Dear Dr. Bone: Could you settle an argument? My friend says that Steve Jobs "bought" his liver by paying money or donating to the hospital where he was treated. I think that no matter who you are they decide about giving you an organ based on how sick you are, not the money. Who is right? We also wonder about treating cancer in the liver with a transplant. Is that routine?
-- J.P., West Palm Beach, Fla.
Dear J.P.: Both of you and neither of you are completely right. It is true that you cannot "buy" an organ by donating a wing to a hospital or paying off a surgeon, but there are ways that the very wealthy have an advantage when trying to secure an organ.
Each state has an organ donation waiting list. In order to qualify for a transplant, you must register with the state and commit to being able to travel to the hospital within a certain period of time, usually within 4-6 hours, after an organ becomes available.
Not too many people can do that. If you can afford to maintain a private plane and a pilot "on call" to take you to your destination in time, you are ahead of the game.
I am certain Mr. Jobs was on transplant lists in states other than California where he lived, because the lists were shorter. That is why he went to Tennessee and was able to get his liver quicker than somebody else.
Ultimately, he had to wait his turn after it was determined that he was a candidate for transplant, but he got to the top of the list quicker because the list was shorter.
The second part of your question is much tougher. Mr. Jobs had cancer that started as a neuroendocrine tumor in his pancreas. Eventually it spread and he underwent a Whipple procedure to remove his pancreas and part of his intestine to control his cancer.
Eventually it recurred in the liver. His physicians must have felt confident that the cancer was contained there and not spread to other parts of his body.
One of the concerns about transplanting a liver in a cancer patient is that the cancer might already be elsewhere. For that reason certain cancers are a contraindication to liver transplantation. Also, the drugs to prevent rejection of the liver weaken the immune system and might contribute to cancer coming back.
The upside is that liver transplantation in appropriate patients can take a bleak prognosis and convert it to a good one. Before transplants, liver cancer patients had a zero percent five-year survival and now that number can be as high as 80 percent.
Dear Dr. Bone: My oncologist told me not to use lavender because it can act like estrogen and stimulate any remaining cancer cells. Your foundation uses a lavender ribbon and many lavender products. Do you think this is a responsible thing to do?
Dear Anti-lavender: First let me explain the lavender ribbon. The color lavender represents all cancers and general cancer awareness. I did not invent that. My foundation, Cancer Sensibility Foundation, is about all cancers. We use the lavender ribbon because we want everybody to know that we represent all cancers.
As for lavender and breast cancer, let me explain what I know.
A study done on three prepubertal boys in England showed that they had early breast development, probably due to using hair and skin care products containing tea tree oil and lavender oil. Theoretically, lavender contains some molecules that can act as phytoestrogens -- or natural plant estrogens. Having said that, I could not find a single study that showed lavender to be harmful to breast cancer patients.
Actually, there were a number of studies emphasizing the beneficial antioxidant effect of lavender along with its calming effect.
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