group. It’s a reality that has attracted help from Congressman Steve Cohen to the local NAACP.
If you think political hardball is played in government, it’s often no match for the politics in health care. A hospital’s application for Certificate of Need (CON) for more beds from Tennessee Health Services and Development Agency regularly results in a pitched battle with a “take no prisoners” attitude.
Some of that approach has been evident on the debate about the waiver to the Centers for Medicare and Medicaid Services with Methodist Healthcare being accused of allowing well-connected, well-to-do people to cut in line and get their transplants and being only concerned about making money.
A Number, Not A Name
Mid-South Transplant says the “newer regulations are not, however, best for Methodist’s bottom line. The current regulations allow Methodist to do more transplants and their patients are able to ‘cut in line’, many times ahead of someone who may be sicker elsewhere.”
It’s a not too subtle reference to Apple founder and guru Steve Jobs, who received his liver transplant at Methodist Healthcare. The news media found these same claims to be baseless back at the time of Jobs’s transplant. Someone like Mr. Jobs’s, with his mobility and his savvy, sign up with multiple transplant sites to improve their odds. It is estimated that 3-5 percent of the people on the transplant list are on multiple sites.
Because of the way the system works, Mr. Jobs was a number that the computer spit out. There was no name. No one knew who he was because that’s how the system works. And despite the fear campaign to the contrary, 95 percent of the transplants here are performed on people from our region.
This practice of multiple listing is allowed under the existing regulations but if there is to be a debate about whether this provides some people with special opportunities to get their transplants, that is a national debate rather than a local one to be directed at Methodist Healthcare.
Center of Excellence
Ten years ago, a new system called MELD (Model for End Stage Liver Disease) was created with the goal of leveling the playing field. At its core is an objective score generated from a patient’s blood test in order to rank the severity of their illness. MELD scores range from 0 to a severe near-death score of 40. The sicker one gets, the higher the MELD score goes. At a MELD score of 15 or above, doctors begin to recommend a transplant.
More to the point, we do not understand why Memphis should be denied the opportunity to have a national center of excellence in transplants and to attract the surgeons, specialists, and trained staff that are drawn to these centers. At the time when our community has set bold ambitions for its biomedical future, it’s hard to see Methodist’s transplant program has a negative.
Finally, the head of Methodist Healthcare Gary Shorb has said that the transplants are not a big money-maker for his hospital, and in fact, they lose money. There is no one in the local health care business who we respect more than Mr. Shorb and we trust him to be dealing with the facts.
He has an abiding interest in the success of the Memphis Medical Center and the Memphis Bioworks Foundation, and he has been a key driver of the accomplishments in both places. We suspect that his motivation in requesting this waiver is to serve the interests of both
It’s easy to see these kinds of issues as the arcane esoterica of government bureaucracies, but Memphians have a lot riding on the outcome of Methodist Healthcare’s waiver. In short, it might very well determine who lives and who dies.