Who Gets the Organs?

A territorial dispute erupts over transplants and donors.

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Face it, Memphis doesn't get statewide bragging rights that often — FedEx, the river, Elvis, St. Jude, the Grizzlies, a few others. So when I heard in 2009 that Apple founder Steve Jobs came to Methodist University Hospital for a life-saving liver transplant, I thought it was pretty cool.

It was an example of the positive effect that universities and hospitals — eds and meds — have on a community. And it was a good story, with a rich celebrity, a dynamic company (Apple's stock market value increased $300 billion between the surgery and Jobs' death last year), a skillful surgeon, a mystery about Jobs' whereabouts, and an underlying ethical question about who gets a liver when there is a waiting list for donors.

I could imagine John Grisham writing about it in a novel called The Transplant or a movie with Ryan Gosling as Jobs. But that didn't happen. Instead, the back story is about turf wars, and the scriptwriters are federal bureaucrats. Methodist University Hospital is at odds with Vanderbilt, and, in an odd twist, a Memphis nonprofit that procures organs for transplants is criticizing Methodist University, while a similar nonprofit in Nashville is sympathetic. In condensed form, here's the deal:

In 2008, a contractor that runs the federal organ procurement and transplant network revisited the 20-year-old organ-sharing agreement, resulting in a change in the area from which organs are drawn for local transplants. It doesn't take effect until the end of this year, which is an indication of the sensitivity and complexity of this issue. Presently, Memphis is part of a donor area that includes all of Tennessee. The change, upheld by the Department of Health and Human Services, puts Memphis in a Mid-South region that includes West Tennessee, plus part of Arkansas and Mississippi.

"There are basically two major transplant programs in Tennessee, one in Memphis and one in Nashville," said James Eason, medical director of the Methodist University Transplant Institute and the surgeon who performed the liver transplant on Steve Jobs. "Starting in 2008, Vanderbilt did not agree to the sharing agreement. Under the new plan, we will only have access to our area and Nashville has access to their area, which has 75 percent of the donors. At the end of the year, we will be looking at a 75 percent reduction in transplant access.

"A liver in Jackson, Tennessee, can go to the least sick person in Nashville while our sickest person with a few days to live on life support won't be able to access that. This also affects kidneys. We have the largest African-American population in the state, and 80 percent of our kidney recipients are African-American."

Failing to get HHS to reconsider, Methodist University went to Plan B, which was to recommend a merger of donor nonprofit organizations in Memphis and Nashville. No sale.

"The statement that more patients will die, we just don't believe to be true," said Kim Van Frank, executive director of the Mid-South Transplant Foundation in Memphis, which has a $11.7 million budget and recovers some 220 organs a year. "The current system gives Methodist an advantage, and their patients don't have to wait as long, which is why individuals outside the Mid-South are coming here. They are cutting in line, make no mistake."

Nashville-based Tennessee Donor Services, with a $41.7 million budget, is pro-merger.

"We would not object at all," said executive director Jill Grandas. "Many states already have organ procurement organizations that cover the entire state."

To an outsider, this is where the story gets baffling. Both organizations are well funded. Public documents show that Van Frank made $169,000 in 2010 and Grandas $264,000. Can't nonprofits with a similar mission merge? No. Martin Croce is director of the Elvis Presley Trauma Center at the Med. He used to be chairman of the board at Mid-South Transplant Foundation.

"I made it clear I thought the best thing for our organization was to merge," he said. "I wanted everyone on the board to know my position, and, after that, I was not reelected or reappointed to the board. Mid-South Transplant is a well-performing organization, but they just don't have the numbers."

The decision to change Tennessee's transplant territory predates it, but the Jobs transplant has had a lingering impact. Van Frank said "it brought forth a lot of those myths we try to dispel." Eason said Jobs and Methodist went strictly by the rules.

They agree that any publicity that encourages more donors is good. If you are so inclined, consult the nonprofits for the how-tos.

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