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Life, Death And Privilege

New York Yankees great Mickey Mantle, 63, needs a new liver. So does Vietnam vet and former electroplating supervisor Richard LoBello, 47.

Mantle needs one because he has liver cancer and, his doctor says, a long history of alcoholism probably contributed to his illness. LoBello, little more than a social drinker before he fell ill, needs one because of a losing battle with hepatitis C, which the Providence, R.I., man contracted while in Vietnam.

Mantle, one of the bestknown names in sports, will likely get a new liver within a month. He’ll have a chance to live.

LoBello, whom you’ve probably never heard of, has been waiting for his transplant for 2 years. His illness forces him to spend most of his time napping, taking nearly 30 pills a day and trying to keep from bleeding to death when his liver failure causes blood vessels to suddenly rupture.

The two cases reflect the contradictions and conundrums of organ transplantation.

Because there aren’t enough transplantable organs for the people who need them, the hearts, lungs, livers and the like end up going to the people who are sickest, regardless of how much they contributed to their own illness.

It’s a shortage that raises questions about who is getting the precious organs, and whether the system for divvying them up is fair.

Late Wednesday night, it was reported that a liver had been found for Mantle, and that the transplant may take place this morning.

LoBello, a rabid Yankee fan who idolizes Mantle, stressed yesterday that he doesn’t begrudge the exslugger a new liver.

But he also wishes he could get a transplant before he has been completely drained of his savings, his energy and his life force. The way the rules are set up now, he said, “I have to be dying to get the transplant.”

Over 4,600 people in the United States are waiting for a liver transplant. Last year, 3,650 got one.

Many people die before an organ becomes available.

The fact that celebrities don’t seem to have that problem - musician David Crosby and singer Jim Nabors come to mind - has fueled the suspicion that prominent people don’t face the same wait or the same risk of death as the rest of us.

People involved in the organ transplant business say that’s simply not true.

The system is fair and “you can’t manipulate the system,” said Richard Luskin, executive director of the New England Organ Bank, which coordinates organ transplants in the New England area. “There is a set of national rules we all work under.”

In deciding who will get a liver transplant, the first rule is how sick the would-be recipient actually is.

Whether a person’s liver was de stroyed by a long history of alcoholism doesn’t factor into the decision, said Luskin. “There was an extensive debate on this issue early on, but that’s not a significant issue now.”

“You begin to tread into very dangerous waters when you begin to talk about who’s more worthy,” he said. “Alcohol abuse may be an obvious concern, but there are dozens of other issues that can be put on the table where it’s not so simple. Do you favor the young over the old? The gainfully employed over the unemployed? Someone who has a wife and kids versus someone who doesn’t?”

But, said Dr. Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, the real difference that fame makes is in whether a person is put on the liver transplant waiting list in the first place.

Caplan explained that “25,000 Americans die of liver disease each year. Fifteen thousand might have been transplant patients. But only a small number get on the transplant list.” That means, he said, that “clearly, crucial decisions about who gets on the list are made using all sorts of criteria: Can you pay? Are you famous?”

“Mickey Mantle has a better chance than Mickey-on-the-street who has no doctor or no access to health care,” he said.

“Americans don’t like to believe, or feign horror at the idea, that someone who is rich or famous will be able to get health care that may save their lives when others can’t,” Caplan said. But, he added, that attitude is “akin to saying it’s shocking to find out that gambling goes on in sports.”

LoBello’s wife, Judith, said she’s not sure how fair the system is.

One reason Richard hasn’t gotten a transplant, she said, is that he takes his medicine and she has worked hard to care for him at home.

If the pair had allowed LoBello’s condition to deteriorate, she said, he might have gotten his transplant by now, and he might have been able to go back to work.

“Money does make a difference,” she said. The rich “don’t have to worry about how they’re going to buy groceries or health insurance next week. I do.”

LoBello said he’s trying to be “as noble as possible. But you get depressed thinking about the things I should be able to do that I can’t do.”

“But you have to maintain your faith in the system,” said his wife. “You have to believe these people who are getting them are getting it because they need it.”

“It’s like the justice system,” LoBello added. “It’s not perfect, but it’s all we have.”