Steve Jobs

of Jobs’s oncology team was Stanford University’s George Fisher, a leading researcher on gastrointestinal and colorectal cancers. He had been warning Jobs for months that he might have to consider a liver transplant, but that was the type of information that Jobs resisted processing. Powell was glad that Fisher kept raising the possibility, because she knew it would take repeated proddings to get her husband to consider the idea.
    He finally became convinced in January 2009, just after he claimed his “hormonal imbalance” could be treated easily. But there was a problem. He was put on the wait list for a liver transplant in California, but it became clear he would never get one there in time. The number of available donors with his blood type was small. Also, the metrics usedby the United Network for Organ Sharing, which establishes policies in the United States, favored those suffering from cirrhosis and hepatitis over cancer patients.
    There is no legal way for a patient, even one as wealthy as Jobs, to jump the queue, and he didn’t. Recipients are chosen based on their MELD score (Model for End-Stage Liver Disease), which uses lab tests of hormone levels to determine how urgently a transplant is needed, and on the length of time they have been waiting. Every donation is closely audited, data are available on public websites (optn.transplant.hrsa.gov/), and you can monitor your status on the wait list at any time.
    Powell became the troller of the organ-donation websites, checking in every night to see how many were on the wait lists, what their MELD scores were, and how long they had been on. “You can do the math, which I did, and it would have been way past June before he got a liver in California, and the doctors felt that his liver would give out in about April,” she recalled. So she started asking questions and discovered that it was permissible to be on the list in two different states at the same time, which is something that about 3% of potential recipients do. Such multiple listing is not discouraged by policy, even though critics say it favors the rich, but it is difficult. There were two major requirements: The potential recipient had to be able to get to the chosen hospital within eight hours, which Jobs could do thanks to his plane, and the doctors from that hospital had to evaluate the patient in person before adding him or her to the list.
    George Riley, the San Francisco lawyer who often served as Apple’s outside counsel, was a caring Tennessee gentleman, and he had become close to Jobs. His parents had both been doctors at Methodist University Hospital in Memphis, he was born there, and he was a friend of James Eason, who ran the transplant institute there. Eason’s unit was one of the best and busiest in the nation; in 2008 he and his team did 121 liver transplants. He had no problem allowing people from elsewhere to multiple-list in Memphis. “It’s not gaming the system,” he said. “It’s people choosing where they want their health care. Some people would leave Tennessee to go to California or somewhere else toseek treatment. Now we have people coming from California to Tennessee.” Riley arranged for Eason to fly to Palo Alto and conduct the required evaluation there.
    By late February 2009 Jobs had secured a place on the Tennessee list (as well as the one in California), and the nervous waiting began. He was declining rapidly by the first week in March, and the waiting time was projected to be twenty-one days. “It was dreadful,” Powell recalled. “It didn’t look like we would make it in time.” Every day became more excruciating. He moved up to third on the list by mid-March, then second, and finally first. But then days went by. The awful reality was that upcoming events like St. Patrick’s Day and March Madness (Memphis was in the 2009 tournament and was a regional site) offered a greater likelihood of getting a donor because the drinking causes a spike in car accidents.
    Indeed, on the weekend of March 21, 2009, a young man in his midtwenties was killed in a car crash, and his organs were made available. Jobs and his wife flew to Memphis, where they landed just before 4 a.m. and were met by Eason. A car was waiting on the tarmac, and everything was staged so that the admitting paperwork was done as they rushed to the hospital.
    The transplant was a success, but not reassuring. When the doctors took out his liver, they found spots on the peritoneum, the thin