Steve Jobs has just resigned as CEO of Apple Computer. I wish him a speedy and complete recovery from his illness. Below, I am reposting an article I wrote from earlier this year where I suggested a way to increase organs available for transplantation - by encouraging coworkers (in addition to family, friends, and people who worship together at their given Congregations) to donate organs to their fellow coworkers. Are their any Corporate Health Promotion/Wellness Managers who aren't afraid to make waves who would like to champion this idea in their companies? If they look at their costs for paying claims for employees with ESRD/kidney failure who are on dialysis, they certainly should be paying attention.
The original post from Monday, January 24, 2011, is found below:
You probably have heard about Steve Jobs, CEO of Apple, taking a medical leave of absence so that he can focus on his health. Here is the press release. Previously, he has battled pancreatic cancer and undergone a liver transplant.
I wish Steve Jobs all the best and a quick and complete recovery and respect his right to privacy.
I hope Apple champions an intra-company live donor organ donation program whether Steve Jobs is currently in need of a transplant or not because this can bring a revolution to the world or organ transplantation. Corporations like Apple pay towards their employees health insurance costs so they have an economic incentive to keep their employees as healthy as possible. Also, the good-will created by saving and improving the quality of life of their employees is priceless. And it may just contribute towards saving the life of their CEO, Steve Jobs.
I think that an astute Medical Coordinator or Benefits Manager at Apple may want to seize on the opportunity created by the Steve Jobs health situation and implement a corporate initiative to encourage live donor donations from healthy Apple employees to other Apple employees in need of transplants (FYI - therefore, this would work for kidney donations, bone marrow donations, and partial liver donations, depending on transplant center policy.)
Three previous blog posts linked to here, here, and here discuss various statutory laws that decrease the ability to increase the quantity of organs available for transplantion along with a few of my ideas to improve the situation including intra-company live donor donation programs.
Wednesday, August 24, 2011
Monday, August 22, 2011
A Poorly Designed Government Progam: Medicare (non)Coverage to Create an AV Fistula for Hemodialysis Access: A Case Study
While the U.S. government should be commended for offering universal health coverage for people with ESRD who require dialysis due to kidney failure, the Medicare program could be designed in a more efficient manner to promote increased life expectancy while saving the government money as well (in other words, have cake and eat it too.)
I want to deal with just one point to bring out this point. People who undergo hemodialysis who have vascular access points with AV Fisutulas have lower mortality rate compared to people with catheters. They also have decreased costs related to their treatment. (For examples of articles that support these suppositions, see here and here.
Moreover, Medicare's ESRD coverage does not cover the surgical procedure to create an AV Fistula before dialysis begins even though this correlates with lowered mortality decreased costs. See here for Medicares description of benefits for people with ESRD. The pertinent passage is excerpted here: "Important: Medicare won’t cover surgery or other services needed to prepare for dialysis (such as surgery for a blood access [fistula]) before Medicare coverage begins. However, if you complete home dialysis training, your Medicare coverage will start the month you begin regular dialysis, and these services could be covered." (See pp. 11-12 of the link provided above for a fuller explanation.)
Here is the bottom line. Medicare for people with ESRD should cover the costs associated with creating AV Fistulas for all people who require dialysis because this correlates with super clinical outcomes for the people undergoing dialysis (which leads to a lower mortality rate) while also resulting in substantially lower costs compared to people with catheter access.
I want to deal with just one point to bring out this point. People who undergo hemodialysis who have vascular access points with AV Fisutulas have lower mortality rate compared to people with catheters. They also have decreased costs related to their treatment. (For examples of articles that support these suppositions, see here and here.
Moreover, Medicare's ESRD coverage does not cover the surgical procedure to create an AV Fistula before dialysis begins even though this correlates with lowered mortality decreased costs. See here for Medicares description of benefits for people with ESRD. The pertinent passage is excerpted here: "Important: Medicare won’t cover surgery or other services needed to prepare for dialysis (such as surgery for a blood access [fistula]) before Medicare coverage begins. However, if you complete home dialysis training, your Medicare coverage will start the month you begin regular dialysis, and these services could be covered." (See pp. 11-12 of the link provided above for a fuller explanation.)
Here is the bottom line. Medicare for people with ESRD should cover the costs associated with creating AV Fistulas for all people who require dialysis because this correlates with super clinical outcomes for the people undergoing dialysis (which leads to a lower mortality rate) while also resulting in substantially lower costs compared to people with catheter access.
Saturday, August 13, 2011
Ethical Dilemnas in Directed Kidney Donations
Should a person be able to donate his or her kidney to whomever they prefer, or should all kidneys go to the next person on the waiting list?
This is a major ethical dilemma. Basically, with one possible caveat, I feel that a person should be able to direct their kidney donation to whomever they see fit. I explain my opinion fully below.
Basically, Douglas Hanto, M.D., a Harvard Medical School physician, is quoted to have said “Organs should go to the person who needs them the most, not to people because they are members of a club.” See Dr. Sally Satel's article about one example of Dr. Hanto's action to try to stop directed kidney donation
here.
Robert F. Hickey, Ph.D. is a big advocate of live donor kidney donation. Dr. Hickey's life was saved by a live donor donation and he zealously advocates for the right of people to direct their live donor organ donation. He debated Dr. Hanto on this topic recently at Harvard University.
Robert F. Hickey asked me about my reaction to a situation that was raised at the debate at Harvard. A certain Rabbi who was in attendance said that he advocates for his congregants to donate their organs [exclusively] to other Jews and (I think) to only accept organs from other Jews. Below is my response to the Rabbi's approach.
"This is what I feel about a Jew, or any other segment of the population directing their donation to their own group. While I feel that their motives may not be completely pure, I care about pragmatic results, not some theoretical morality or utopian concept of altruism. If a Rabbi encourages his congregants to donate organs only to other Jews, I feel he is doing a morally just thing anyways b/c Jews are on the waiting list like everyone else so if he encourages his congregants to give directed donations and thereby increasing the pool of organs available for transplantation, there will be a net gain in organs available for transplantation and therefore it will, in final analysis, help Jew and non-Jew alike by that Rabbi encouraging his congregants to donate their organs to Jews."
"Now, a morally troubled outgrowth from such an approach that may arise would be if there was a non-Jew on the waiting list who would certainly die today without the transplant and a Jew who can still live for a while as he awaits a transplant. I would recommend in that situation to give the organ to the non-Jew (pay the organ forward) and then give the next organ that becomes available on the waiting list to the Jewish person on the waiting list."
"Besides for these reasons, I believe that the Rabbi can legitimize his approach from a personal autonomy/libertarian perspective as well."
"Personally, though, I feel the best thing to do would be to take a different approach. I think that the Rabbi may be misguided because his approach can be interpreted with a xenophobic connotation so I think he would be better off to teach his congregants the economics lesson I shared above so that his congregants will understand that by donating organ, they will help everyone on the waiting list, which will definitionally move all of the Jews on the list closer to getting their transplants as well."
I do think, however, that people will tend to donate organs in greater numbers for people they fell a greater kinship for (like family, friends, coworkers, etc.) so from a behavioral economics perspective, there would probably be an increased number of organs available for transplantation if we encouraged more people to give directed organ donations to people they are close with socially. This would, in final analysis, cause more lives to be saved so I think the Rabbi is doing a positive thing - saving human life.
This is a major ethical dilemma. Basically, with one possible caveat, I feel that a person should be able to direct their kidney donation to whomever they see fit. I explain my opinion fully below.
Basically, Douglas Hanto, M.D., a Harvard Medical School physician, is quoted to have said “Organs should go to the person who needs them the most, not to people because they are members of a club.” See Dr. Sally Satel's article about one example of Dr. Hanto's action to try to stop directed kidney donation
here.
Robert F. Hickey, Ph.D. is a big advocate of live donor kidney donation. Dr. Hickey's life was saved by a live donor donation and he zealously advocates for the right of people to direct their live donor organ donation. He debated Dr. Hanto on this topic recently at Harvard University.
Robert F. Hickey asked me about my reaction to a situation that was raised at the debate at Harvard. A certain Rabbi who was in attendance said that he advocates for his congregants to donate their organs [exclusively] to other Jews and (I think) to only accept organs from other Jews. Below is my response to the Rabbi's approach.
"This is what I feel about a Jew, or any other segment of the population directing their donation to their own group. While I feel that their motives may not be completely pure, I care about pragmatic results, not some theoretical morality or utopian concept of altruism. If a Rabbi encourages his congregants to donate organs only to other Jews, I feel he is doing a morally just thing anyways b/c Jews are on the waiting list like everyone else so if he encourages his congregants to give directed donations and thereby increasing the pool of organs available for transplantation, there will be a net gain in organs available for transplantation and therefore it will, in final analysis, help Jew and non-Jew alike by that Rabbi encouraging his congregants to donate their organs to Jews."
"Now, a morally troubled outgrowth from such an approach that may arise would be if there was a non-Jew on the waiting list who would certainly die today without the transplant and a Jew who can still live for a while as he awaits a transplant. I would recommend in that situation to give the organ to the non-Jew (pay the organ forward) and then give the next organ that becomes available on the waiting list to the Jewish person on the waiting list."
"Besides for these reasons, I believe that the Rabbi can legitimize his approach from a personal autonomy/libertarian perspective as well."
"Personally, though, I feel the best thing to do would be to take a different approach. I think that the Rabbi may be misguided because his approach can be interpreted with a xenophobic connotation so I think he would be better off to teach his congregants the economics lesson I shared above so that his congregants will understand that by donating organ, they will help everyone on the waiting list, which will definitionally move all of the Jews on the list closer to getting their transplants as well."
I do think, however, that people will tend to donate organs in greater numbers for people they fell a greater kinship for (like family, friends, coworkers, etc.) so from a behavioral economics perspective, there would probably be an increased number of organs available for transplantation if we encouraged more people to give directed organ donations to people they are close with socially. This would, in final analysis, cause more lives to be saved so I think the Rabbi is doing a positive thing - saving human life.
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