Medical Marvel

03.26.12

How Dick Cheney Got His New Heart

Let's not jump to any conclusions about 71-year-old Cheney leapfrogging a bunch of other worthies to get his new heart. As far as we can tell, he got his transplant simply because his number on a waiting list turned up. Plus, seven surprising facts about heart transplants.

When last we left our hero, he was slowly dying, living out his sorrowful last moments tethered to a left-ventricular-assist device, waiting to shuffle off his mortal coil with calm resignation and karmic equipoise (OK, this last part, maybe not really). After all, he already had attained executive-branch closure by penning a remarkably vain autobiography.

Well, dry those tears, America—he’s back! We all woke up Sunday morning with the chilling news that Dick Cheney has a new million-dollar heart and may be as good as ever, or as good as a 71-year-old man on multiple medicines who just underwent a major surgery can possibly be. Given his track record of opting never to die, we should figure he will be around and ready to go as VP for both Jeb Bush in 2016 and George Prescott Garnica Bush (one of the little brown ones—let’s call him “P”) in 2024. And never mind the minor business with the 12th and 22nd Amendments—Dick will take care of it.

How did this happen? No, not the Florida recount, but how could someone so old and frail be a candidate for that most precious commodity, the human organ? Did Dick do a dick thing and leapfrog a bunch of other worthies, people who aren’t viewed by some as war criminals and evildoers but rather are decent folk decades younger, likelier to contribute to society and to provide a better return on investment for our taxpayer health-care dollars?We went through similar societal contortions when Mickey Mantle got his liver and Steve Jobs, surreptitiously, his, though we never made up our minds, celebrity being as powerful as it is.

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The conversation about Dick Cheney's heart transplant gets heated on NewsBeast, our daily roundtable.

With Cheney, let’s not jump to any conclusions. Yet. First let’s review the numbers which are tracked both by the United Network for Organ Sharing (UNOS), a nongovernment organization, and the Organ Procurement and Transplantation Network (OPTN), a slightly more arid government version. According to each, on Sunday, March 25, 2012, there were 113,639 people on the waiting list for an organ, of whom 72,822 were on the “active” roster, suggesting a more pressing need. That’s a mighty long roster.

But many different human organs are transplanted each day, including hearts, lungs, kidneys, livers, intestines, corneas, and the pancreas. And that does not count the human tissue that gets moved around—faces, tendons, bones, skin. (These latter items don’t count as “organs” in the 113,639 total.) In fact, a person who wants to really donate can at death contribute about a hundred different parts. Some of these parts (especially kidneys and the liver), can be borrowed from a living donor; for the rest though, the donor has to die and be young and healthy and noninfectious enough to be suitable.

According to OPTN, the vast majority of those on the waiting list are hoping for a kidney—more than 91,000 people. The kidney list can grow though, because dialysis affords an option for temporizing; the need for a lung (1,639 people) or a heart (3,162 people) is less forgiving. These latter waiting lists can be cruel: about 300 people a year die while waiting for a heart transplant.

So there is a real pinch on organs—doesn’t that mean 71 is too old? Wrong again—at least no law dictates this. The transplant world is a Dick Cheney dream—a loosely regulated, market-driven free-for-all that follows whatever rules the local oligarchy sets forth. One hospital might set the cutoff at 20 or 50 or 100 years old, while another might figure 55 is the way to go. In a free market, people can find their own way.

Besides, he was not the only septuagenarian in the hunt. Granted, a recent government breakdown of those on the waiting list by age doesn’t go above 64 years, but notes that 61 percent on the list are older than 50; the same source notes that 1,320, or 56.6 percent, of all heart recipients were older than 50. According to ABC, last year 332 heart transplants were performed on people older than 65, and according to the UNOS, 14 percent of heart recipients are older than 65. And do please ignore all the talk about how long (20 months compared with the typical one year or less) poor Dick waited for his blessed organ. This seems most like the groundwork of his omnipresent team of flacks working to blunt the inevitable criticism the surgery will attract.

So Cheney still has cut no corners—but what about Inova Fairfax Hospital, where Cheney had his surgery (and where, one might note, advanced age is a possible exclusion for transplant)? According to the (federally mandated) records, we can see just who else was waiting for a heart at Inova: on March 16, 2012, 31 people, of whom 15 were 50 to 64 and three were 65-plus (including our Dick), were on the list. And in 2011, two of the 19 people transplanted were at least 65 years old.

The transplant world is a Dick Cheney dream—a loosely regulated, market-driven free-for-all that follows whatever rules the local oligarchy sets forth.

So as appalling as it may be, it is likely that Dick got a heart because he was a on a waiting list and his number turned up. (Maybe. We will never know if someone made a phone call for him any more than we will ever learn about his Energy Task Force). But don’t feel bad—with his latest act of narcissism, Cheney has brought into focus a critical issue the very week when the Supreme Court is ready to review the constitutionality of the Affordable Care Act. He has made us think about whether health care is a commodity or a human right. Heady stuff, Mr. Cheney.

The problem for him and his is that he has shone the spotlight a bit too brightly on the wrong side of the debate. Old man Cheney and his million-dollar heart serve to remind us just how ugly health care can be when it is a simple commodity given to someone with friends in high places, even if he (possibly) did get the organ through routine channels. He now and forever is the poster child for why health care must be a right, not the latest luxe trinket for those few who can afford it.