Arsinel and his new kidney  

Thrown (Ţâpat) in ,

Quite a few people are (or were back in September, but it takes a while for local news to cross the Atlantic) appalled that Alexandru Arsinel, an aging and beloved Romanian actor, has supposedly bribed doctors (or used his fame) to jump the queue for a new kidney. But isn’t the outrage itself somewhat outrageous?

kidney-rinichiul-ArsinelMy opinions on this matter are formed by my own experiences (no, not as an organ donor or receiver). He’s not my favourite actor, but I do like him – he typifies the “bonhomme (ro: bonom)” character.

As for the surgery (done, apparently, on debt?), Radu Alexandru writes in a satire & humour magazine:

But it may have been that gentleman Arşinel was respectful to the laws of nature, waiting quietly for a kidney and, through a lucky twist of fate, received it in three days. Doctors confirm this story. They say there have been cases of people who have received a kidney super-fast. From a group of six potential recipients of kidney, doctors say that only Arşinel, 74 years old, and a girl, 29, were compatible. And he was more compatible. Because chronological age is not relevant. The biological age is all that matters. And biologically, Arşinel was in better shape than a chronologically young but biologically irrelevant 29-year old.

In case you’re wondering who he is, here’s a few videoclips (which may end up deleted): capsuni, gaina, mielul, rendez-vous, didina, karatist, seara, billy, buona sera, suzi, giulia, romeo & julieta, imitatii.

The number one issue “debated” in the Romanian press is whether the actor bribed the doctors for his new kidney. Having known some famous people, I think that there is a possibility he did not, and the doctors helped him jump queue out of deference and respect and for the emotional connection the actor created with them or the doctors’ parents. Either way, he did it his way.

If you are on the actor’s side, imagine it’s your 29 year old daughter he jumped over in the queue.  If you’re on the girl’s side, you might consider the argument that ends all arguments in Romania: it happens in the West as well. For instance, it happened with Dick Cheney who got a heart transplant at 71 (and it wasn’t his first either, if I remember correctly). Unlike Arsinel, Dick wrote a book, Heart: An American Medical Odyssey – possibly to pay his debt for surgery+bribes [ABC Interview]. As usual, there are those who see a conspiracy theory here [Trayvon Martin was sacrificed for Cheney (he was shot around the same time and was a good runner, after all)] and doctors hold different views.  

There was a rather lively debate in the American mass-media over Cheney’s transplant (cbs-debate).

"You can't leapfrog the system," said Dr. Allen Taylor, cardiology chief at MedStar Georgetown University Hospital. "It's a very regimented and fair process and heavily policed."

More than 3,100 Americans are waiting now for a new heart, and about 330 die each year before one becomes available. When one does, doctors check to see who is a good match and in highest medical need. The heart is offered locally, then regionally and finally nationally until a match is made.

Cheney's case reopens debate about whether rules should be changed to favor youth over age in giving out scarce organs. As it stands now, time on the waiting list, medical need and where you live determine the odds of scoring a new heart - not how many years you'll live to make use of it.

"The ethical issues are not that he had a transplant, but who didn't?" Dr. Eric Topol, a cardiologist at Scripps Health in La Jolla, Calif., wrote on Twitter.

Cheney received the new heart Saturday at Inova Fairfax Hospital in Falls Church, Va., the same place where he received an implanted heart pump that has kept him alive since July 2010. It appears he went on the transplant wait list around that time, 20 months ago.

Cheney had severe congestive heart failure and had suffered five heart attacks over the past 25 years. He's had countless procedures to keep him going - bypasses, artery-opening angioplasty, pacemakers and surgery on his legs. Yet he must have had a healthy liver and kidneys to qualify for a new heart, doctors said.

"We have done several patients hovering around age 70" although that's about "the upper limit" for a transplant, said Dr. Mariell Jessup, a University of Pennsylvania heart failure specialist and American Heart Association spokeswoman. "The fact he waited such a long time shows he didn't get any favors."

Patients can get on more than one transplant list if they can afford the medical tests that each center requires to ensure eligibility, and can afford to fly there on short notice if an organ becomes available. For example, the late Apple chief Steve Jobs was on a transplant list in Tennessee and received a new liver at a hospital there in 2009 even though he lived in California.

That's not done nearly as often with hearts as it is for livers or kidneys, said Dr. Samer Najjar, heart transplant chief at MedStar Washington Hospital Center. Each transplant center decides for itself how old a patient it will accept, he said.

"Most centers wouldn't put somebody on" at Cheney's age, said University of Pennsylvania bioethicist Art Caplan, who has testified before many panels on organ sharing issues.

"I've been arguing for a long time that the system should pay more attention to age because you'll get a better return on the gift" because younger people are more likely to live longer with a donor organ, Caplan said.

There have been other recent reports of successful heart transplants in septuagenarians.

In Canada, a man described as a home builder and philanthropist received a heart transplant when he was 79 at the University Hospital in Edmonton, Alberta, Canada. He lived for more than a decade with the organ, dying in 2010 at age 90.

In Texas, a 75-year-old retired veterinarian received a heart last year from a 61-year-old donor, but he had been a marathon runner and was presumably healthier than many of his peers.

Which Dick Cheney? – you might ask. I’m talking about the dark presence behind Bush the Young (istet, critica, clinton), the puppeteer who happened to coordinate NORAD air exercises on 9/11 “from an undisclosed location”; that 9/11, you know, when the 3rd tower, even though no plane hit it, decided to collapse out of solidarity with the other twins: “life has no meaning without you, guys”; dude also had a “change of heart” when he learned that his daughter is gay. You Don’t Know Dick but you can learn more from tds-dick-cheney: Dick’s Box, Safe, Gitmo, Google Earth, Iraq-5y, 4th Branch, Presidency, uncut, Rummy, camera 3, VPs, still-cheney, zen-ringtone, zen-heart, zen-obamacare, cutler, gop, torture, christie, old man, humanization, starwars, leak, decisions-2007, 2008-last day.

Now that you [hopefully] know Dick, you might say that there really is no connection between Alexandru Arsinel’s kidney transplant and Dick Cheney’s heart transplant. Oh, but there is – here’s a summary for the slower among us.

  • As they are risky surgeries performed on older people, both raise significant ethical questions in terms of how long will these old-timers get to benefit from this very limited resource (as opposed to younger people).
  • Both are public figures; there is a clear and obvious suspicionpossibility that their status (and, very likely, their money) had a corrupting influence on the selection process.
  • You will generally find that people who like them will support the quest for longer life, while those who don’t will be against it. Indeed, it seems that that’s the only criterion the average Joe uses when it comes to what essentially is a bioethics question.

I don’t have the time now to expand on a larger argument, but Blegoo asked for it, so here’s a sneak preview:

  1. as a whole and even when choosing for themselves, doctors tend to be over-pessimistic and choose, overwhelmingly, death (articles in NYT)
  2. organ transplants are often performed from unsuitable donors (who died of cancer), or with organs that have been improperly removed and / or stored
  3. there’s an entire organ donation mafia, taking organs from people who have never given consent
  4. in Canada, doctors went all the way to the Supreme Court to short-circuit the existing decision body and decide only themselves who is kept on life support and who isn’t
  5. in Nazi Germany, 50% of doctors were Nazis; most other professions (Engineering, Law) had only around 20% membership
  6. a couple of Harvard studies have found that among professions, Doctors and Engineers are most predisposed to radical points of view

I will never allow my organs to be used for others and I will soon modify my will to ensure that upon death, my body will be cremated and none of my organs donated - I fear that checking “organ donation” on my driver’s license will cause doctors to try not-so-hard to save me in case of accident. I’ve seen how easily someone gets euthanized against their will and how this does not even get to be talked about.

Sources / More info: ra-catavencii, libertatea-mb, evz-penal, tds-dick-cheney, cnn-gupta, salon-monster, cbs-debate

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