Cheney’s Surgery

Dick Cheney Surgery: 7 Essential Facts about Heart Transplants

The Daily Beast answers questions about heart transplants like the one Dick Cheney just underwent.

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How many people get heart transplants each year?

Heart transplants have become more and more common since they were first performed in 1967. Dick Cheney’s was one of the roughly 5,000 heart transplants performed worldwide each year; about 2,000 are performed in the U.S. alone. This actually is a rather low figure, considering that at any given time, there are more than 3,000 people waiting for a heart transplant. Today, there are at least 3,100 people awaiting a heart transplant in the U.S.

Who is considered for a heart transplant?

Heart transplantation is considered a last resort when a person has reached end-stage heart failure that does not respond to any other therapies—medicines, mechanical devices, and surgery. The patient must also be likely to die without a transplant. As sick as the patient must be to experience such heart failure, he or she must be otherwise healthy to be considered.

How does the waiting list work?

Because of the limited number of organs available, patients in need of a transplant are put on the national waiting list, but they are not listed in any particular order, and being first on the list will not necessarily give a person priority. A patient can be removed from the list at any time if he or she starts to recover or suffers another devastating medical event. Once a heart is found, it is given to the best possible match based on blood type, body size, and medical condition. A patient who makes it onto the waiting list may have to wait for several months for a heart, and many will die before a suitable donor can be found. The amount of time spent on the waiting list varies, but the average wait time is six months to one year. Cheney, with a 20-month wait, actually waited much longer than average.

How do they find organ donors?

Hearts come from designated organ donors who have recently died or become brain-dead, often from car accidents or head injuries. These individuals usually agreed to be organ donors before their deaths, but permission is also usually required from family members at the time of the donors’ deaths. Once a donor heart has been selected, it is subjected to rigorous tests to make sure it is OK to use. A heart is usually taken from a donor who is younger than 65 and had no history of heart disease or serious chest injuries. Perhaps most important, the heart cannot have been exposed to hepatitis or HIV. A common misconception is that donors must be older than 18 to provide their organs. In fact, although minors cannot personally authorize the use of their organs, parents can authorize it after their child’s death.

What is the standard procedure for a heart transplant?

Since the first heart transplant was performed in 1967, the operation has become a fairly routine procedure. The surgery is carried out shortly after a suitable donor has been located. Doctors put the patient on a heart-lung machine before surgeons remove the heart—except for the back walls of the atria. The back walls of the donor’s heart are then removed, and the organ is sewn into the patient. Once all the blood vessels have been connected, the heart will begin to beat, and the patient can be removed from the heart-lung machine after the doctors have checked for leaks. The entire procedure lasts between four and 10 hours. Due to the shortage of hearts that can be transplanted, scientists are experimenting with the concept of preparing hearts to order, with the ultimate goal of creating a “heart in the box” that could be readily stored in hospitals. Although such an achievement is theoretically possible within five years, creating a functioning heart for clinical testing would cost roughly $5 billion.

How long can one live after a heart transplant?

The immune system may reject the body’s new organ, because it is a foreign object and is not technically supposed to be there. Barring that, however, successful heart transplants can extend life by several years. Some 88 percent of patients will live a year after transplant surgery, 80 percent live at least two years, 75 percent will live for five, and 56 percent of patients will have their lives extended by 10 years. However, survival rates are slightly lower in patients older than 65.

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Is it strange that Cheney received a transplant when he was over 70?

Much ado has been made about Cheney receiving a heart transplant at age 71, but such transplants do occur occasionally. There is no legal cutoff at age 70, and people over 70 tend to do as well as their younger counterparts after a heart transplant. The difficulty is that, for a patient to receive a heart transplant, he or she must have no health problems aside from heart failure. It becomes less and less likely that a patient will have no other health problems the older that patient gets, but it certainly does happen. According to the United Network for Organ Sharing, 332 people older than 65 received heart transplants last year.