June 29 (Bloomberg) -- Steve Jobs, Apple Inc.’s chief executive officer, got a liver transplant quickly because of a U.S. system that favors patients with the means to rush to geographic areas where there is less competition for organs.

Memphis, where Jobs got the transplant, is one of several U.S. meccas for liver patients who can afford to travel, doctors said. Flight records show Jobs’s personal jet flew at least six times this year from California, with one of the longest transplant lists in the U.S., to Memphis, where the wait is shorter. He returned to work at Apple today after a medical leave that began in January.

Jobs, 54, got his transplant in part because regions can keep donated organs on a local list -- even when there may be sicker patients not far away. His experience spotlights organ allocation practices that have been under fire for decades and will be discussed at a national public meeting the United Network for Organ Sharing in Richmond, Virginia, plans for later this year, doctors said.

“You could call it gaming the system, that may be true,” John Fung, chairman of transplant surgery at the Cleveland Clinic in Cleveland, said in a telephone interview. “But until we tackle the problem of what makes the system unfair, we can’t criticize people who are trying to help themselves.”

Shorter Waits

About 17,000 Americans were on liver transplant waiting lists in 2008, and about 6,000 received them, according to the Scientific Registry of Transplant Recipients, a national database of transplant statistics based in Ann Arbor, Michigan. Patients go to transplant centers in Memphis, as well as in Jacksonville, Florida, because the wait is shorter than other parts of the U.S., said Elizabeth Pomfret, chairman of the department of transplantation at the Lahey Clinic Medical Center in Burlington, Massachusetts.

Memphis is part of Region 11 of the United Network for Organ Sharing, which administers the U.S. organ waiting list and allocation system. As of June 30, 2008, there were 4,120 patients on the list for livers in Region 5, which includes California, compared with 1,084 patients listed in Region 11, according to the registry of transplant recipients.

On the same date, there were 594 patients on the list at Stanford University Medical Center, 14 miles from Apple headquarters, compared with 98 at Methodist University Hospital in Memphis, where Jobs had his surgery.

Jobs received a liver transplant about two months ago, according to a person familiar with the matter. The median waiting time for a liver in Tennessee in 2008 was 135 days, according to the organ-sharing network. The organization hasn’t been able to make the same waiting-time calculation for California since 1996 because less than half those waiting got transplants.

MELD Scores

Patients in the network’s Region 11 receive livers before their health has deteriorated as much as in other districts, such as California’s Region 5, according to the registry of transplant recipients. The organ-sharing network divides the U.S. into 11 regions.

Under the organ-sharing network’s rules, most livers are allocated locally using a system called model for end-stage liver disease, or MELD, that assigns scores to liver health and function. Patients with higher scores on the scale of 6 to 40 gain priority for receiving a liver.

MELD scores rate the chances a patient will die of liver disease within three months and are adjusted as patients with chronic illnesses get sicker.

Steve Dowling, a spokesman for Cupertino, California-based Apple, declined to comment on how Jobs qualified for a liver transplant. Jobs didn’t respond to an e-mail seeking comment.

Geographic Divisions

Apple fell 47 cents to $141.97 at 4 p.m. New York time in Nasdaq Stock Market trading. The shares have gained 66 percent this year.

In Memphis, 8 percent of the waiting list patients progressed to a score higher than 30 before getting a transplant. In California, 25 percent of transplant recipients topped 30. The national average for transplant recipients above that score is 14.8 percent, according to the registry.

The geographic divisions mean a patient with just months to live can be denied a liver while a healthier person a few miles away gets a transplant because of lower demand in that area, said Russell Wiesner, a medical professor at the Mayo Clinic in Rochester, Minnesota, and former president of the United Network for Organ Sharing.

Organ System Criticism

Some surgeons in low-demand areas back the system because it allows them to perform operations that cost about $350,000, including extensive post-surgical care, Wiesner said.

“It’s a money-grab,” Wiesner said in a telephone interview. “Someone has to say this isn’t right. We need to maximize the utility of these livers and save the most lives we can.”

The organ system’s regional disparities have been criticized by doctors for decades, said the Lahey Clinic’s Pomfret, who is also chairman of UNOS’s liver and intestine transplantation committee. On June 24, she asked for a meeting of the organization’s board to discuss how to address regional differences in access to livers.

“There are people who are traveling to other areas of the country every day because the list is shorter there,” Pomfret said in a telephone interview. “Not everyone can just pick themselves up and move altogether.” She said her request for the meeting isn’t related to Jobs’s transplant.

Jobs’s Jet

Jobs’s Gulfstream V, a business jet made by General Dynamics Corp. of Falls Church, Virginia, flew into Memphis at least 10 times between March 24 and May 21 this year, according to flight records Bloomberg News obtained under the Freedom of Information Act. Whether Jobs was on those flights couldn’t be confirmed, and Dowling refused to comment on the plane records.

Patients with the means to travel also frequently list themselves at a number of transplant centers to increase their chances of receiving an organ, Pomfret said.

The organ-sharing network’s board has discussed banning liver patients from joining waiting lists at multiple hospitals because of possible unfairness to those who can’t travel, said Anne Paschke, a spokeswoman for the organization. The board ultimately decided in 2003 to require hospitals to inform all patients of the option of multiple listings, she said.

Patients who need new organs because of conditions that may not affect liver function, such as cancer, can appeal for higher MELD scores, said Aaron McKoy, supervisor of general review boards for the United Network for Organ Sharing. The appeal is anonymous, and doctors can advocate adding any number of points to their patient’s score, McKoy said.

Jobs Was Sickest

Jobs said in 2004 that he had a rare cancer in his pancreas. That kind of cancer, called neuroendocrine tumor, often spreads to the liver, according to the Cleveland Clinic’s Fung. Such patients often have fairly good liver function, and therefore, low transplant MELD scores, said John Lake, director of liver transplantation at the University of Minnesota in Minneapolis.

Jobs was the sickest liver patient in the Memphis area at the time the organ became available, James Eason, chief of transplantation at Methodist University Hospital, said in a June 23 statement confirming the Apple chief’s surgery there. Ruth Ann Hale, a spokeswoman for the hospital, declined to comment beyond Eason’s statement.

MELD Appeals

If Jobs’s MELD score was more than 15, an organ available near Memphis would have gone first to him, rather than be offered to sicker patients from other transplant centers in the region, which includes Tennessee, Kentucky, North Carolina, South Carolina and Virginia, according to organ-sharing network rules. Jobs may have had to appeal for more points to get his MELD score above that level, Lake said.

Lake and Fung said they haven’t treated Jobs and don’t know the details of his case. Apple’s Dowling declined to comment on Jobs’s MELD score.

The organ sharing network began using the MELD system in 2002 to objectively allocate scarce livers to the sickest patients and minimize people dying while awaiting transplants, Joel Newman, a spokesman for the network, said in a telephone interview.

The MELD point appeals process is needed so cancer patients aren’t disadvantaged, doctors said.

The local and regional system of organ distribution needs to be changed, Fung said. The Cleveland Clinic doctor argued for more than 10 years that the system should be reformed, then surrendered.

“After a while you get sick of beating your head against the ground,” Fung said.

To contact the reporters on this story: John Lauerman in Boston at jlauerman@bloomberg.net; Connie Guglielmo in San Francisco at cguglielmo1@bloomberg.net

Last Updated: June 29, 2009 16:31 EDT