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Author: intercst Big funky green star, 20000 posts Top Favorite Fools Top Recommended Fools Feste Award Nominee! Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: of 58834  
Subject: Shopping for a new liver? Date: 6/20/2009 4:47 AM
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http://online.wsj.com/article/SB124546193182433491.html#mod=...

Steve Jobs [a resident of Los Gatos, CA], who has been on medical leave from Apple Inc. since January to treat an undisclosed medical condition, received a liver transplant in Tennessee about two months ago.

The specifics of Mr. Jobs's surgery couldn't be established, but according to the United Network for Organ Sharing, which manages the transplant network in the U.S., there are no residency requirements for transplants. Having the procedure done in Tennessee makes sense because its list of patients waiting for transplants is shorter than in many other states. According to data provided by UNOS, in 2006, the median number of days from joining the liver waiting list to transplant was 306 nationally. In Tennessee, it was 48 days.

</snip>


intercst
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Author: GusSmed Big gold star, 5000 posts Old School Fool CAPS All Star Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 19486 of 58834
Subject: Re: Shopping for a new liver? Date: 6/20/2009 8:17 AM
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the median number of days from joining the liver waiting list to transplant was 306 nationally. In Tennessee, it was 48 days.

People in Tennessee don't drink?

- Gus

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Author: ariechert Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 19487 of 58834
Subject: Re: Shopping for a new liver? Date: 6/20/2009 8:33 AM
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the median number of days from joining the liver waiting list to transplant was 306 nationally. In Tennessee, it was 48 days.

</snip>

intercst



It's all the wannabe Nascar drivers in Tennessee. They go to the Nascar races and get all fired up and then drive out of there like their ass is on fire. At the end of the Union County Tennessee High School yearbook/annual (where I taught for 1 1/2 years) there were about 20 pages at the end of kids who died in automobile accidents.

Art

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Author: ariechert Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 19488 of 58834
Subject: Re: Shopping for a new liver? Date: 6/20/2009 8:35 AM
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the median number of days from joining the liver waiting list to transplant was 306 nationally. In Tennessee, it was 48 days.
-----------------------------------------
People in Tennessee don't drink? - Gus



Yes, they drink. There are probably more livers available due to the influence of Nascar. Wannabe Nascar drivers.

Art

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Author: telegraph Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 19490 of 58834
Subject: Re: Shopping for a new liver? Date: 6/20/2009 8:42 AM
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"
Steve Jobs [a resident of Los Gatos, CA], who has been on medical leave from Apple Inc. since January to treat an undisclosed medical condition, received a liver transplant in Tennessee about two months ago."

Not to worry...under Obama care, liver transplants will be too expensive and not 'medically cost effective'.

Jobs would likely have to go to India and buy one on the black market instead. He has the money.

Regular folks would simply be given whatever pain killers an anti-depressants until they pass into Art's holographic universe.

Do they do liver transplants in Canada at all?

t.

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Author: GusSmed Big gold star, 5000 posts Old School Fool CAPS All Star Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 19491 of 58834
Subject: Re: Shopping for a new liver? Date: 6/20/2009 8:46 AM
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Art, that was intended as an ironic joke, playing off popular stereotypes for Tennessee.

- Gus

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Author: SeattlePioneer Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 19492 of 58834
Subject: Re: Shopping for a new liver? Date: 6/20/2009 9:24 AM
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<<The specifics of Mr. Jobs's surgery couldn't be established, but according to the United Network for Organ Sharing, which manages the transplant network in the U.S., there are no residency requirements for transplants. Having the procedure done in Tennessee makes sense because its list of patients waiting for transplants is shorter than in many other states. According to data provided by UNOS, in 2006, the median number of days from joining the liver waiting list to transplant was 306 nationally. In Tennessee, it was 48 days.

</snip>

intercst
>>


I guess it would be better if UNOS clamped down more, and Steve Jobs were dead. Good example of how government rationing systems create and preserve shortages (by refusing to pay people for organ donations) and allowing people to bid for available organs.

Frankly, I discourage anyone from donating organs "for free." It's a conspiracy against the transfer of wealth to poor people especially and the midddle class.

And it's a conspiracy in restraint of trade against wealthy people who ought to be able to bid for organs if they wish to do so.



Seattle Pioneer

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Author: HarryHope Big red star, 1000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 19495 of 58834
Subject: Re: Shopping for a new liver? Date: 6/20/2009 10:33 AM
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More notes from the Twlight Zone.

Not to worry...under Obama care, liver transplants will be too expensive and not 'medically cost effective'.

Jobs would likely have to go to India and buy one on the black market instead. He has the money.

Regular folks would simply be given whatever pain killers an anti-depressants until they pass into Art's holographic universe.

Do they do liver transplants in Canada at all?

t.


Messed up twice in one day reading t. May have to reconsider this practice as both were good for LOL and there's not enough humor in this world.

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Author: telegraph Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 19497 of 58834
Subject: Re: Shopping for a new liver? Date: 6/20/2009 10:58 AM
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Here's the liver transplant info from Canada

http://secure.cihi.ca/cihiweb/en/media_19sept2001_fig2_e.htm...

you'll note that as money became a problem, the wait time doubled between 1995 and 2000

Here's the statistics on how many died waiting for the transplants

http://secure.cihi.ca/cihiweb/en/media_19sept2001_fig1_e.htm...

You'll note it steadily rose and costs were 'contained'.....

Of course, part of the problem is they don't pay docs well....

http://www.cmaj.ca/cgi/content/full/168/6/760-b

"It's hard to say whether someone died because a transplant surgeon wasn't readily available," says Dr. Philip Belitsky, director of transplantation services at Capital Health, the province's largest health authority. "We'd like to believe that wasn't the case, but it may have been a contributing factor in a small number of cases."

In 2001, the year the program was suspended indefinitely, 4 patients in Atlantic Canada died while awaiting a liver transplant. Last year, there were 10 deaths. However, Belitsky says this is only "a 1-year experience — we have to be careful not to draw conclusions from this."

Capital Health is currently recruiting 2 surgeons, the minimum needed to resurrect the QE II's liver transplant program, which will serve all of Atlantic Canada. The senior surgery position has proved difficult to fill. "We are looking on more than 1 continent," notes Belitsky."

Of course, not many want to become or stay docs in Canada due to the low pay, the high work load, and the reams of regulations on what they can and can't do.

England has an even worse problem. Really acute shortages.

It's amazing France has any doctors, when they pay them $50,000/yr.

Of course, both Canada and France pay the medical school costs to train the docs. But why be a doc when you graduate in France with a PhD in history and get a cushy government job making $80,000/yr?

Of course, don't smoke any grass....

http://www.expressnews.ualberta.ca/article.cfm?id=9689

"Although Canadian transplant centres are more willing than those in the United States, not everyone says yes to liver patients who smoke marijuana, and a University of Alberta researcher says that decision-making process is unacceptable.

Karen Kroeker, along with three other students at various universities, sent out surveys to a number of transplant clinics across the United States and Canada. Results found that the difference between the two countries were obvious in some patient groups: around 60 per cent of Canadian centres would either do the surgery or consider it for a liver transplant patient who smoked marijuana, while 70 per cent of U.S. transplant programs said absolutely not. Kroeker also found that patients in both countries, who have no social support-meaning they have no family, friends or a social worker-aren't likely to receive the organ they need. "

t.

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Author: sykesix Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 19499 of 58834
Subject: Re: Shopping for a new liver? Date: 6/20/2009 1:33 PM
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Telegraph wrote:

Here's the liver transplant info from Canada

http://secure.cihi.ca/cihiweb/en/media_19sept2001_fig2_e.htm......

you'll note that as money became a problem, the wait time doubled between 1995 and 2000


According to that graph, the median wait time in Canada is 161 days for patients who did not require hospitalization prior to the transplant. Much shorter waits for the serious cases. From the original article:

According to data provided by UNOS, in 2006, the median number of days from joining the liver waiting list to transplant was 306 nationally.

So you would typically have to wait almost twice as long for a liver transplant in the United States as you would in Canada. That means the Canadian system is hugely more efficient at providing timely health care in this area.

I don't think there is another poster on this board who has worked as tirelessly as telegraph to expose serious problems with the American medical system. A lot of this stuff I would never think to look up. I would have just assumed wait time were roughly comparable. But he has exposed yet another area of serious deficiency in the US system.

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Author: HarryHope Big red star, 1000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 19500 of 58834
Subject: Re: Shopping for a new liver? Date: 6/20/2009 1:50 PM
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It's amazing France has any doctors, when they pay them $50,000/yr.

Not sure about pay in France but they do get paid less than in the US. Obviously they are very good or France would not have the top rated medical system in the world. And the amount of pay hardly guarantees having the best MDs since the US pays the most and is ranked #16. My experience is French doctors are overall superior to their US counterparts in quality of care. Doesn't mean they're not good MDs just not providing the same quality of care.

Check out the following:

The HMO Fiasco

A doctor speaks out.

WebMD Feature

June 19, 2000 -- A young woman sits in front of me with tears in her eyes, so grateful to have finally gotten an appointment in my office. She has end-stage liver disease and will need a liver transplant. She recently moved to our community so that she could live with her sister and find a good doctor close to a transplant center.

After two months in our system, she has seen three different doctors, but none would spend more than fifteen minutes with her. When she heard that I had a reputation for spending extra time with my patients, she asked the health maintenance organization (HMO) to transfer her care to my office. During 30 years of experience in my field, I have cared for many patients like her. I will make sure she survives to receive a liver transplant.

What's Wrong With This Patient?

What is it about this perfectly nice young woman that aroused so little compassion from her doctors? Nothing about her would make her an undesirable patient -- except that she is sick and will need a lot of attention. In the past, when doctors assumed responsibility for complex cases, they were reimbursed in a manner proportional to the amount of their time required. Now, under the so-called "capitated" payment systems used by most HMOs, they are paid a small fixed fee per year for each patient, no matter how many visits, operations, or hospitalizations are needed.

In my community, this fixed fee is so small that if a patient needs to be seen more than two or three times a year, the physician will actually be working for nothing because the fixed costs of seeing the patient (including secretarial time and paperwork) are not paid for by the HMO, but come right out of the physician's pocket. It is not an exaggeration to say that this payment system makes every sick patient a direct financial liability to his or her doctor.

Needless to say, the physicians who care for the greatest number of sick patients are penalized because they need to spend more time with each patient and can't see as many overall. It is the number of patients -- not the time spent with each -- that determines a doctor's income.

In most communities, the doctors who care for the sickest patients are highly regarded by their peers. They are the "doctors' doctors."
http://www.medicinenet.com/script/main/art.asp?articlekey=51...


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Author: telegraph Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 19503 of 58834
Subject: Re: Shopping for a new liver? Date: 6/20/2009 2:41 PM
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"That means the Canadian system is hugely more efficient at providing timely health care in this area. "

No..it means they never authorize them in the first place!

t.

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Author: Hubris Three stars, 500 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 19507 of 58834
Subject: Re: Shopping for a new liver? Date: 6/20/2009 7:24 PM
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So you would typically have to wait almost twice as long for a liver transplant in the United States as you would in Canada.

I don't know about livers specifically, but to be listed for a heart transplant you have to have funding. Either insurance, or cash in hand (don't know the exact number off hand but it's six figures). UNOS says they don't discriminate based on funding status in allocating transplants, but that's very disingenuous. The true barrier occurs prior to listing. The waiting time figures you see are for all people that got listed. For the subset of patients that are unfunded, the waiting time is essentially infinite if they can't raise the money through private fund raisers.

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Author: flightdoc100 Two stars, 250 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 19516 of 58834
Subject: Re: Shopping for a new liver? Date: 6/21/2009 1:29 PM
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Here is a a story apropos of I am not sure what. I work for an HMO and had a patient in need of a liver transplant for reasons ostensibly not his own doing.

We had him listed with our local University who does all this work in our area. He fell out of their program when he tested positive for marijuana at a periodic visit, (at their clinic, not mine). Expected behavior and exclusion criteria were of course made known to him.

He then went to a private program in the midwest where for 250k he went right to the front of the line and had a very successful transplant.

I have no problem with people getting what they pay for, but I wonder how the organ donors would feel about this?

fd

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Author: HoracePuckey Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 19520 of 58834
Subject: Re: Shopping for a new liver? Date: 6/21/2009 7:02 PM
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We had him listed with our local University who does all this work in our area. He fell out of their program when he tested positive for marijuana at a periodic visit, (at their clinic, not mine). Expected behavior and exclusion criteria were of course made known to him.

Is marijuana use contraindicated for liver disease? I don't understand why this would make him ineligible.

Horace

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Author: TeraGram Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 19521 of 58834
Subject: Re: Shopping for a new liver? Date: 6/21/2009 7:41 PM
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Is marijuana use contraindicated for liver disease? I don't understand why this would make him ineligible.

I'm sure the logic is something like this:

- Marijuana is an illegal drug.

- Therefore, it is bad.

- Anyone who uses marijuana is not deserving of a new liver because GOD ONLY KNOWS what ELSE they've done!

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Author: Hubris Three stars, 500 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 19526 of 58834
Subject: Re: Shopping for a new liver? Date: 6/21/2009 9:33 PM
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Another possibility to consider:

You're going to die. The only way you won't die is if you get a liver. You are as motivated now as you will ever be for anything. The liver transplant team has told you you need to do specific things: not drink, not smoke (tobacco or marijuana), come to all your appointments, etc. to be listed for transplant. If you can't comply with the requirements now, when you are maximally motivated to do so, how likely are you to comply near perfectly with an extremely complex plan and major restrictions after your transplant?

I don't really care if people use marijuana, as long as it doesn't adversely affect other people. It's inconsistent that we as a society make alcohol and tobacco legal and marijuana illegal, but that's a different discussion. I don't deny that there is an element of IMO unwarranted judgmentalism against people who smoke marijuana going on. That said, in the decision process on how to allocate a critically limited resource (donor organs) I don't think it's a bad idea to try to select patients who will be most likely to succeed from a compliance standpoint.

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Author: telegraph Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 19528 of 58834
Subject: Re: Shopping for a new liver? Date: 6/21/2009 10:42 PM
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Once you get a transplant, you have a strict regimen of what you can and can't do.....and lots of drugs with side effects you must take..otherwise, it is all for naught.

Sorry...if the rules are not pot, sorry.

If your job requires drug testing, and you flunk...well, what did you expect?

Sorry...I don't want airline pilots and truck drivers zipping down the other side of the road using recreational drugs 'because they want to'......pot, coke, whatever...because 'they should be free to do so'.

What is amazing is that you can 'buy' a liver for that amount, and be a poor prospect for actually living with it...

t.

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Author: AAAAmanda Big red star, 1000 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 19530 of 58834
Subject: Re: Shopping for a new liver? Date: 6/22/2009 7:16 AM
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Frankly, I discourage anyone from donating organs "for free." It's a conspiracy against the transfer of wealth to poor people especially and the midddle class.

And it's a conspiracy in restraint of trade against wealthy people who ought to be able to bid for organs if they wish to do so.

Seattle Pioneer


Let me respond to this as a donor.

I am a donor because I want to improve the quality of someone else's life. This is also why I give at Kiva.com and other places. It is not my intent to make money off of this. Frankly, I think that your priorities are a tad skewed if you think that this is a lost money making opportunity.

And just how do you suggest that I make money off of my liver, corneas, heart, bone marrow, etc.? Will I have to sign a document saying that I promise never to smoke (cancer), eat beef (mad cow disease), have unprotected sex (STDs), or ride in a car (which could make those items unusable)? Will my estate have to give the money back if I die in a plane crash?

Perhaps just my heirs should receive the money. Do you consider it seemly that they stage a bidding war while I am hooked up to life support, willing to unhook me only after they are satisfied that they have squeezed every possible cent?

To me, that is capitalism run amuck. We have already seen what happens in the banking industry when that happens.

4A

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Author: vickifool Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 19532 of 58834
Subject: Re: Shopping for a new liver? Date: 6/22/2009 9:24 AM
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I work for an HMO and had a patient in need of a liver transplant for reasons ostensibly not his own doing.

We had him listed with our local University who does all this work in our area. He fell out of their program when he tested positive for marijuana at a periodic visit, (at their clinic, not mine).


Is what he had painful? Marijuana is effective for pain control, and my town is discussing taxing it to help balance the budget.

And why have you only posted 61 times in 6 years? Are you a doppel?

Vickifool

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Author: SeattlePioneer Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 19533 of 58834
Subject: Re: Shopping for a new liver? Date: 6/22/2009 11:40 AM
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<<And just how do you suggest that I make money off of my liver, corneas, heart, bone marrow, etc.? Will I have to sign a document saying that I promise never to smoke (cancer), eat beef (mad cow disease), have unprotected sex (STDs), or ride in a car (which could make those items unusable)? Will my estate have to give the money back if I die in a plane crash?

Perhaps just my heirs should receive the money. Do you consider it seemly that they stage a bidding war while I am hooked up to life support, willing to unhook me only after they are satisfied that they have squeezed every possible cent?

To me, that is capitalism run amuck. We have already seen what happens in the banking industry when that happens.

4A>>



If you want to donate your organs for free, I certainly wouldn't stand in your way.

If other people prefer to sell them to people interested in paying for them, they should be permitted to do so.

Right now, there is a huge imbalance in demand for organs. Large proportions of the population (notably African Americans) usually refuse organ donations.

Why do you want to preserve this shortage and restrict the supply of organs? Pay people and a lot more will likely be available instead of being wasted.



Seattle Pioneer

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