We Are Frogs in Boiling Water

A researcher once put a frog in a pan of tepid water, then put the pan on a burner turned very low. As the water warmed gradually, the frog, being cold-blooded, thought it was pleasant and saw no need to move. Since it’s normal for a frog’s body to change temperature along with the environment, the change caused no alarm. Only a sudden change would have triggered a response. Eventually the heat caused the frog to pass out and he was boiled to death.

What frightens me is that our entire civilization may be on a similar track when it comes to organ transplants. Fifty years ago the number of people on waiting lists for new organs was zero. The amount of money paid for transplants was zero. None of our tax dollars went to support such operations, and the budgets of HMO’s were not being strained by the enormous costs of transplants. When a person’s organs failed, they died, and no one thought to complain about it, because that was the way things were.

Suddenly it’s all changed. It’s a crisis, if you read the newspapers. There are ten times as many people wanting organs as there are organs available, and in some places around the world there is a black market in organs. Some poor people sell a kidney. I read recently about a prisoner – a convicted felon – who got a new heart at taxpayer expense. The cost: about one million dollars. That sounds like a lot, but maybe he was tougher to operate on than an ordinary citizen.

We often read of a relative who offers a kidney or piece of liver to someone near and dear. How noble—but if you refuse, how selfish! Doctors want you to carry a card that says you can be cannibalized for organs if you die in a car crash. (High-tech civilization mangles us with one hand and patches us back together with the other.)

It often happens that as soon as a new life-saving device is invented, people get more reckless. I read that the Automatic Braking System resulted in people driving faster and taking more chances on slippery roads. I had the following discussion with a friend who was a heavy smoker not long after the first heart-lung transplant took place:

“Don’t you realize you’re filling your lungs up with tobacco tar? Eventually you won’t be able to breathe. You’ll get emphysema.”

He shrugged. “I’ll just have a lung transplant. I enjoy smoking too much to stop right now.”

Politicians are fond of talking about “slippery slopes” these days. That’s when you commit to something and there’s no going back. Organ transplants are a prime example of a slippery slope. You can’t just tell people, “Well, this was a bad idea from the get-go, and we’re not going to do any more transplants.” Oh no! Instead, the number of surgeons specializing in transplants will zoom. Transplant facilities will sprout in every major city. This new industry will dwarf the auto industry in size and profit. Life before organ transplants will seem unthinkable.

But let’s consider the economics of the matter. The cost of a new car, perhaps $30,000, compares roughly with the cost of a kidney transplant. So far, so good. You may have to choose between a car or a new kidney, but it’s your decision and your money. On the other hand, heart-lung transplants cost from $100,000 to $1,000,000. If the government or a health plan won’t pick up the tab, you may have to spend your life-savings, impoverishing yourself and leaving your children with nothing. One thing is clear: someone has to foot the bill for your new organs. Ultimately, society as a whole bears the burden.

Here’s the future, and it isn’t pretty:

There is an eleven percent annual increase in the number of patients placed on waiting lists for kidneys but only a four percent annual increase in the number of kidneys transplanted. In other words, demand far exceeds supply. What happens under such circumstances? There is a rush to increase the supply. The “transplant industry” is trying very hard to improve these statistics by finding new organ donors and working to make animal organs acceptable. Let’s say they are successful, and all potential candidates receive transplants. What is the cost to society?

The average cost of any transplant is about $150,000, excluding ongoing drug therapy and patient care. So our present 100,000 transplants are costing us some $15 billion a year. However, there is another $15,000 cost per year every year thereafter, to pay for anti-rejection drugs and other care. That’s $1.5 billion per year. Since there is a brand-new group of transplant patients being added to the pool every year, the cost begins to escalate. By year ten, there would be one million transplant patients each costing $15,000 a year, or another $15 billion. This assumes the number of new transplant patients remains constant.

But of course, it doesn’t! With the ability to transplant an increasing diversity of organs and tissues, the rate will increase. There has been a historical increase in the number of potential organ transplant patients of about thirty percent a year.

Well, you may say, it’s not about money. It’s about saving an individual life or extending it. But what about the lives of those not requiring transplants? Are they to be ignored? The cost of raising one child from birth to adulthood is about the same as one typical heart transplant. Is it reasonable to spend as much to keep one person alive another ten or twenty years as it takes to raise a child from birth to adulthood?

To repeat, the era of organ transplants is obviously here, and you can no more stop it than you could stop the automobile—until the country goes bankrupt. Curiously, I’ve never seen any serious discussion of these consequences. I find it ironic that we can produce complete, healthy, brand-new, bodies at virtually no expense. They’re called babies. But will we have the money to raise them?<br

Jim Bowden
Sonoma