A celebrity like Apple CEO Steve Jobs scores a rare organ transplant and the world wonders: Did he game the system? The rich have plenty of advantages that others don’t. But winning the “transplant lottery” involves more than the size of your wallet — and true medical need.

A Tennessee hospital has confirmed that it performed a liver transplant
for Jobs, putting him among the lucky 6,500 or so Americans each year
who get these operations. Nearly 16,000 others are waiting now for such
a chance.

No one can buy a transplant
that’s against federal law. And no one is suggesting that Jobs or the
Memphis doctors who treated him bent any rules to show him favor. The
hospital said he was the sickest person waiting for a liver when one
became available.

However, people who understand how the transplant system works, and who have the money to make the most of what they learn, have a leg up on getting the body part they need.

An Internet database — the Scientific Registry of Transplant Recipients — gives average wait times, success rates and other details on every transplant program in the nation.

“Anyone can go to that Web site and see which transplant centers transplant quicker than others,” said Dr. Anthony D’Alessandro, liver transplant chief at the University of Wisconsin-Madison.

Jobs, who lives in Palo Alto, Calif., was able to get on a shorter waiting list, in Tennessee.

Here’s where money comes in.

To get on a transplant
center’s list, a prospective patient must go there, be evaluated by the
staff and have tests to confirm medical need. If accepted, the patient
must be able to get to that center within seven or eight hours if an
organ becomes available. That means renting or buying a place nearby or
being able to afford a private jet, or $3,000 to $5,000 for a chartered
plane, to fly in on short notice.

People also can get on as many wait lists as they like as long as they can travel there and meet the terms.

“It is at the transplant
program’s discretion if they know it is a multiple listing” to accept
someone already on another waiting list, said Joel Newman, a spokesman
for UNOS, the United Network for Organ Sharing, which runs the nation’s
transplant system.

Three different
times, UNOS has considered banning or limiting multiple listings, most
recently in 2003. But patients protested, saying they needed to go
wherever they could to improve their odds, said D’Alessandro, who has
headed UNOS panels on organ allocation.

It’s not known if Jobs was on more than one list.

He has an “excellent prognosis” after his transplant at Methodist University Hospital Transplant Institute in Memphis, said transplant chief, Dr. James Eason.

“He received a liver transplant
because he was … the sickest patient on the waiting list at the time
a donor organ became available,” Eason said in a statement Tuesday
night on the hospital’s Web site.

Apple declined to comment further.

54, had surgery in 2004 for a rare form of pancreatic cancer, an islet
cell neuroendocrine tumor. Jobs said afterward that he was cured.
However, his health made headlines last summer, when reporters at a
company conference saw he had lost a lot of weight.

In January,
Jobs said he was suffering from an easily treatable hormone imbalance
and would remain CEO. Less than two weeks later, he said his medical
problems were more complex, and that he would take a medical leave of
absence through June, leaving Apple’s chief operating officer, Tim
Cook, to run day-to-day operations of the Cupertino, California-based

Several doctors without firsthand knowledge about Jobs’
health said the type of pancreatic cancer he had tends to be
slow-growing. When it spreads, it tends to land in the liver first.

most likely scenario is that undetectable cancer cells traveled from
the pancreas to the adjacent liver at the time of Jobs’ 2004 surgery,
these experts said. That type of cancer can often remain in the liver
for years without causing symptoms, but can cause the kind of weight
loss Jobs’ recently experienced.

Jobs had end-stage liver disease, meaning extensive liver damage had occurred.

Patients in such bad shape would get priority on any organ transplant
list, and if Jobs did have a recurrence of cancer, that would give him
even higher preference, said Dr. Roderich Schwarz a pancreatic cancer
specialist at the University of Texas-Southwestern Medical Center in

Liver transplants in such cases
can cure the cancer, although patients remain at risk for another
recurrence, Schwarz said. In addition, the powerful immune-suppressing
medicine they must take to keep the body from rejecting the transplanted liver also can increase their risks for recurrence.

Dr. Michael Porayko, medical director for liver transplants
at Vanderbilt University, said a less common scenario would be that
Jobs’ earlier surgery resulted in scarring or blockage of bile ducts,
causing liver damage.

But he said Jobs’ doctors would have known
to watch for and treat that, and he agreed that it’s much more likely
Jobs’ cancer had spread to the liver.

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