If you are checking out this Dteg website on your Apple Mac Pro, plugged into music on your iPod or iPhone, then you should really be grateful for the progress that cancer treatment and liver transplantation have achieved in the twenty first century.

The corporate genius behind the technological phenomenon called Apple is Steve Jobs. Without his inspiration to galvanise a team of very special technical designers the Apple brand may not have achieved the dizzy heights that it has today.

Without treatment for pancreatic cancer and a liver transplant Steve Jobs would not be alive today.

In mid- 2004 Jobs was diagnosed as having a rare form of neuroendocrine tumour in his pancreas. He tried alternative therapies to reduce the growth of the tumour, but he was eventually advised to have the tumour removed – an option only available to 20% of pancreatic cancer sufferers. In July Jobs underwent what is known as the ‘Whipple’ Procedure, a pancreaticoduodenectomy, to remove the tumour at the Stanford University Medical Centre in Palo Alto. Given the fact that Steve Jobs was the Chief Executive and Chairman of Apple at this time, his health status was retained as a ‘personal matter’ and not for public consumption. This fuelled a great deal of speculation as to whether Jobs could continue as the head of one of the most valuable corporations in the world.

Continued weight loss and several prolonged periods of leave of absence suggested that Jobs had not fully recovered from the cancer surgery. There is much speculation that his need for a liver transplant in June 2009 was a result of the cancer spreading to the liver. His liver transplant was carried out at the Methodist University Hospital Transplant Institute in Memphis.

In 2009 Steve Jobs sought further treatment in Switzerland at a specialist cancer clinic adding to the speculation about his health and ability to remain head of Apple. In January 2011 he took more leave due to medical reasons and on August 24th 2011 he announced his resignation as the Chief Executive Officer of Apple – he remains the company’s chairman and will continue as a director and employee.

Commercial and medical controversy has been aroused by Jobs’ transplant. When an individual is so pivotal to the success of a publicly listed company are shareholders and stock markets entitled to more information about their health and life expectancy? Patient confidentiality is a key part of the relationship between a doctor and patient. But when the health of a company executive can influence share prices to the degree that Steve Jobs can, should greater transparency be allowed?

Patient confidentiality will also prevent a clearer understanding of whether Steve Jobs liver transplant should have gone ahead given his history of pancreatic cancer. What is interesting to the public is not always in the public interest and vice versa. Patient confidentiality is a fundamental principle that should be adhered to. Nobody would relish their medical history being plastered over the mass media.

Some very cynical reporting has implied that Steve Jobs should not have received a liver transplant in 2009 and that maybe his wealth, status and influence gained him greater access to this lifesaving procedure. In the USA livers for transplant are allocated to patients according to a points system which determines the patient’s level of need. When Jobs received the transplant the Methodist Hospital in Tennessee released the following statement:

“Mr Jobs underwent a complete transplant evaluation and was listed for transplantation for an approved indication in accordance with the Transplant Institute policies and United Network for Organ Sharing (UNOS) policies. He received a liver transplant because he was the patient with the highest MELD score (Model for End-Stage Liver Disease) of his blood type and, therefore, the sickest patient on the waiting list at the time a donor organ became available. Mr. Jobs is now recovering well and has an excellent prognosis.”

But Jobs lives in North California not Tennessee, so how is he able to secure a transplant in Memphis? In the USA it is permissible for a patient in need of transplant to get themselves listed at several transplant clinics across the country in order to maximise their chances of securing a transplant – unlike in the United Kingdom. Jobs chose Tennessee because it had a high survival rate for liver transplants and one of the shortest waiting times in the country.

But in order to get listed in several transplant centres a patient must be able to afford expensive assessments at the different centres which involve significant travel and accommodation costs. It has been pointed out that when Jobs received his liver transplant in June 2009 there were about 16,000 people waiting for this surgery. Only 1,581 patients received a liver transplant in the first quarter of 2009, none of whom had cancer related problems – except Steve Jobs. Patient confidentiality protects Jobs and his medical advisors revealing whether aggressive cancer has returned to his body. If the American rules permit this multiple listing wouldn’t anyone take advantage of this opportunity? A journalist called William Saletan thinks that Jobs has ‘gamed’ the system by using his influence to get ahead of the liver transplant queue. He believes that Jobs has received preferential treatment because of his celebrity status and tremendous wealth.

You decide for yourself whether Steve Jobs got his transplant based on impartial criteria related to clinical factors. I leave you with a web link to a very cynical article by William Saletan: [Web link to Saletan's article.]

The thrust of Saletan’s article is that solid organs should go to patients who have the closest tissue match to the next available organ and who will be able to maximise the use of that organ in terms of medical survival. He uses expert opinion to suggest that Jobs’ cancer history did not make him the ideal candidate for a liver transplant. So were other non-medical factors brought into the reckoning? Would Jobs transplant have taken place under UK guidelines and regulations? You decide.

Regardless of the circumstances behind his transplant Jobs creative genius and corporate expertise will continue to shape the way we communicate.

I hope his fight against cancer is successful, but the fact that he is on powerful immunosuppressant drugs to protect his liver makes this a daunting prospect – Steve Jobs is now facing the biggest challenge of his 55 years. It goes to show that the need for a major transplant operation can hit anyone, at anytime in their life - even multi-billionaires.

TRANSPLANTS SAVE LIVES, MONEY and MISERY.