A new study presented this week at the American Heart Association’s annual meeting in Orlando shows that wealthy organ transplant candidates can and do use their resources to game the system and jump in line on transplant wait lists, reports the Washington Post.

The key, according to the report, is getting onto multiple wait lists, at different transplant centers around the country—a proposition that’s apparently more difficult than you might think:

Getting approved for a transplant at any one center is an expensive and time-consuming process that often requires evaluations, tests and interviews with a half-dozen or more specialists. Each hospital has its own procedures, and many of them require regular check-in appointments every two weeks or six months to stay on the transplant lists.

Researchers looked at data from 2000 to 2013: “33,928 candidates on heart transplant wait lists; 24,633 on lung transplant wait lists; 103,332 on liver transplant wait lists; and 223,644 on kidney transplant wait lists.” They found a small minority of candidates who were on multiple lists and, as a result, had higher transplant rates and lower death rates—2 percent of heart patients were on more than one list, as were 3.4 percent of lung patients, 6 percent of liver patients and 12 percent of kidney patients. Not surprisingly, these candidates were wealthier than the rest and were more likely to be insured.

You can imagine how this goes: in order to get on multiple lists and stay on multiple lists, you’d need the time and resources to travel around to different centers, giving you a chance to meet whatever criteria for getting on each list. You’d need to be able to stay eligible via check-in appointments, which means more travel. You’d need the ability to return to any of those centers at the drop of a hat, while a donated organ is still viable. You’d need, in other words, a lot of money, and a lot of free time.

The Washington Post report examines this via the case of Steve Jobs, whose 2009 liver transplant took place in Tennessee, “more than 2,000 miles away from his home in Northern California.” Rather than just get onto a list at the nearby center, Jobs took advantage of “rules set by the United Network for Organ Sharing, a nonprofit that manages the country’s organ transplant system under a federal government contract,” that allow patients to get on multiple lists simultaneously. The benefits of this are obvious: while other candidates—and especially those on Medicaid, who reportedly “don’t have the option to get listed more than once”—got on the local list and waited in line, Jobs was moving up different lists across the country, essentially putting him on a national list available to only those who can afford the steep cost of entry.

The study’s lead author, Raymond Givens, has a polite way of calling this bullshit: “It undermines a bedrock principle of organ transplantation — which is that the sickest people should be transplanted first.” Like so many other things, this is a principle America’s wealthy can buy their way out of.

[Washington Post]

Image via AP