The receipt of a liver transplant by baseball great Mickey Mantle is calling attention to the allocation of scarce organs and the ethical issues behind it.
Mantle, 63, underwent surgery on June 8, only a few days after surgeons at Baylor University Medical Center in Dallas placed him on the waiting list for a liver. At the time, they said progressive liver failure might kill Mantle within a month.
His transplant, though, raises questions about the distribution of organs, particularly whether his baseball fame assured him a donated liver before other patients.
Richmond, Va.-based United Network of Organ Sharing, which develops transplant policy, says celebrity status has no influence on organ reception.
Available organs are matched first against the physical characteristics of the most critically ill patients in a local service area, a UNOS spokesman said. If no match is found, patients at the next levels of illness are eligible. The process is repeated regionally and nationally until a recipient is identified.
The highest priority is given to patients expected to die within seven days without a transplant. Mantle was at the next priority level: patients who require continuous hospitalization.
Yet, the median wait for the 4,659 people who required liver transplants as of June 1 will be three to four months, according to UNOS statistics. About 8% will die while waiting, data show.
In 1993, charges of preferential treatment followed the unusually swift procurement of a heart and liver for Robert Casey, then governor of Pennsylvania. UNOS issued new standards for listing double-transplant patients after the outcry (July 12, 1993, p. 18).
Mantle's quick liver transplant also raised two other issues, one clinical and the other ethical.
Mantle had an early-stage cancerous tumor on his liver. Cancer, depending on its stage, can significantly reduce patient survival.
In addition, Mantle is an admitted alcoholic, which his physicians said contributed to his liver problems.
Many medical ethicists say such moral issues shouldn't be criteria in transplant cases.
"Many people think the only ethically justifiable criteria (are those) based on the needs of the individual," said Bradley Wilson, a University of Pittsburgh ethicist.