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Mar 25, 2012

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Cheney too old for transplant? Bioethicist weighs in
Mar 25th 2012, 17:33

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.

thumbnail Witness: Zimmerman 'never ... tried to help' Trayvon Martin
Mar 25th 2012, 16:11

By NBC News, msnbc.com staff and news services

A woman who says she and her roommate witnessed the final moments of Trayvon Martin's life told Dateline NBC that George Zimmerman had "his hands pressed on his back" and "never turned him over or tried to help him."

Zimmerman's lawyer, when shown part of the interview being aired Sunday night on Dateline, emphasized that his client would be claiming self-defense.

"I think there were efforts made to render aid to Trayvon," Craig Sonner told NBC's TODAY show.


Mary Cutcher told Dateline that she and her roommate both saw Zimmerman "straddling the body, basically a foot on both sides of trayvon's body, and his hands pressed on his back."

Cutcher added that Zimmerman told her and her roommate to call the police.

"Zimmerman never turned him over or tried to help him or CPR or anything," Cutcher said.

A friend of Zimmerman's who appeared on TODAY with Sonner added that Zimmerman, 28, was distraught over the teen's death.

"Right after the shooting he couldn't stop crying," said Joe Oliver.

Zimmerman has not been charged in the Feb. 26 shooting that has ignited racial tensions and raised questions about the Sanford police's handling of the case. Martin was black, and Zimmerman's father is white and his mother is Hispanic.

In light of the Trayvon Martin incident, a Meet the Press roundtable breaks down violence by citizens against blacks in America.

On Saturday, Sonner said he believes evidence will show that Florida's "Stand Your Ground" law was properly applied.

"Is George a racist? The answer is no, absolutely not. He's not a racist," Sonner said about his client. "The incident that transpired is not racially motivated or a hate crime in any way. It was self-defense."

Sonner said he's spoken with several of Zimmerman's friends, including some who are African American. "They only have good things to say about him," Sonner said.

They're reluctant to come forward, though, because they fear that the backlash over the investigation will make them and their families targets, too, Sonner said.

More from NBC Dateline

Sonner declined to detail what transpired between Zimmerman and the 17-year-old Martin, who was unarmed, but he said he believes the case falls under Florida's stand-your-ground law, which dictates that a person has the right to stand his or her ground and "meet force with force" if attacked.

"I believe what the evidence will show is that this case does fall under that," Sonner said. "I believe we have a good case."

If charges are brought against his client, Zimmerman would be willing to turn himself in to police, Sonner said. "We will follow the law," Sonner said.

Sonner would not say where Zimmerman was. 

White House adviser David Plouffe discusses President Obama's conversations on the Trayvon Martin case.

Amid the outcry over the lack of charges against Zimmerman, the Sanford police chief and state's attorney in the case have both stepped aside.

The U.S. Justice Department has opened a civil rights probe into the shooting, and a grand jury is scheduled to meet April 10 to consider evidence in the case.

Daryl Parks, the Martin family attorney, said federal officials and local officials met with the teen's family Thursday and gave them "a strong sense that (the Department of) Justice was very committed" to investigating the case.

Indeed, President Barack Obama weighed in Friday, calling the shooting a tragedy and saying, "When I think about this boy, I think about my own kids."

But Parks added "it was clear from Justice's statements that charges of a hate crime are going to be a challenge."

Parks also said the Florida Department of Law Enforcement has told the family's legal team that they know Zimmerman's whereabouts, but that it was not clear whether they are offering protection to Zimmerman, who has been in hiding and has received death threats in recent weeks.

Martin's parents also met Friday with the newly-appointed special prosecutor in the case, and the family's legal team plans to pursue a civil case against the Twin Lakes homeowner's association, Parks said.

About 400 people rallied Saturday in downtown Chicago to protest Martin's killing. In a racially divided city beset by shootings, gang violence and run-ins with police, the teen's death brought to mind the 1955 slaying of Emmitt Till, a 14-year-old black boy from Chicago who was shot and bludgeoned to death while visiting Mississippi for supposedly whistling at a white woman. His body was found in the Tallahatchie River.

No one was ever convicted, but Till's killing galvanized the civil rights movement.

"It's a precedent that with the right excuse it's OK to gun down black males," protester Ashten Fizer said of Martin's killing. "It's a return of Jim Crow."

In Washington, D.C., a large crowd gathered in Freedom Plaza to call for justice in the shooting.

Among the demonstrators Saturday was Jimmy Neal, a District of Columbia resident who said his daughter has been asking him questions he didn't want to answer.

Jonathan Ernst / Reuters

People gather at a "Stand Up for Trayvon Martin" rally in Washington, D.C., on Saturday.

"She's asked me the question ... 'Why, daddy, when he was carrying candy and a soda or iced tea and why did the man kill him?' I had to explain that to her. And those are discussions you don't plan to have with your kids," Neal said.

"Hoodie Marches" were organized Saturday in two South Carolina cities over social media. Many of the people participating carried bags of Skittles and wore hooded sweat shirts, like the one Martin wore when he was killed.

Martin was holding a bag of the candy while walking to his father's fiancée's home from a convenience store when Zimmerman started following him, telling police dispatchers he looked suspicious. At some point, the two got into a fight in the gated community and Zimmerman pulled out his gun.

The Associated Press contributed to this report.

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