Making a list... Checking it twice...

So, you've made the Dean's list. You've watched a Letterman Top 10 list, written a shopping list, and perhaps, after your diagnosis, you've made yourself a "bucket list" (more about that later). You will soon find out that every list you have made or seen COMBINED all pale in comparison to getting onto the transplant list. So how do you do it?

First, you find a Transplant Center. My choice was Henry Ford. At some point, your Doctor will decide that it is time to "get you listed". This means what seems like an unending stream of tests, meetings, and appointments. Most go into this process thinking that the purpose of all of these is to determine how sick you are, and where you go on the list. For the most part, that is absolutely wrong.

Remember, most Doctors want to heal us and return us to our lives -- every single patient that they see. However, this is where reality rears it's ugly head. While some of the tests will determine how sick you are and how vital it is to get you an organ sooner rather than later, the vast majority are for totally different reasons. First, remember that a hospital is, at it's core, a business. Although the Doctors may not like it, they have to make sure that if they do this procedure, that you will have the ability to pay for it (typically through insurance). Like it or not, those without the means to pay or appropriate insurance will have a much more difficult time getting on the list, if indeed they ever do...

Second, the Transplant Centers are rated on one thing -- Patient survival. Plain and simple -- Was the surgery a success 3, 5, 10 or more years down the road? Hence, they look at things like your heart (can you survive an extremely invasive and difficult procedure?), your support system (do you have appropriate help with your medications and care after the procedure, as well as drivers to take you to appointments?), and your psychological history and status (to be frank, this is a procedure that can drive the most sane person to the brink... But it would clearly be more difficult for someone with these types of issues).

And finally... There is a CRITICAL shortage of organs. While the transplant committees appear to be trying to "play god" with the organs, the real truth is that they have an ethical responsibility to give the organ to someone who has a better chance of a full recovery and a meaningful life. These are extremely difficult decisions -- For example, do they list an 80 year old person who is otherwise reasonably healthy, or do they list a 13 year old who needs an organ but has a vast array of other maladies? Or both, or neither? Having to make these types of decisions are one part of their job that I truly do not envy.