There were 39,000 organ transplants performed in 2020. That’s a lot of potentially life-saving operations. But it’s also worth noting that there are 106,572 people on donor lists. So the need far outweighs the ability to fill it. That’s part of the reason why there are some rigorous standards in place to qualify for an organ transplant. Unfortunately, not all of those standards and reasons turn out to be good ones.
10. Criminal History
When a hospital considers the reasons for or against giving someone a transplant, they will inevitably settle on one in particular when it comes to denials. If a patient who needs a liver doesn’t stop drinking, that’s a cause to deny the transplant. Likewise, a lung transplant patient will be denied if they keep smoking. But sometimes they’ll offer up more esoteric reasons like “noncompliance.”
In organ transplant terms, that can mean a lot of things, like a fear that the patient won’t follow through on steps to ensure a healthy recovery after the fact. Back in 2013, for 15-year-old Anthony Stokes, noncompliance was the reason he was denied a life-saving heart transplant. Officially, it meant that the boy had a history of poor grades and spending time in juvenile detention. So, basically, the hospital refused to save his life because he had a criminal history. At age 15.
After the story got out, the hospital miraculously reviewed their position and changed their mind. The boy, who was given six months to live, was granted the surgery and received a transplant. In one final, tragic twist, two years later Stokes died in a car crash after fleeing police.
9. Vaccination Status
The Covid-19 pandemic has had more ups and downs than a Pogo stick, but one thing that slowly grew out of it was the divide between vaccinated and unvaccinated. Those who remain unvaccinated found that more and more of the world was becoming unwelcoming to them. Restaurants, movie theaters and borders were closed to those who couldn’t prove their vaccine status. And if you can’t eat indoors at a restaurant without being vaccinated, maybe it makes sense that you can’t get a lung transplant, either.
With over half of the world vaccinated, including about 64% of the United States, hospitals have begun cracking down on the unvaccinated in some serious ways. Most noticeably when they denied a heart transplant to 31-year-old DJ Ferguson, in part because he remains unvaccinated.
According to the hospital, they take vaccine-status and lifestyle choices into account when determining who qualifies for the very limited number of organ transplants towards the goal of ensuring the best chance of survival for recipients. In other words, if you aren’t willing to get vaccinated against a disease that will probably kill you thanks to your compromised post-transplant immune system, they’re not going to bother with the procedure in the first place. After a transplant, a patient’s immune system barely exists at all, so the vaccine is essential in their eyes.
8. The Numbers Game
Around 40% of the fruits and vegetables produced on farms is trashed before consumers ever get to see it for no other reason than because it’s ugly. Imperfect produce is considered unsellable, so it’s not even sold, which is a huge waste. Who wants an imperfect apple, right? Probably a lot of people, but that’s neither here nor there. And it turns out this same attitude applies to human organs.
Imperfect organs, by whatever metric one uses to determine such a label, began being turned away with a change to federal standards in 2007. This was essentially an issue of the bottom line. Imperfect organs make for higher risk surgeries, just like a recipient who is extremely ill. The more risky a surgery is, the less likely it is to be successful. If too many unsuccessful surgeries are performed, a hospital’s rankings go down and they will receive less federal funding. So, in order to keep their ratings high, they simply perform fewer transplants and only go for what they consider the “sure thing” surgeries.
This point of view flies in the face of what transplant surgeries are meant to do in the first place, and the idea that the sickest people deserve the organs first. After a report outlining this was issued, standards were changed to allow hospitals to have more surgical fails without losing funding, but it still seems to be a metric by which funding is gauged.
7. Patients Rejected for Being Too Poor
Imagine learning that your heart is failing and if you want to survive, you will need a transplant. We already know that there are 100,000 people waiting for organs and only a fraction of that many to go around. But assuming you’re in otherwise good health and check all the right boxes for qualifications, you have to be near the top of the list. Now imagine finding out the average cost of a heart transplant is over $1.3 million.
It seems weird to suggest that you can be denied a life saving procedure because you can’t afford it, but it turns out you can. Hedda Martin was denied a heart transplant because her finances were not up to the task of covering the job. The hospital recommended she start a fundraiser to pull in at least $10,000.
Patients are routinely required to prove they can pay in advance before any progress is made on a potential transplant. While a heart is the most expensive, even a kidney can cost up to $400,000. Plus, there are anti-rejection drugs that cost $2500 a month and you need to take them for exactly as long as you plan to live after the surgery.
Many recipients start GoFundMe campaigns, but if the money doesn’t flow, neither do the organs.
6. Potential Disability Risk
Obviously as lay people, we are not privy to the same information medical professionals have when deciding who gets an organ transplant and, in effect, who lives and who dies. But we can make some assumptions that align with what makes sense. What should be right in a subjective sense. When we hear that a baby needs a heart transplant, that seems like a no-brainer to us. Of course, a baby moves to the top of the list. It’s a baby.
In 2013, a 5-month-old baby born with a heart defect was denied a heart transplant. Two surgeries had already failed, and he was in heart failure. He was going to die. Doctors said his condition put him at risk of tumors and infections. But when his mother researched his condition online, she couldn’t find a single mention of that being the case. A doctor confirmed it to her.
One thing she did know was that children with her son’s condition often grew up to have serious disabilities and that was what she believed the true reason was. The same thing had happened to a three-year-old girl who needed a kidney transplant. And while it’s been known that intellectual disabilities will keep people off the transplant list, which we’ll get into shortly, this was a preemptive strike on a baby who hadn’t even had time to develop one way or the other.
5. Intellectual Disabilities
One of the biggest moral questions the healthcare industry has dealt with in regards to transplants is what should disqualify a person from receiving one. And no issue is more debated than intellectual disabilities. To some, it’s literally considered a waste of an organ to transplant it into someone with an intellectual disability.
Unsurprisingly, the issue comes up, is tossed around in the media, and maybe even some petitions are signed. But not a lot of progress is made. As late as 2021, there was some hope that the issue of disability discrimination might get before Congress. There is still no official rule on the books and hospitals around the country continue to deny transplants to those with intellectual disabilities on the grounds that they are not able to properly care for themselves and therefore cannot get the most out of the organ.
4. Faulty Test Results
There are as many as 12 million diagnostic test errors in America every year. Tens of thousands of people die per year as a result of medical errors, upwards of 22,000 according to recent research, with some of those numbers undoubtedly the result of testing errors. But what happens when testing is needed to determine who gets organ transplants? Well, that can screw up, too.
A woman who needed a liver transplant found herself rejected from the list when doctors determined she’d been drinking alcohol. Obviously, that’d be a big disqualifier for a liver. You don’t want to give someone a new one that they’re just going to destroy. But the problem was, the woman hadn’t been drinking.
The problem with testing for things like this is doctors are predisposed to not believe patients when they have contradictory evidence. And they’re not necessarily wrong about that, lots of patients lie. But that doesn’t mean they all do. In this case, it turned out the woman’s bladder was producing its own alcohol. After looking into the case more, she was eventually reconsidered for a transplant.
3. Marijuana Use
36 states currently allow for the use of medical marijuana and half that allow for its recreational use. A number of countries around the world have also legalized, or at least decriminalized, its use in many circumstances as well.
Despite its legality, there have been cases where transplants were denied to people using it as it was legally prescribed. Timothy Garon died after being denied a liver because of his marijuana use. The hospital said that was not the sole factor in determining any patient’s eligibility, but Garon’s lawyer disagreed.
Garon’s doctor had prescribed marijuana for him to deal with the nausea and pain caused by his condition. The hospital said he had to be off the drug for six months, but he didn’t even have that long to live. They recommended a 60-day program, but his condition was too advanced for that as well.
2. History of Alcohol Abuse
More than once now, we’ve addressed the idea that a person might be denied a transplant based on their history of substance abuse. In particular, a person can be denied a liver if they have a history of drinking. On paper, that makes sense. But in practice, it can often be discriminatory.
An indigenous Canadian woman was denied a liver transplant based on her history of alcohol use. It was suspected that acetaminophen had actually caused her liver damage, and though she had a drinking problem in the past, she was apparently sober at the time she needed the surgery. Nonetheless, she was denied.
An indigenous man from BC was also denied after he failed to meet a six-month abstinence policy the province of BC had set up for those in need of a liver. Indigenous Canadians have disproportionately high rates of alcoholism in their communities due to a number of systemic conditions, ranging from abuses in residential schools, poverty, and racist policies that severely impacted their abilities to thrive and even survive in Canada. The abstinence requirement was challenged as being discriminatory on those grounds.
The policy was alleged to be rescinded in 2018, although the case we just mentioned happened in 2019. The transplant board called this a mistake, and the man was put back on the list to have a transplant.
1. Father Violated Probation
The only thing worse than being denied an organ for something you’ve done is being denied for something someone else did. That’s what happened to two-year-old AJ Burgess.
Burgess was born prematurely and in need of a kidney. His father was a perfect match and had a kidney to spare. Seemed like a no-brainer. But the hospital refused to perform the transplant because the father had served time for a parole violation. The hospital stated that they needed parole and probation information so they could see he had been on his best behavior for three or four months before they would perform the transplant.
Luckily, after the outcry, another matching kidney was found and Burgess got a transplant after all.