Steve Jobs, Liver Transplants, And What’s Next for Apple

Steve Jobs just wants to be left alone, and I don’t blame him. Facing down an organ transplant can be daunting, scary, all-consuming, and, perhaps most importantly, time-consuming. As I have some personal experience in the transplant business — mostly of the bone marrow kind, but I know a fair amount about what happens in the overall world of organ transplants, let me weigh in on what’s down the road for Jobs and Apple should a liver transplant be next on Steve Jobs’ to do list.

First and foremost, needing a liver transplant and getting a liver transplant are two different things. Lots of people need them — approximately 16,000 by the latest count — and here in Northern California, the average wait is 12-36 months, depending on the severity of the recipient’s condition. That’s the first hurdle of transplantation: you need a donor. And donors can be hard to find. Motorcyclists and auto accident victims provide a fair amount of the transplantable livers used for these purposes: suffice to say there’s a steady but indeterminate supply. This means that, assuming the health problems that are forcing his leave of absence won’t improve until he has a transplant, Jobs could be out of the picture for a number of years while he plays the waiting game.

Assuming a donor shows up before he he becomes too sick to be a recipient — way too many potential recipients reach this stage, or pass away, before an acceptable donor organ can be secured — the other issue to take into consideration is the short-term and long-term medical care that he will need as a post-transplant patient. Also assuming all goes well, Jobs will spend several months convalescing before he can return to some quantity of work. Most post-transplant guidelines don’t take into account what a Type-A, highly-driven person like Jobs is capable of trying to do before he’s ready. So, while the chance that he will try very hard to get back to work quickly is high, his potential success at a rapid return to work is not guaranteed.

Militating against a quick return to his former life will be the medications he will be taking for the rest of his life. Organ rejection is the main thing he will be fighting, and the only way to do that is to tamp down the immune-system so that it basically doesn’t try to kill off the new liver the way it would any other “foreign” object. This dumbing down of the immune system takes a drug regimen that is itself highly toxic, and exposes the recipient to the threat of opportunistic diseases, from fungi to the flu, that can make day-to-day living a lot more challenging for the transplant recipient. And a lot more scary. Even if Jobs remains generally healthy, managing his health will take a fair amount of effort — compliance is the number one trick to transplant survival, and non-compliance is the number one reason for post-transplant mortality.

So, with that background, here’s my take on Steve Jobs’ and Apple’s future together. Having lived for the last 15 years with a successful transplant recipient (my dear, still very healthy wife), I’m pretty sure that Jobs will be out of pocket for the next two years. If he chooses to keep his hand in Apple, it will be possible for him to be involved, but the day-to-day grind won’t be possible until a number of months post-transplant. Once he’s cleared the main post-transplant period, he could be almost as good as new, with the caveat that he’ll have to be much more careful and much more attentive to his health and daily regimen than he’s ever been before.

This means that Apple, and everyone else, should look at Job’s leave of absence as a first step in the post-Jobs’ era. Not because he won’t be back, but because he will be gone long enough that Apple had better learn to swim without him. Two years without strong leadership is a long time for a tech company, and longer still in the current economic climate. So, while we can expect Jobs back, we should be sanguine about what is going to happen next: Apple needs some new, strong, dynamic leadership, someone who can work with Steve waiting in the wings while taking firm control of the present. This could be one of the hardest jobs in tech today: playing first violin and second violin at the same time to the most demanding maestro in the business.

Considering Apple’s previous track record without Jobs (lackluster is the best spin I can come up with), I beg to differ with Jobs’ contention that this news is not “important.” A liver transplant will be life altering for Jobs, and Apple too. Considering how tightly intertwined the man and the company are, this is an important as it gets. For better or worse.

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