Apple 2.0

Covering the business that Steve Jobs built

Steve Jobs: The sickest patient on the waiting list

June 24, 2009: 6:29 AM ET

Methodist HospitalAfter three days of ducking the press -- and telling the Wall Street Journal that Steve Jobs was not listed as a patient there -- Methodist University Hospital in Memphis finally admitted Tuesday that Jobs did in fact receive a new liver at their transplant facility.

It the process, the faith-based hospital revealed more than we knew about just how sick Apple's (AAPL) CEO had been.

With Jobs' permission, Methodist's chief transplant surgeon, Dr. James Eason, issued a four paragraph statement designed to counter the impression -- apparently widespread -- that Jobs had jumped to the top of the transplant waiting list on the strength of his wealth and celebrity.

Judging from our comment stream, most readers believe Jobs' new liver should have gone to someone who had been waiting longer, needed it more or had a better chance of survival.

Eason flatly denies that. His statement reads, in part:

"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."

This is revealing.

MELD is the numerical measure used by transplant centers to assess the severity of chronic liver disease. It was developed to predict the odds that a patient will die within three months based on a scoring system that ranges from less than 10 (4% mortality) to 40 or more (100% mortality).

The MELD algorithm takes values from the patient's blood and urine tests and spits out an answer. In a hospital's computer, it looks like this:

MELD model

Where

  • INR, or international normalized ratio for prothrombin time, is a measure of how fast the patient's blood clots
  • Bilirubin levels tell doctors how well the patient's liver is functioning
  • Creatinine levels provide a measure of the patient's kidney function
  • Dialysis treatments, which do the work of the kidneys, affect creatinine readings

We don't know whether Steve Jobs was getting dialysis twice a week, but if his MELD score was higher than every other liver transplant candidate with his blood type in Tennessee -- which has a relatively short waiting list but still averages 48 days -- he was very sick indeed.

Jobs had a cancerous tumor removed from his pancreas in 2004 and went on a medical leave January to deal with continuing health issues that he initially described as an easily treated hormone imbalance.

Although he was spotted on Apple's Cupertino, Calif., campus Monday, his spokespeople continue to say only that Jobs looks forward to returning to Apple at the end of June.

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About This Author
Philip Elmer-Dewitt
Philip Elmer-DeWitt
Editor, Apple 2.0, Fortune

Philip Elmer-DeWitt has been following Apple since 1982, first for Time Magazine, and now on the Web for Fortune.com.

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