Occasionally, a story comes along and I sense that there is a message in that story, but I cannot quite decipher it.

I had that sense when I heard that Charlie Spoonhour died.

The much-loved basketball coach had a lung transplant at Duke University Medical Center in August 2010. The stories at the time noted that West Virginia coach Bob Huggins had called Duke coach Mike Krzyzewski to help get Spoonhour approved for the surgery. That seemed odd.

It didn't seem odd that Krzyzewski could help get somebody approved for a transplant at Duke Medical Center. Coach K is Coach K. I can't imagine anybody at Duke turning down any request of his.

But why would Spoonhour need help? He wasn't destitute.

A friend of Spoonhour's offered an explanation. The friend said Spoonhour had been considered too old for the surgery. He was 71 when he had it. It was not a matter of age discrimination, the friend said. Nobody was suggesting that younger people were more deserving. It's just that a lung transplant is so physically stressful that older people don't do well. Their bodies can't tolerate it.

That made some sense. That would explain why Krzyzewski had to intervene on Spoonhour's behalf.

Sadly, Spoonhour didn't do well. He was in and out of the medical center from the time of the operation until his death Wednesday. His weight had dropped to 110 pounds.

It was all very sad. But was there, is there, a message in the story?

If so, it's about rationing health care. By necessity, that is exactly what transplant teams do. There are not enough organs for the people who need them.

So these organs are rationed. It's a delicate dance. If you require a transplant but are still relatively healthy, your case is not a priority. But if you get too sick, you might be considered a poor risk to survive the operation. Ideally, then, your condition should be grave but not too grave.

Then, too, there is the question of culpability. Consider a lung transplant. Should a nonsmoker be given preference over a smoker?

"That debate has been going on since transplants began," said Greg Richardson, the manager of heart and lung transplant coordinators for the Barnes-Jewish Transplant Center. "Some people feel very strongly about it."

Strong feelings aside, the consensus in the medical community is that culpability is not a medical criteria. At Barnes-Jewish, for instance, a lung transplant recipient has to have been tobacco-free for at least six months. That's it.

Spoonhour never smoked.

Incidentally, I suspect that most laypeople would disagree with the medical community. I think most of us would consider culpability to be a factor. Nonsmokers would have priority over smokers.

How about power and influence? We should be honest about this. Power and influence are always going to be factors.

I remember watching Dick Cheney on television last year talking about the new heart pump that doctors had implanted in his chest. He said he was grateful to medical technology. Without the pump, he said, he would have required a heart transplant.

He said it quite casually, and I was struck by the realization that he had no doubt at all that he would have gotten a heart. He was 70 and a former smoker.

Perhaps the most famous case in which culpability and influence came together was when Mickey Mantle got a liver transplant 48 hours after his name went on the waiting list. He was an alcoholic. His liver cancer was almost certainly related to the fact that his liver was cirrhotic. He died three months after receiving his new liver. That happened in 1995. That same year, 804 people died while waiting for a liver.

I have no answers. If I were in charge of things, Spoonhour would have gotten his lung transplant. In the first place, he had no culpability. He had idiopathic pulmonary fibrosis. Idiopathic means no known cause. In the second place, he was a great guy. A wonderful person. Goodness should count for something.

Of course, that is not the way the medical community looks at things. Perhaps when you have the power to play God, you make an effort not to be judgmental. Not about culpability and certainly not about goodness. You stick with medical criteria.

I asked Richardson if Barnes-Jewish does lung transplants on people over 70.

"We don't have an absolute line in the sand," he said, "but for this operation, I would say it's going to be a very small number of people over 65."

That was probably the sentiment at Duke until Coach K intervened. I admire him for helping a friend, but maybe medical decisions should be left to the medical community.