Doomed to Fail - Ep 198: I'll take one of those! - Organ Transplants pt 1

Episode Date: May 19, 2025

Today, in part 1 of Organ Donations, we talk about the history and the rules behind giving someone your organs. It does get a little gross when we learn that lungs come apart into 'lobes' but it's probably still a good thing to know! Join our Founders Club on Patreon to get ad-free episodes for life! patreon.com/DoomedtoFailPodWe would love to hear from you! Please follow along! Instagram: https://www.instagram.com/doomedtofailpod/  Facebook: https://www.facebook.com/doomedtofailpod  Youtube:  https://www.youtube.com/@doomedtofailpod TikTok: https://www.tiktok.com/@doomed.to.fail.pod Email: [e-mail] 

In a matter of the people of the state of California versus Orenthal James Simpson, case number B.A.019. And so, my fellow Americans, ask not what your country can do for you. Ask what you can do for your country. That's it's in the rough meetings. Hello, Taylor. Hello. How you doing today?

Good. How are you? Good. Did you have a fun, active weekend? Oh, my God. Like 19 crazy things happened. I've been waiting to tell you. Can we hear them all? Yeah. First, hello. Welcome to Dune to Fail.

I'm Taylor, joined by Fars. We bring your history as most notorious disasters and epic failures twice a week. And I had a crazy freaking weekend. You were just talking about how I should move to Texas. And I was like, I love California. I'm not moving, but also. So I'm in Joshua Tree between Palm Springs and 29 Palms. This dude yesterday bombed a fertility clinic in Palm Springs.

And then, like, had another bomb in 29 Palms. like I think maybe went off. There was like a blast zone. I don't know what happened. I think the guy's dead. But he was like, his manifesto was like, had it wrote down. He was pro-mortilist,

which means that life should be ended as soon as possible because it only results in death, which is why he bombed a fertility clinic. And he said, having children is unethical because it only exposes more people to future suffering and death. It's weird.

It's almost like a nihilist perspective, but done extremely, extremely badly yeah and so that happened and then today was at a birthday party at a park like a public park that's nice but you know i know that like some kind of there's some shady characters that hang out there or whatever a dude died in the bathroom during the birthday party today i would say that's not that weird when i was living in l-a the starbucks that i would frequent also had a dead body in the bathroom from an l-odd so yeah and like the the people the parents that were there they actually work in recovery and so they had an arcane

in their cars you know they were like as the closest they could have gotten but they didn't get there in time and i'd like talk to the kids and be like hey kids let's stay over here you know god it's awful it's awful yeah okay well you had you had a lot that went on wild yeah um okay so i think it is me going first this time. Yep, it's your turn. So I didn't mean to do this, but I am going to end up doing a two-parter, I think, because this ended up getting pretty long and super juicy. So I, and this is entirely by accident.

I just learned, like, like, an hour ago that Sanjay Gupta is going to be having a whole special on this topic on CNN. I just, it is airing tonight. I literally only learned it like an hour ago, so I promise I'm not getting inspiration from other people. This is straight from my dome. I started getting super interested in organ transplantations and the whole process in the multiple different variations of people getting organ transplants, the history of it and all that good stuff. So I'm going to get into a bit of the first half of the story in terms of organ transplantation history, the process, the donation system within the United States, the country that does it the most, which is not, well,

On a per capita basis, it's not the most. It's on the United States, but I'll talk about that later. I'll tell some fun, interesting stories around the topic as well, but the juicy, juicy bit is part two, which is the duress voluntary donations or the worst, which is involuntary donations. Is that like being like taking to a hotel room and put into a bathtub? Exactly. Precisely that. um there was something i just saw yesterday on the internet that was like science has enough bodies i'm gonna donate my body to english lit and see what they do with it that was really funny and they're just gonna make a book out of your skin it'll be cooler it'll be more metal for sure so much more metal

i like it yeah so i went through the history of organ donations and organ transplantations in general and there's a really really stupid story about this chinese doctor who did it in like 300 bc where he swapped the heart of two men, one who was strong-willed, but strong in spirit or some shit. Sure, sure, sure. It was one of those deals. Like, it was obviously not real. And it just sounded like this guy was basically collecting corpses. Um, the first actual organ donation that we can really call a modern organ donation happened in Boston in 1954. And that was a kidney transplant. Wow. The history of organ transplant surgeries was such an insane leap of faith. It goes back to what I told you before, which is, like, I feel like back in the old days, life just didn't

matter. Like, your life didn't matter. People didn't care about their lives. I don't think that it's that necessarily. I think, like, we're talking about the other day with, like, the death industry, it just was more common. Maybe because you saw it more. Maybe the death industry was more part of what you did, or you saw your experience. Yeah, before, before, before it became what we have now, you experienced it a lot, you know. It's true. And I think that that makes it, it makes it a couple of things. It makes it like easier to deal with if you are them. And also it makes it less scary and more scary if you're us because you don't see it or

a lot, you know, which I think I'm after doing all this, I'm solely coming to your side, which is we should probably be more closely tied to it. You know, it's funny the other day. I was thinking about my dog dying. I got really upset and was like, like I literally worked myself up. Totally. I was really depressed about it. And I was like, well, that's going to.

to happen like i like you know i'm gonna die everybody so just get past it but so yeah you're right like maybe if i didn't have sort of off distance relationship with it it wouldn't have been so emotionally traumatic for me to think about yeah i mean when i had my when i had my daughter i had to be like in my head i was like listen enjoy every freaking second time with her like that's all you can do you know otherwise i'm going to lose my mind just taking care of this person that i love so much yeah like try to figure out how to survive you know it's crazy yeah and you're all endured enjoy it well with the history of organ transplant surgeries um there was so many stories such a long history of what's called unsuccessful transplants which is literally just

people dying on the operating table or shortly thereafter i also i'm so sorry i interrupt you i don't review a lot okay i have a lot of thoughts i have no idea where things are in my body I've very, very recently understood for the first time that your fallopian tubes aren't like this. Like they're not in a T, they're like in a blob in your body. No, they're a blob.

They put them in the T so you can see what they are. But in your body, it's like uterus, floating tubes on the side of them. It's like a big blob together. And I'm like, I don't know that. Like, why did I not know that? That's so weird.

Like, I just think that's, like, I don't know where you're thinking. You know what's funny. In the middle of this, when I get towards like probably like the 30% part of this is when I had a similar experience where I'm going to go into lungs and I'm like, wait, that's how they're shaped. Oh, yeah.

I can't wait to hear it. It is so much different than what I thought it was. Yeah. But yeah, basically like with the original pre-1950s and even the 1950s experience of organ transplants, it was a lot of doctors shuffling organs around between different animals, see what works and how it works. And then kind of trying some of that in humans and seeing. what takes and what doesn't take my favorite story is a guy named not favorite in a good way

but it was a guy named boyd rush who was the person received the first heart transplant in january 1964 this goes back to like an old bill per bit where he was like talking about hair transplant surgery he's like never be the first one to do anything for real that's exactly that i was just thinking it was like oh god do not be the first guy to get your freaking heart transplanted i mean i guess it's your favorite choice you're like i'm going to die anyway but But he didn't really make the decision in this case. He was suffering from acute heart failure. And by the time he was taken back to initiate the transplant surgery, he'd gone into shock and his heart had stopped already.

He was already dead, basically. It wasn't like a voluntary thing. Well, he knew he was going to do. They knew that this was going to happen that he might wake up. But he also knew he was going to die no matter what. So the doctors did the next obvious thing when he died in 1954 in Boston. And what do you think the next obvious thing was here, Taylor? Try to put his heart in somewhere else's body.

So, you know what? I wrote, that's right. They stuffed the chimpanzee heart into Boyd. So you got it wrong, and the outline isn't going to correct the record that you got that wrong. I don't know. I don't think I would have guessed that. So she got me. The story goes that it was like these surgeons who had been like tinkering with chimp hearts.

And they had, somehow they had four chimpanzees. the hospital. It's like that was more common because they were doing, they were doing a ton of like testing on it, right? I would feel weird if I went to like a, a hospital and they were also running like a part-time zoo in it. But yeah, I guess back then, back then it was the wrong word. Like animal torture chamber, I think is the right word.

Yes, yes. To their credit, to their credit, this guy's heart, sorry, the chimpanzee guy's heart did beat for, about an hour and a half, and he did come back to life for an hour and a half before the chimp heart failed on him. He was unconscious, right? He was unconscious, yeah. The first normal heart transplant, quote, unquote, was performed in South Africa in

1967. This one was a guy named Weschkowski, who survived for 18 days without any other medical intervention before dying of pneumonia, presumably due to the anti-rejection medication that he had to suppress his immune system. and that was part of the after it was like because nobody had done this you're just like tinkering

it's like baking a cake like okay so if I add like the eggs of the heart and then the immune suppression is like the flour and like how long you cook it is the surgery also so many veins so many veins

like insane amount of veins they're just so together I'm going to ask you this what do you think the most complicated transplant surgery is. Okay. So you're saying like,

face. I did not do any research on face surgeries because that is kind of a new invention. My dad says he wants to only donate his face. That is a funny. That is funny. I don't know.

All right, we're going to get to it. We're going to get to it. I was curious if you would have any assumptions here. You know what? We're going to get to it right now because I forgot that the next part of the outline is this piece. The lungs... Oh, okay, you just mentioned that.

Our particular challenge compared to all the other organs that have to be transplanted. So it took until the 1980s to really perfect this one. The lungs are the least likely to have long-term success. And the reasons for it are they are the only parts of your body that touches. Sorry, it's the only part of your organs that touch the outside world. You're breathing in air. You're breathing in pathogens. You're bringing in different things.

And the other factor is things like who can donate. a lung who can receive a lung for example the recipient can't have any infections or cancers or hepatitis they can't be overweight they can't be underweight they can't have a history of alcohol they can't this is fascinating they can't have a history a long-term history of smoking which who do you think needs the lungs right but if you smoke forever you damage your lungs you donate them well you can't donate them but you can't be the The, sorry, the recipient, the person getting the lungs can't be a smoker. And those are the ones that are most likely to require it.

The trick shot tends to be with these folks. They have to be basically healthy. And it's a little bit hard to come by a relatively healthy person. I think of our former friends who got, needed a lung transplant, but he needed it because he had to get cancer treatment that scarred his lungs. It wasn't because he was a lifelong smoker. But most people in your lung transplants need, need them because of smoking. do they usually keep smoking you can't so like part of part of the cessation process no part of the cessation process and this is also goes into like that income disparity and lack of

equality when it comes to this kind of stuff is that you have to have had a prolonged period of secession not just of smoking but of any nicotine or whatever and also counseling and psychological evaluations like you had to have gone through a very expensive and protracted process once you're qualified to even qualify to be added to the list for a lung transplant because they don't want to give these organs to just anybody yeah makes sense so i think this should be obvious but some donations require a living donor versus others that require a dead donor you have um let's say for example a full lung um a living person that can obviously not donate a lung, except in certain rare conditions in Japan and in the United States where a living

donor can donate what are called lung lobes, which I did not know. So when you look at the picture of the lungs and there's these like deep creases in them, you know? I'm going to look up lungs. I'm going to regret it. Those are the lobes. Those deep cuts that look like they're like chopped in there with like a cleaver. Those are lobes. So apparently you need two donors to create one full lung on the left side. In three, to create a full lung on the right side. But otherwise, you can only obtain lungs from a dead donor. Because you can't, it's hard to convince two or three living people to undergo this surgery.

So the creases are different sections. Yes. So it's not like one full lung. They're lobes. I'm going to throw up. They're lobes. You're filled. You're chalk full of lobes, Taylor.

Should I click on the ones that have like the blurred and image? I think I will. It's got to be so gross. I've seen like as a. Child of the 90s. Do children still see pictures of black lungs? I don't know, do they? There's also a very...

Do you ever watch Hannibal, the TV show? No, I should. I should probably watch it. I need to start over. I think it was... I watched a couple of seasons. I forgot where I was, but obviously he's a cannibal. But he does this, like, he is also a, like, brilliant chef, you know, in this one.

And so they have, like, really long scenes of him, like, making this beautiful dish out of lungs. And then I, like, read an interview with, like, the set designer. and she had to like make them out of other things you know obviously like like them look as much like lungs i you should watch it but also you just not eat when you do yeah it's gross it's all gross i i can't do those meats i can't do i can't do lung i have i have not jesus lung i can't do liver like i've tried liver before and i just cannot apparently those meats are the best for you though they're the most i know i was going to say

that if you are in a down-a-price situation pull up the liver and eat it, that's going to help you the most. If you're in a what situation? A donor party situation. A donor party situation. Okay. It's fair. So I'm assuming

can you guess the most in-demand organ possible for transplantation? Heart? Kidney. Kidney is the most. So in the U.S., about 91,000 people are waiting for a new kidney. And there's 100,000 people total on the overall organ donation list.

So it's a huge chunk of what people need. There are a lot of differences in supplying someone with a kidney versus anything else. For example, if someone receives a complete healthy lung, their survival rate tends to barely be about half. Like it's about 52, 53% for five years if you get a healthy lung from someone. By 10 years, a lung transplant person is about 28% chance of survival. The person that we're thinking about, he lasted 11 years, if I remember correctly. But I think you also had double lung transplant, didn't he? He did, I think so.

He had two different ones. Yeah. Oh, my God. Lungs are so gross. Hey, love the ones you got. Yeah, for real. Stop smoking. I know it's great, but stop it.

You don't want to deal with this. Do you have failed brought to you by Marlboro. Oh, God, remember when the cigarette people would come into the bars and give you free lighters and stuff? I don't recall. all that in new york all the time there were cigarette people and they would come and they would be like hey try these marlboroughs here's a marlborough thing you can get your points and like get a jacket you know you get like marlboro points oh yeah of course yeah but then there's all people that were like there's jobless to get you to do it yeah of course it's good business

the heart is slightly better on the survivability rate um after five years it's 69% for women and 73% for men so uh go men although it's interesting because If a man receives a woman's heart, John Hopkins has determined that their survivability rate after five years decreases by 15%. And this tends to be because men need larger hearts and there's a different cardiac output based on the size. And so that's part of the reason. Also, I didn't know this, but apparently women have way better immune systems. And that's really good for like normal stuff. But apparently women are also, what is it, four times more likely to develop.

autoimmune diseases than then because like their body will attack because their immune system works that well that it can attack itself um and also a lot of this stuff you're like I said you're kind of tinkering like with how much rejection to take and how much not to take and all that stuff and so having two different gender organs together can mix mix the whole thing up yeah never thought about that yeah I didn't either makes sense though yeah do you have to have the hardest one that this seems like sizes you? I don't think you need to have the same size. I think they just do the calculus based on your eligibility for it, your compatibility with

it. And then, hey, like, you might have gotten one and you're off the list and this is going to last you probably five years. And the next guy might get 10. We don't know. Right. You just kind of hope for a good one. Yeah, we're going to go into the details of that allocation piece because that is

incredible. So I share all that to say that organ transplant in general are like kind of. non-obvious and mostly not totally quantifiable in terms of what'll work how long it'll work who it'll work for all that stuff like the human body is kind of complicated there's a lot going on in there yeah so by comparison of the hearts and lungs kidney transplants after five years you have about 80 to 87% chance for survival so it's pretty high yeah with living donors their quality of life isn't severely impacted so the donor giving the kidney isn't severely impacted the remaining kidney apparently will grow to compensate for the missing one in a lot of

cases and typically they go back to normal life within four to six weeks was kind of incredible yeah the only obvious risk or challenge i could find was being a donor other sorry with being a donor other than the few weeks of discomfort was slightly higher risk of complications during pregnancy and apparently difficulty in getting life insurance or in some states you get higher health insurance premiums that's it there yeah so that's a little bit of the demand side let's get to the supply side real quick because this is where it gets super juicy juice e there are two ways to obtain organs voluntarily and voluntarily let's get to the easiest one first which is voluntarily with no duress no coercion and you're talking to a organ donor so spain apparently has the

highest rate of transplant surgeries on a per capita basis and it's interesting because it's because they have well part of the reason is because they have an opt out system can you guess what that means that you cannot oh that it's not opt in it's out yeah yeah every citizen is by default an organ donor unless they explicitly state that the wishes not to be an organ donor they also accept more donor types than other countries do for example they will accept organs from elderly people which most countries don't they won't like there's a certain cutoff here and also an interesting thing that we don't do here in the u.s. is that they consider the organ donation and organ harvesting process to be part and parcel with the end of life support for

somebody when you're in the room doing like palliative care like those people were there with well not probably breathing over you like the grim reaper but still you know what I'm saying with like a cooler I know it's like hey we're ready to go choppers choppers fueled up let's get the show on the road guys the US is the highest in terms of absolute organ transplant surgeries but we use an opt-in system so let's look at the donors starting with the legal framework for deciding who is a organ donor for the sake of being dead to harvest their organs. You are legally dead if there has been irreversible cessation of circulatory and respiratory function or irreversible cessation of all brain activity.

One is obviously better than the other. It's the brain one. Yeah. So these two factors are determined by physicians who have nothing to do with the patient's care, the one who's dying being the donor, or the recipient. care whatsoever. Basically, it has to be a total random uninterested doctor who assesses

whether you are dead for the purpose of organ donation. Once that's determined, then organ donation, the process can be started with the appropriate consents before death or through family consent. So, what I was saying earlier, that

in Spain, this is part of the end of life, you are dead. Then the process begins. So like you're losing time here. Like the window of time is gradually. Because your body is decaying immediately. That's why I said one is better because it doesn't decay immediately

if it's brain death. So condition is somebody being brain dead because the heart doesn't depend on the brain to pump. So it just keeps on going. Meaning the heart keeps oxygenating the organs that you might eventually want to transplant. Then there's

donation after circulatory death or DCD. This happens when the person has severe head trauma, but brain isn't dead yet these are more time-sensitive situations where life support is withdrawn a two to five-minute window of time is observed to ensure death is not reversing itself which should have been in the final destination movie i just saw yesterday but oh you how was it fun oh my god i cannot wait we know the we know the producer he's someone that wanted us from film school so we're even more excited tell him he did great oh i can't wait and tony todd was

incredible. I'm so glad that he's dead, but, like, if that was a last movie for him, that's the one for him. Ah, so exciting. I felt like, I almost felt like it was like too good having him in there. Like, he added a gravitas to the movie that was like, whoa, like you just like kicked it up like several

notches and I was expecting this to be like it was just a popcorn flick. Wow. So anyways, you had a two to five minute window of time. Then you make sure death isn't reversing itself and then the body is rushing a surgery to retreat the organs. I mentioned earlier that Spain includes organ donation as part of end of life treatment. Like I said,

this does not occur in the U.S., mostly because I think the U.S. has more of a conspiracy mindset when it comes to this stuff. Like, I'm sure you've also heard people talking about how doctors will not save you because they want your precious organs. Yeah, yeah. Yeah, I don't know why we ended up with that mentality

here. I understand why for one demographic we're going to touch on later. I don't totally get why that's the case here that's why it is totally separate it's all deliberate yeah so nine states plus washington dc have individual decided physician assisted suicide laws meaning that you on your own can just show up to a place and say i want to die montana yeah california's one of them cool montana has court approved physician assisted suicide in none of those cases can the organs of those people under any circumstance consent or not be donated and then again there's no physician no organs from somebody who passes from physician assisted suicide

can ever be donated under any circumstance interesting oh is that okay tell me why well the why of it gets into the moral and ethical kerfuffle that we're going to definitely go super deep into and and part two of this topic. But it's the moral aspect of it. It's like you don't want people to, I would assume that part of the logic around this is that you don't want to create incentive structures for people to do things that society might deem

not helpful on an individual basis. So somebody who is, if somebody's suffering from like something horrible, like a horrible, horrible, horrible cancer, and they are never going to recover and they want to get a physician-assist suicide, A, they weren't going to be a candidate anyways, right? Because in that situation, your organs are not transferable to another healthy human.

So you're basically cutting out every demographic that could potentially be a donor, except for the ones who are obviously severely mentally ill. And those people make decisions that are not reasonable and rational. And you don't want people who fall into that line of thinking to have incentive structures around, oh, I'm doing something good. I should kill myself. It's going to help these other people. Right.

I think that's the theory behind it. I get that. I mean, obviously, like, the whole bunch of reasons someone might choose that, but, like, that definitely makes sense for it. And also, like, you could easily become an organ harvester. You can, imagine how many people are manipulated into, like, being only fans, people, or whatever. Like, you could, you could find, you could obviously see a universe where people are like, yeah, you should do this and your family will get a $50,000 or whatever.

We're going to get it super deep into this because the moral, aspect of donating is like really touchy for people I think going back to this so once the person is declared dead that's when the organ donation process starts the hospital will contact what is called the organ procurement organization the OPO which is a non-profit that is funded entirely by the government it's its own separate entity but it's all run of the office of the government so it's basically the government outsource all this the federal government I meant outsource all this to this one nonprofit and it's their job to recover the organs the opo then checks donor registrations and contacts the family if the consent is received then the body is placed on ventilators and

fluis to preserve the organs and then the organs are recovered matching happens and the organs are sent to the recipient's hospital there's one thing i learned about this which like was incredible look up heart in a box on google and i know that that we imagine people are just running around with organs and like Coleman's little fridge things like in little coolers actually a picture of that but oh cool that's cool you know you say that's cool but if you watch a video of it after this you're going to be like what Frankenstein contraption is it they're keeping it alive are they're keeping it so basically what this contraption does is it keeps it active so if you actually watch a video of it if you see a picture

You're not going to be able to tell, obviously, but if you saw a video of it, it is a literal human beating heart completely removed from the body and just floating in this box. It is dystopian as dystopian gets. I hate it. But it's a way to keep the heart live, and it's a way to keep it from getting like freezer burn before transplantation. So that's the incentive structure for that. I know you don't remember. There's been around one tree hill when they dropped the cooler with the heart in it. the dog eat it in the hospitals you know what's funny taylor you said that and i kind of do remember

that actually out of all the things you've ever asked me um so we discussed the class uh the class of people that are not one class of person that is not able to donate organs and that's the medically assisted suicide people there's a pretty extensive list so this is interesting so typically people with HIV can't donate but in the U.S. in 2013 they passed the Hope Act which allows people with controlled viral loads of the disease to donate to others who also have it so that's good the the thing I didn't know is like even even when they decided to this it's also super rare that we actually do do this in the U.S because apparently there's a thing called HIV superinfection.

Have you heard of this? No, that sounds bad. It's when an HIV positive person gets infected with another distinct genetic variant of the same virus. Mm-hmm. So they, like, have to find new ways to treat it because there's now multiples of it. It's like, apparently. So because of this and multiple different reasons, even under the Hope Act, this is super,

super tightly controlled. like I said earlier cancer patients they can't donate because of the risk the cancer cell could spread to other people anyone with a prion disease

is absolutely restricted from donating zero exception so mad cow disease that is full stop amazing yeah also this one is interesting so if someone dies like under mysterious circumstances

like their cause of death isn't like obvious they are also excluded or people who are living like a risk your life lifestyle like prostitutes or intravenous drug users they're also excluded people who have been say again i mean that makes sense yeah and people who have been incarcerated or died during incarceration are also excluded death row inmates can never voluntarily donate their organs like that

is a no no and again that goes back to like the moral and ethical aspects of this which is like yeah what are we going to do we're going to start telling people to get rich people's to have these organs like that's that's a whole thing also what's really interesting is people who die outside of a hospital and they're far enough away from a hospital they never get to donate their organs even if they consented because they're too far for their organ retrieval so oh that's too bad yeah so all the people like in car accidents or plane crash i guess the organs swore up anyways but still yeah so let's break down the key demographic data of donor versus donor recipients so the age age wise donors are typically between 35 and 49 years old

And no shocker, the recipients are older adults in the 50 plus age range, which we are rapidly approaching, which is like super weird that it's called an older adult. Gender-wise, women are disproportionately represented as 64% of living donors are women. And the reason generally seems to be that like it's for family members. It's like they're more, you know, that aspect of it. The recipients are men. They're disproportional recipients of organs, about 60 to 70% of all organ recipients are men. racially black americans are disproportionately represented on weight lists for transplantation um they make up about 14 just under 14% of the overall population but make up 30% of the

transplant list and some of this has to do with the fact that there's a apparently three to five times higher rate of end stage renal disease and kidney failure amongst black Americans and white Americans. This part kind of gets a little bit, we're going to dive into this into more detail, but it gets into the socioeconomic disparities around things like donation and transplantation in overall kind of health outcomes because this kind of plays a big deal in it. There has been called out in several research papers about the Tuskegee Airman study and how things like that built a deep distrust within black Americans of like the medical community and why like some of the guidance being offered there isn't necessarily adhered to also like i said like if you are

not close to a hospital to get the donation when the call comes or you there's reasons why you wouldn't be able to accept the donation even if you were allocated of one and a lot of them are due to your socioeconomic status so that's the benefit of all this and the biggest one tends to be wealth which is like shocking to no one. I mean, we know, the person that we know that had the long transplant who has since passed away,

but they definitely had someone who has a lot of money talk to people and say, do this. Yeah, I think it was like three billionaires. Yeah. Yeah. We were like, cool.

And then a lot of us were like, that fucking sucks. Well, I want to actually get your opinion on this. and we can actually dabble in it before we get into the second pieces because I am curious to hear your perspective on and kind of debate this a little bit. Getting to the wealth piece.

So on paper, the organ allocation program is designed to be impartial and neutral with no consideration given to wealth. So that is like, that's how it's supposed to work. And it actually does do that because the algorithm

running the checks on availability versus need, it said the United Network for Organ Sharing or UNOS, it's not able to be gamed. Like the algorithm is algorithm. can't gain a base during your wealth. The thing that it looks at is that it looks at medical urgency, so the sickest people go to the top of the list.

Then the next step is it looks at the time of the people that are on the wait list, and then it goes through the compatibility aspect of organ compatibility, geographic territory, regions, all that stuff. So it tries its best to get the people who need it the most first. Exactly, exactly. It's not actually, like, it's not, in its nature, it's not designed to be gamable. it is though so

sorry sorry that was funny you were like it is though in various ways so you can't be evaluated at all to join the transplantation list unless you undergo extensive

medical evaluations you have to consent and do consistent health care follow-ups on ongoing basis you have to show proof that you can handle the post-transplant

care including the immunosuppressant drugs, and those can run somewhere between $10,000 to $20,000 per year. Wow. So it is an inherently very expensive thing to do. And there are people who were in need of organs that were denied access to the list because they could not fulfill all the requirements of being on the list.

Yeah. So that's where money comes into play in part. There's other parts where it comes into play because the people who are super, super duper wealthy, they can afford consistent travel. They can afford homes in multiple locations. They don't have to be confined to a specific geographic territory where the donation could occur.

So let's talk real quick about Steve Jobs. Have you heard the name? I have a yes. Great. So in 2009, the waitless in California for a liver transplant could take up to five years just due to the need there. By comparison of that time, Tennessee only had a few-month waiting list. In 2009, while still living in California, Steve Jobs got listed in Tennessee on their

wait list for a liver. Wow, I don't know that. Which wasn't a problem because when the liver became available, he and his team of caretakers, his doctors just boarded his private jet and then scooted over the facility. they got there in enough time as somebody who's poor in rural Tennessee would have had to drive all the way there. Right.

So you get access to this broad pool and he got his operation, he got his liver transplant, and I mean, he ended up dying anyways. I mean, you would because it's a, well, the lung was a hard one. It's so like he ended up dying. But regardless, he had access to do that.

He only waited a few months when a lot of people would have waited half a decade, if not longer. Wow. So according to a 22 audit of UNOS, there were hundreds of missed transplant operations that could have happened every year but didn't because of lack of communication, delays, or patient availability. People who have missed an organ transplant surgery did so because they might have missed a call. Their cell phone was dead. The battery was dead. Or there was bad weather making transportation super difficult.

Or because they arrived to the hospital, additional tests. found something new that precluded the operation, which are all things that you would have known if you were rich and were surrounded by a team of doctors. So, like, there is a disparity in potential outcomes here. All that to say, I'm going to go ahead and stop this here because the next segue after this has to do with the supply side on the coerced legal and the illegal organ side of things

and the worst of the worst, which is the involuntary. organ i don't even know if you call donation side of things but i will say oh yeah donation i don't think well i don't know whatever when i was when our friend was going through what they were going through i do remember thinking that if somebody wants to be paid to give away their organ and is like exorbitant comps like life-changing money they should be a lot to do it yeah like one of them like a kidney not like your heart yeah of course yeah yes yes yes you can only do it once you only do it once but i'm sure you can find someone yeah like so part of the thing we're to get into next week is that places like the philippines um the outskirts of russia like

thailand places like that people are getting paid like 1600 to like two thousand dollars to sell their kidney and when you hear the other side of it somebody is paying 120 to $150,000 to get a kidney right so that person the middle man's making all the money that's where I have like a huge moral issue with it is like how screwed over like that person should be paid a ton for what they're doing they're not and that is bad and so anyway i think that's where i land on this i will say that the world health organization was offered a pilot program for federally paid for organ compensation and they refused it and the reason they refused it was around how there's a coercive effect potentially of paying people

for organs and that's probably also true so i don't i think i get both sides of the equation. It's just I don't know I don't know how I feel about it yet. Yeah, it's gross. Weird. Give any you have an opinion on it. No, I don't know. I feel like you should

I don't know if it was like you get like a ton of money and people would be like lining up to do it once. I don't know. But then what happens when that one kidney starts failing? Right. Then you just create a machine that just, self-perpetuates right yeah you know what and that's not good for you to continue to go through like that over and over again no i read i read that the dialysis process is typically three times

per week with it being five to eight hours per session yeah it's awful it is like it is debilitating time but again if you're wealthy you can afford one that's in-house so they can run while you're sleep and it's still uncomfortable and it's still awful but like you know again the wealth thing comes in a play here so yeah um but we'll we'll talk about that in more detail also one country came up which is the only country in the world that allows for legally selling organs which just blew my mind we do you want to guess which one yeah uh canada no no i'm not gonna tell you because i'm gonna i'm gonna i want to ruin this but it it will be shocking when you hear it but um anyways that is the story a brief story this topic is so complicated and so fascinating um if anybody has

any stories about this i would love to hear them because it sounds it sounds almost like the medical science this is still kind of in its infancy there's some talks of them being able to grow organs and through from stem cells or using um uh fetal pig organs right we've been talking about that for like 30 years but that's that's what I mean like it's so complicated like our bodies are crazy complicated and like the I mean just the fact like even between same age adult same race and everything people who are of the of a different sex it doesn't work like it is super nuanced and complicated obviously I also have like same blood type right yeah do you Yeah, that's the, that's the easiest, that on the checklist, that's the easiest box to typically check, unless you're one of the rare blood types.

But like, for the most part, that is the easiest one to check. The hardest thing it sounds like is just going through, in the U.S., is just going through the process of not intermingling, life saving with organ donation. Because it creates this complete and utter firewall between the two. and that kills time and time is the enemy of getting organs that are healthy into another person and so really interesting stuff but yeah I realize

I'm not qualified to be a doctor in this process I think it's too late yeah probably thank you I think it's a little bit part of it also I just looked up to Cheney's still alive because he doesn't have a pulse right if you heard that so does he have like the only robot heart

in existence. He might. He might. He did. So I think he got one hard transplant. But he has like, he had like, he had a, I think his first heart attack was like 30 years old. He was like crazy young when he got his first heart attack. But also, he was super fat or Christian Bale played him super fat. I didn't watch that. God, I don't know. I have a very controversial thing to say. Let's, let's hear. We can edit out if we have to. He looks kind of cute in his Wikipedia picture. Oh my God. just his punishment i'm not going to edit that out he's like kind of like winking at you a little bit are you looking at christian bail or no i'm looking at dick cheney i don't feel good about this i'm just sharing it uh yeah he is he is a very very uh let's call him a unique and complicated person somehow still alive despite having a robot hurt dude they all went through this like did i think like clinton have like four bypassers he did yeah

like all these guys like they do these like crazy high pressure jobs except bush bush seems chill i think it's because he smoked so much weed when he was drunker had to beat the weed good for him good for him um yeah no um cool super interesting lots of factors go into it um but yeah we'll leave it there i think next we seem to be super interesting I kind of left the boring stuff for this episode because next week is like we're guessing like the gritty like human drama of the transplant trade

and what goes on there. Oh he's, okay, I'm sorry. I'm on Dick Chains, he smoked three packs of cigarettes a day for 20 years. He had his first of five heart attacks in 1978 at age 37. So I will say this and I know that this is going to get me probably flamed.

He is winked. he is winking I don't like that no I will I will say this like the more I'm reading about like the complications of the human body and everything that it entails

the less into the body positivity thing I'm into because it is conclusively scientifically unequivocally proven that a healthy body weight is necessary yeah that's different for everyone

and that also goes for the guy like there's all these bodybuilders who are dead at like 30 years old absolutely because absolutely destroys their heart yeah it's this is not like a don't eat pancakes for breakfast conversation this is like a do the right thing yeah don't do extremes on any equation like all those guys like your body's only meant to handle so much like certain designed a certain way and like if you operate outside those boundaries it affects everything so Plain me if you want. I think of cigarettes a day is constantly sweating cigarettes.

You said three packs a day? Yeah. For how long? 20 years? I mean, good for him. I can't leave us alive. Good for him. See, like, you don't want his, you don't want his lungs in you.

No. His lungs are charred. Or maybe if you get part, one of his organs, you too can live forever from whatever deal he made. There was something about how there was. able if you're a there's something about live organ donations for children that i'm struggling to remember right now but it's something along lines of you can do a liver transplant to a live donor to a live recipient if it's a child because what they can do is snip a piece of it off graft it and then it'll grow the recipient grows back and the new one gets the full one when it grows

up. Gross. Can you look up if it's true that dentists practice on real human heads? Shatcha BT to the rescue. I mean, I don't have to look it up right now. I mean, for the next episode. I could, I could do it also from the computer.

My mom told me that she saw human heads in a thing in a conference room at work one time. Yeah. Yeah, they have. I specifically put in my will that I don't want my head to go to dentists. All right. Well, hopefully that is,

it lost in the melee of your cremation or whatever's happening. I hope it helps with you because they don't want to look at stuff on my heads. My head. This topic all came up, Taylor, because Rachel was telling me about the body's exhibit. Oh yeah, I've never seen that.

I never seen it either. She said it was really incredible. She was also like, did you know that it was like Chinese dissidents and like the... There's definitely someone who's like, I think my son's in it and they won't tell her if it's him. So that is in the outline. I'm going to cover that at the very

end under miscellaneous. The outline's already done. Good for your week ahead. I love when I find a topic I'm super interested in because it's not like working. I'm just like super interested. I want to keep going to keep going. Anyways, hopefully you guys found that interesting this episode dragged down a little bit. Apologies for that.

Taylor, do you have anything to read us off with? Um, no. But thank you everyone for listening. I had some fun conversations with folks on Instagram this week and if you have any ideas for us, let us know. We're at doomed to fell pod at

gmail.com. We have a Patreon where you can opt in to add free episodes forever. I'm on TikTok a bunch and yeah, mine as there. Doom to fail pod. All things. Thank you all. Thanks, Taylor.