Volume Liver Transplants

Of all the issues raised by the Wall Street Journal’s recent reporting on volume liver transplants, those concerning property law may be the least salient. But the questionable behavior of Amadeo Marcus, the former director of clinical transplantation at the University of Pittsburgh Medical Center (UPMC), reminded me of the infamous Moore v. Regents of the University of California. In Moore, the California Supreme Court decided an individual has no property right in his excised cells. Moore helps introduce students to questions of commodification and inevitably leads to discussions about whether people should be allowed to sell organs and other bodily materials. Regardless of their position on this question, students sometime need to be reminded about the extent to which such bodily materials have already been commodified. The next time I teach Moore, I’m going to use recent events at UPMC to amplify this point:

The transplant program is a source of both profits and prestige that UPMC leverages to attract star doctors and build its other businesses, which include a health-insurance arm. Hospitals charge $400,000 to $500,000 for a liver transplant. UPMC’s transplant program produced $130 million of revenue in its latest fiscal year . . . .

Liver-transplant volume in Dr. Marcos’s first full year [at UPMC] jumped to more than double the volume in the year before he came, according to data from the United Network for Organ Sharing, or UNOS. But the way he boosted it raised questions for some colleagues.

A shortage of transplantable organs from cadavers is a perennial constraint on the number of liver transplants. Dr. Marcos overcame this in part by using organs from so-called expanded-criteria donors — deceased people who had been older or sicker than preferred liver donors. . . . Dr. Marcos put some of these organs into patients who were in the early stages of liver disease. . . . These were patients, [some experts say], who sometimes didn’t need a transplant. . . .

Besides using more expanded-criteria livers, Dr. Marcos sharply increased the number of transplants from living donors. In these, part of the liver of a healthy person is cut off and grafted into a sick patient. If all goes well, both pieces eventually grow to normal size. The procedure is controversial because it could be risky for the otherwise healthy donor.

UPMC did 150 such surgeries while Dr. Marcos was there, according to UNOS. No donors died. However, in 69% of the cases, the recipient had [various medical indicators suggesting] that UPMC was putting some living donors at risk to do transplants on patients in which the risks of the operation may have outweighed the benefits.

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8 Responses

  1. Joe R says:

    Yeah, but did you see this article in yesterday’s paper?

    http://www.pittsburghlive.com/x/pittsburghtrib/news/s_602934.html

    They are actually proud to say they told Dr. Starzl that he couldn’t go into the Starzl Institute. And they believe no one cares.

  2. Sarah Waldeck says:

    Joe,

    I hadn’t seen this article. Thanks for bringing it to my attention.

    Sarah

  3. Sarah Waldeck says:

    Joe,

    I hadn’t seen this article. Thanks for bringing it to my attention.

    Sarah

  4. Joe R says:

    Astounding isn’t it, yet presented as if it were absolutely normal to be as disrespectful of both Dr. Starzl and the patients.

    Above the law I guess.

  5. Shelagh Ruane says:

    I’m writing to see if anyone is aware of any class-action suits against Dr. Marcos or UPMC?

    I was a living donor for my sister in fall of ’05. Her meld score was “low”. However, I willingly volunteered to donate, after which I became critically ill with various complications and required subsequent surgeries. This affected my career, home life and more.

    Additionally, my sister had to have subsequent surgery. She’s doing much better than I, however.

    When I asked the staff how many living donor transplants were performed at UPMC as well as complication statistics, I never got a straight answer. Complications were minimized. And Dr. Marcos told me that the death of a donor in NY was his fault! He said the donor ate lobster in the hospital. I can tell you from likewise experience that I did not want to eat anything in the hospital, particularly lobster.

    I think Dr. Starzl is the hero in this mess that Dr. Marcos created. He is doing the right thing by shedding light on a process that he invented (using cadaveric livers) that has been bastardized. Shame on UPMC!

    I don’t understand UMPC’s nonsensical thinking except to surmise that it is simply greed. Live donor transplants were cash cows to UPMC. I naively thought saving lives was the priority.

    With thanks.

    Shelagh Ruane

  6. Sarah Waldeck says:

    I’m so sorry that things have gone badly for you.

    I haven’t read about any class actions, but I would think that plaintiff’s attorneys would be lining up for the litigation that is likely to follow the breaking news about UPMC.

    I assume that you’ve searched the Internet for any mention of litigation? I will certainly let you know if I learn of any suits being filed.

    Good luck.

    Sarah

  7. shelagh says:

    Sarah,

    Thank you so much for responding and your kind words. I’ll continue my search on the Internet…that is how I found you.

    Take care,

    Shelagh

  8. Jennifer says:

    Sarah,

    I came across your article while doing research on Dr. Marcos and the transplant team at UPMC since this came about:

    http://www.post-gazette.com/pg/11146/1149362-100.stm

    A family member of mine had a cadaver liver transplant in 2004 done by Dr. Marcos (I will never forget his face, nor his attitude towards her and our family), and wholly believe that she should have never gone through with the transplant. I’ll never forget the day he came into the family room roughly 1-2weeks after her transplant to tell us that ‘there’s nothing more he can do, I’m washing my hands of this case’ and that ‘if she hadn’t had the surgery, she probably would’ve died at home in her bed’ instead of suffering in a hospital bed. We subsequently had her transferred to a hospital closer to our home because we knew that death was inevitable, and we at least wanted her to be in her hometown. The doctors who received her were in shock at how poorly she had been taken care of. During our stay at UPMC we watched (and stopped when we could) respiratory therapists walk into her room without washing their hands, without wearing gloves, and suction her tracheostomy tube. Nurses doing the same thing. When her room was cleaned (about once every 3 weeks, not joking), they’d push the mop right out of her room, and into the neighbors. She was a petri dish of infections by the time she got to the transferring hospitals, to include one infection that may have come from the organ itself. Because of what she went through, the transferring hospital (who used to send transplant candidates to UPMC) since stopped sending candidates to UPMC. Out of the 28 patients who were in the TICU during the time my family member was there, only one patient is currently alive. Several patients during our time there (around 4 months) went through the exact same things she went through. Why was this even allowed to happen? Why does the public, especially transplant candidates, not know about what is really going on in their illustrious hospital?