By Art Caplan, Ph.D.
Dick Cheney has just joined a list of high-profile people, including Steve Jobs, Mickey Mantle, Evil Knievel and David Crosby who, received a transplant and thereby created a controversy. Cheney received a heart on Friday from an anonymous donor at Inova Fairfax Hospital in Virginia after a 20-month wait. What is controversial about that? Cheney is 71 years old.
He has been through numerous previous operations that indicate he has other serious medical problems. He has only been able to survive due to the implantation of a left-ventricular assist device (LVAD) — a partial artificial heart -- that has kept him going long past the point where his own heart could have kept him alive.
Nearly everyone on an LVAD winds up getting sicker and sicker and, eventually, so sick that they come off the transplant waiting list because the risk is too great.
What starts as a “bridge” to a transplant when you get an LVAD can become, the more time that passes, a final destination — you almost always die with the device. So despite his age and health problems, how was Cheney able to get a heart while many others wait?
It is concerning that a 71-year-old got a transplant. Many of those who manage to even make the waiting list for hearts die without getting one. More than 3,100 Americans are currently on the national waiting list for a heart transplant. Just over 2,300 heart transplants were performed last year, according to the United Network for Organ Sharing. And 330 people died while waiting.
According to UNOS, 332 people over age 65 received a heart transplant last year. The majority of transplants occur in 50- to 64-year-olds.
Most transplant teams, knowing that hearts are in huge demand, set an informal eligibility limit of 70.
Cheney is not the first person over 70 to get a heart transplant. He is, however, in a small group of people who have gotten one. Why did he?
Cheney has an advantage over others. It is not fame or his political prominence. It is money and top health insurance.
Heart transplants produce bills in the hundreds of thousands of dollars. The drugs needed to keep these transplants working cost tens of thousands of dollars every year. Organ donations are sought from the rich and poor alike. But, if you do not have health insurance you are far less likely to be able to get evaluated for a heart transplant much less actually get a transplant.
The timing of Cheney’s transplant is ethically ironic given that the battle over extending health insurance to all Americans reaches the Supreme Court this week.
If the President’s health reform bill is deemed unconstitutional, those who are wealthy or who can easily raise money will continue to have greater access to heart, liver and other forms of transplantation than the uninsured and underinsured.
It is possible the Cheney was the only person waiting for a heart who was a good match in terms of the donor’s size, blood type and other biological and geographical factors. If not, then some tough ethical questions need to be asked.
When all are asked to be organ donors, both rich and poor, shouldn’t each one of us have a fair shot at getting a heart? And in a system in which donor hearts are very scarce, shouldn’t the young, who are more likely to benefit both in terms of survival and years of life added, take precedence over the old?
Let’s hope we get some answers to these tough questions as we watch both Cheney’s recovery and the fate of health care legislation that is intended to minimize the advantages that the rich now have over the poor when it comes to proven life-saving treatments.
Msnbc.com news services contributed to this report.
