The oft-rumored scandal that has dogged the organ-transplant community since its inception - the false, but feared horror that has been denied, again and again, by those who struggle to use such a terribly limited supply of material to save such desperate patients - has finally taken place for real. What the public has often feared, and was told over and over didn’t happen and couldn’t happen, has happened. A patient on the liver-transplant waiting list at St.Vincent Hospital in Los Angeles was bumped over 50 places on the needs-ranking list to receive an organ that should have gone to another patient. The transplant-service staff then engaged in extensive falsification of medical records to hide the procedure. In the end, not only was one patient denied the organ that should have gone to them, but another patient was removed from the transplant list entirely and their identity used to hide the identity of the actual - unentitled - recipient. Naturally, the whole thing was paid for by the Saudi government: a premium fee of $340,000 to the hospital, undisclosed sums to the surgeons, and who knows what else to grease the skids.

The details couldn’t be more sordid:

On Sept. 8, 2003, the hospital was notified by the regional organ procurement agency that a liver was available for transplant into a Saudi patient, whom Valdespino referred to as Patient A. That patient, however, was out of town.

The transplant team then should have notified the regional agency that the patient was unavailable so that the liver could have been sent to the patient at UCLA Medical Center, who was next on the list.

Instead, St. Vincent transplanted the liver into a different Saudi national patient, whom Valdespino called Patient B. Although the patient had been hospitalized since Aug. 6, he was 52nd on the regional list.

The next morning, a data analyst at St. Vincent notified the national organ network that Patient B should be removed from the waiting list because he had just received a liver — a correct description of what had occurred.

Hours later, however, the analyst retracted his correspondence and requested that Patient B be put back on the waiting list. A form later sent to the national organ network, bearing the signature stamp of surgeon Lopez, stated that, “In the process of training someone to enter data into the … system, there was an error in removing the patient from the wait list. The problem has been addressed and corrected.”

In October 2003, St. Vincent notified the organ network that Patient B wanted to be removed from the waiting list because he was transferring to a center in Europe.

Because the organ was incorrectly labeled as going to Patient A, he was removed from the waiting list. Valdespino said he does not know what happened to that patient or what his condition is now.

So:

1) They procured an organ under false pretenses by deliberately withholding information about the unavailability of the intended recipient

2) They secretly diverted that organ to a different patient who was not ranked high enough to receive it

3) They explicitly lied to the organ-sharing network about their patient’s status, by retracting a true report that the patient had received the (unauthorized) organ, and making up a detailed, false story about that report

4) They compounded the lie with a false document backing up the false story, and bearing the stamp of the program director

5) They submitted further false information to prevent the discovery that the unauthorized patient no longer needed an organ

6) As a result of their diversion of the organ, the highest-ranked available patient on the list did not receive the organ

7) As a result of their cover-up, another highly-ranked patient was removed from the list entirely, against their will

And, of course, there’s the money angle . . .

The Royal Embassy of Saudi Arabia paid the $339,000 cost for the transplant and hospital stay, which is 25% to 30% higher than what the hospital would typically be paid for the procedure by insurance companies and government programs, Valdespino said. . . .

The national organ network has said that no more than 5% of organs should go to foreign nationals, and indeed the actual percentage is much lower. However, data show that the liver transplant program at St. Vincent provided about 8% of its organs to foreign nationals. Overall, less than 5% of the hospital’s organs go to citizens of other countries.

To his credit, the President of the hospital is moving quickly and openly to deal with the issue. The liver-transplant program has been suspended, the director and assistant director have been fired, and the President has openly admitted the abusive practices and promised an investigation. There seems to be no reason to suspect the problem extends beyond the liver program.

But the real problem is not just this one, unconscionable violation - it’s that now, for the first time, the rumors are true. Now it is true that “organ transplant services give organs to high-paying customers rather than waiting sick people” - or, at least, it’s been true once, now, but that’s enough to convince anyone who suspected it all along. There is a vast difference between “that rumor has never been true” and “that rumor was true on one occasion, but . . .”. Now that the system has lost its innocence, it can never be regained - and anyone who wants to think the worst will have clear, unmistakable precedent to point to.

This is a disaster for the entire US - perhaps worldwide - organ-transplant community and their patients. Given the huge over-demand for organs, every vital organ denied for transplant is, essentially, a life lost; every refusal of cadaver donation may be several lives lost. It’s still not clear who is responsible in the St. Vincent case - the two directors are both saying “Who, me?” through their bullshit lawyers, and apparently none of the staff who were knowingly involved have been investigated yet - but whoever it was, and whatever they got out of it, by their stupid, shameless greed and duplicity they have impacted the entire practice of organ transplant. There will certainly be organ refusals as a result of this. (In particular, minority communities that have long been suspicious of medical abuses and favoritism will be further confirmed in those suspicicions now.) Every such opportunity lost is a death on these doctors’ hands.

It’s heartbreaking, and absolutely appalling.

Hat tip: AJOB/bioethics.net