Topic: Apple CEO Steve Jobs’ liver transplant.
Nicholas LaRusso: I guess there are at least two aspects to his situation that have caught the public’s attention. One is the whole issue of whether or not someone of his prominence was given special attention in terms of access to a liver. And the other has to do with the indication for his liver transplantation.
With regard to the former, let me say that the distribution system for solid organs has advanced, particularly livers, has advanced tremendously to a more fair and equitable system with the evolution of the MELD system [the Model for End-Stage Liver Disease (MELD) system] of scoring. So, the system allocates organs based generally on the severity of the liver disease. It’s organized on a regional basis.
Some areas of the country have better access to more livers than other areas of the country. According to the press, he got his transplant in Tennessee. Based on what I know, the availabilities of livers in Tennessee might be better than say on either coast. If that was the case, there was nothing inappropriate about that. He was not “gaming” in the system in any way. Many people will have themselves listed in more than one region in an attempt to get access to a liver. That’s how I would comment on that aspect of.
With regards to the indication, again it’s not clear what he--he had a pancreatic tumor. There are number of different kinds of pancreatic tumors. The most common is what’s called an adenocarcinoma of the pancreas, and this is a devastating disease with very poor prognosis that has a five years survival, in general less than 5%. It would be highly, highly unlikely that that was the kind of tumor that he had, or that anyone would consider a liver transplant for that kind of a tumor when the tumor went to the liver. The likelihood is that he had some type of a neuroendocrine tumor, which are generally slow growing tumors. And the likelihood is from what I’ve read that the tumor was receptive but probably had metastasized to the liver, and that was the indication for a liver transplant. In fact, at many centers a transplant for a neuroendocrine tumor that’s metastasized to the liver is considered appropriate.
Recorded on: June 24, 2009.