Misty Cargill

NPR recently told the story of Misty Cargill, a 25-year-old woman in Oklahoma who will soon need a kidney transplant, but was rejected by Oklahoma University Medical Center's transplant program as a candidate. The most notable part of her story is that Misty also has mental retardation and lives in a group home. The biggest concern brought up is discrimination, which in this form should have no place in any transplant program. This concern prompted a Christmas Day editorial by Timothy Shriver, chairman of the Special Olympics, in the Washington Post.

The medical perspective appears straightforward--Misty has a condition that will lead to end-stage renal disease, and appears to be in good enough overall health to undergo and live with a kidney transplant. We don't know this firsthand, but it's been reported widely and not disupted by any party.

The legal perspective is a conundrum. The hospital said in a statement that the reason they won't list her for a transplant is that they don't believe she's capable of making her own decisions and giving informed consent. But the county department of Adult Protective Services refused to assume guardianship, stating that she is capable of making her own decisions and giving informed consent.

The ethical perspective is worrisome. Not being inside this case or the process, I have no way to judge Misty Cargill's suitability for a kidney transplant. But from the outside, there's a young woman who appears to be a suitable transplant candidate and is being met with rejection, allegations, curt and carefully prepared statements, evasive and illogical responses, and hurdles and brick walls. Not the kinds of things that would make the average person confident in the trustworthiness of the system, the process, or the institutions and individuals involved.

This issue has come up before, in more extreme circumstances. In 1995, Sandra Jensen was denied evaluation for a heart-lung transplant by UCSD and Stanford, solely on the basis of low IQ. Her landmark case prompted intense reactions from Down syndrome advocates, and she was eventually evaluated and transplanted. Perhaps the best message to come out of it was the statement of the medical director of Stanford's lung transplant program: "We rejected her out of hand, based on a label. That was wrong, and I'm willing to admit that." A similar statement ten years later would be just as powerful.

While no one should hold their breath for such a statement, there have been more recent reports about this story. Misty's local paper, The Duncan Banner, reported on her initial reaction to the NPR story. A more recent report has even more information, most of it positive. Another transplant center has offered to evaluate Misty, offers have come for lawyers or picketers (hey, this is America!), and two strangers and four relatives have volunteered to be evaluated as kidney donors.

Ultimately, Misty Cargill's vulnerability to the transplant system is not that unique. Even if someone's IQ is 146 (double of Misty's 73), would they want to be under the care of the center in question? They'll be just as unconscious during the surgery, almost as dependent on the professionals at the transplant program for advice and guidance, and could suffer just as much from any misjudgements on their part. My hope for her, like all transplant patients, is that she gets the best care possible and the full support of the transplant community and those around her to lead a healthy life.