Editor's Note
Fixes for Failing Organs
We’re all searching for a solution to wearing out. Time’s relentless nipping off of neurons, gelling of joints, and flopping of flesh have provoked patients to invest in potions, health club memberships, and facelifts, and have prompted medical science to seek preventives for organ decline and fixes for organ failure.
Borrowing from the car repair industry’s mantra of “if it’s broke, replace it,” medicine’s answer to organ failure for 50 years has been transplantation. Those five decades have seen startling progress in what can be replaced and how well it works after it is replaced. Yet, with that technological progress have come financial and ethical challenges that mirror the dilemmas of health care at large in the United States.
Transplantation medicine’s technological strides have been seven-league. Kidney transplants, treacherous treks through perilous rejections and toxic immunosuppressives during the 1960s, are near-routine procedures today, with minimal mortality and impressive survival rates. Those same techniques have brought hearts, lungs, livers, and pancreata into the world of the transplantable and led to successful multiple-organ transplants. Hand transplants and face transplants push the science closer and closer to science fiction. And transplantation medicine is evolving into regenerative medicine as stem cells and tissue-building techniques foresee the day when organs will be rebuilt rather than replaced.
Yet like all advanced medical procedures, transplants are expensive, and in our era of limited resources and deficit-bloating programs such as Medicare and Medicaid, tough questions about what we can afford tarnish the hype about medical miracles. Not only are more organs being transplanted and more uses for stem cells being found, but more people are “qualifying” for the treatments. In a trend repeated countless times with other medical procedures, as physicians get better at doing them, age limits get liberalized and contraindications melt away. More patients getting transplants means more costs, and the upward, unsustainable cost spiral continues. Even dramatic future medical miracles won’t likely find a government “white knight,” as the dialysis program did in 1972.
And money is not the only limited resource. The supply of donor organs will not likely meet the demand in our lifetime even if all current recruitment ideas succeed. So we will be left with tough ethical choices that will get even tougher. As people live longer, healthier lives, will there be an upper limit on who gets an organ? Will we eventually ration according to chronological or physiological age? Does everybody have a right to the best and latest medicine has to offer, or do we as a society have to figure out how to say “no” to some patients and families? Will we ever reconcile the debate about when life begins and the use of embryonic stem cells so that some version of that technology with all its promise can move forward? As recent debates about health care reform should remind us, we can’t have it all.
So many of these questions boil down to our sense of humanity, who we are and what we expect from this life. Humans will always suffer disease and will always wear out even though medicine of the future will surely modify this. Life has limits, and there is no solution to that.
Charles R. Meyer, M.D., editor in chief, can be reached at cmeyer1@fairview.org