LIKE MANY PEOPLE, I was appalled to learn that skulduggery might have helped a Saudi national jump from 52nd place to the top of the liver-transplant list at St. Vincent Medical Center in Los Angeles.
After The Times broke the story, irate readers wrote expressing their outrage. "I'm not putting my pink dot [designating organ donation] on my driver's license until they clean up their act," one reader said.
That made me wonder just how many people felt the same way. I worried that if this was the prevailing view, many individuals would suffer -- people like me. Thanks to the generosity of someone who bothered to stick a pink dot on her driver's license, I have been given a second life. I had gotten sick while living in Africa. At first, I was told I had intestinal parasites, and for a while, I simply thought I had a bad case of stomach flu. Little did I know that my liver was slowly dying. When I suddenly got worse, I ended up in a Nairobi hospital. The doctors urged me to quickly head to King's College Hospital in London. When my husband and I arrived there, doctors asked my blood type. When I said O-positive, they recommended that I return home to the United States while I could still travel. If I stayed in London, I would have to compete with hundreds of Europeans on the waiting list.
A few days later, I was at UCLA Medical Center, and I was moved to the top of the transplant list because I was probably hours away from dying. Soon I was on the operating table, receiving a liver from a 40-something diabetic woman from San Jose who had died after languishing in a coma.
To protect the privacy of her family, the hospital never told me who she was. I assume that, like many other Californians, she had simply stuck the pink dot on her driver's license to indicate that, if she died, she would want her organs used to save lives.
Like many grateful transplant recipients, I sent a letter of thanks through the hospital. I told her family that her decision gave me a new life: My two young children would continue to have a mother to love and care for them, and my husband would have his partner.
I later learned that I was lucky that my time on the list was mercifully short. Many people -- even those at the top of the list -- die waiting for an organ. The nonprofit United Network for Organ Sharing, or UNOS, oversees the national transplant system, and coordinates regional waiting lists. Among the factors in determining a patient's place on the lists are the patient's condition, age and location. There are 90,000 transplant candidates in the United States.
I sometimes ask: Why me? My time in Kenya taught me enough to know that if I had been a poor African, I would have been dead.
At the time of my illness, my husband, then The Times' Nairobi bureau chief, was researching a story on how roughly half of Africa's population survives on less than a dollar a day. He wrote about a young child who died from malaria because his parents didn't have 20 cents to buy medicine.
The furor over someone jumping the transplant line, perhaps because it was financially beneficial to the hospital, is understandable. Despite all the inequities in our society, Americans are still repulsed by the idea that wealth could blatantly trump need in such matters of life and death.
But we must not lose sight of the fact that, in the vast majority of cases, the U.S. method of allocating organs works. The problems at St. Vincent were unearthed when UNOS auditors began to question hospital authorities. Ferreting out such violations, and taking corrective action, will further ensure the fairness of the system.
We also should not rush to close off our organ transplant system to foreigners, as some have suggested. "It ought to be Americans first," one bioethicist told The Times.
But the fact is, in the last year, foreigners living in the United States have donated organs to American patients in about the same proportion that they received transplants. By allowing a small number of foreigners on the list -- UNOS sets 5% as the guideline -- the U.S. has acknowledged an obligation to offer such operations to people who cannot get them in their home countries. The problem with the Saudi who received a liver at St. Vincent was not that he was a foreigner but that he was unfairly bumped up in the line.
Now that St. Vincent has suspended its liver program while an investigation is ongoing, I worry about the 75 liver patients on that hospital's registry who must move to other transplant centers, perhaps delaying their chances for a transplant. I also worry about how the scandal could discourage people from electing to be donors. Peeling the pink dot off one's driver's license would withhold help to desperately ill patients.
Every time I kiss my kids goodnight, I am reminded of the woman in San Jose who chose to help me, someone she would never know.
ABBY HARRIS MAHARAJ is a community college teacher in Orange.