As a liver transplant recipient (7.5 years out), I find how transplant patients are stereotyped in this somewhat informal article a bit misleading.

First, transplants are about as close to a life-changing miracle as you can imagine. By which I mean night and day change for a reasonable subset of patients. The fact that we now have anything like access to interchangeable parts that can let people live extremely normal lives is absolutely remarkable. Before transplant there were times when I was too weak to walk. One month after transplant I could walk a mile, three months after five miles.

There is zero question I'd be dead by now without my transplant. I might have lived a year or so more with my old one, but it would have been an unpredictable high-wire act between GI bleeds, encephalopathy, coma, and fear that any simple action might trigger an emergency trip to the emergency room. Internal bleeding and encephalopathy put my in a coma for three days and, when I came out, this PhD computer scientist couldn't remember my own kids' names. Now I'm writing this. I am simply so fortunate to be able to have this second chance in life.

As for the misleading parts, "Organ transplant patients are, by their nature, sick patients." Yes, but that's why they get transplants. Many get better. Look at livers. Viral hepatitis (in my case, Hep C) is one of the most common reasons for liver transplant. But we can cure Hep C. I was one of the first people cured before transplant with Gilead's Hep C antivirals. The new liver fixed my cirrhosis. Now I get sick less often than my kids, and my life is extremely normal except for a couple pills a day (tacrolimus) and lab tests every three months. I was a mild hemophiliac, and that was cured by the new liver as well.

If you looked at my lab tests, besides a low platelet count, I would look perfectly normal. And especially for livers, which deal with processing a lot of foreign substances in the body, so it probably more tolerant than other organs, the lifespan on them may be quite long. Older liver transplant patients can sometimes even drop their immunosuppressants completely.

So, for people who have curable diseases, the health of a transplant patient can be quite good, potentially better than their peers. There's no specific reason they as a single less healthy class (as opposed to a set of classes, which also includes people who abuse alcohol or have diseases we can't cure).

To answer some other questions in the discussion, the transplant process tries hard to keep someone from being able to literally buy their way onto the transplant list. For livers, priority of transplant goes by a lab test called MELD which estimates 90 day mortality. You have to be sicker than other people but healthy enough not to waste an organ. It's a fairly macabre competition.

There are, however, advantages to those with means. In the US, organ transplant is administered nationally but organs are still basically allocated regionally. If you can travel to another region in the country with a surplus of organs, you can get a transplant sooner. I did it. It saved my life.

You also need to go through a battery of tests to make sure you are, basically, a good host for the rare organ. In general you have to stop substance abuse. You need to lose weight. You need to take a physical which can disqualify you. You need to have a social support mechanism to help take care of you after surgery (in the hospital, after discharge, and long term).

Finally, you need to have insurance that will cover the potentially million dollar surgery and and complications that might follow. And that means there's another hidden process that happens in the insurance company to assess whether you're a good risk or not.

Most of those conditions strictly require wealth. All of them benefit from it, especially access to health care. On the other hand, it isn't clear that access to health care is strongly correlated with an absence of dementia, is it?