I Hate Dialysis Message Board
Off-Topic => Off-Topic: Talk about anything you want. => Topic started by: cariad on April 02, 2012, 09:55:24 AM
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I have not seen a discussion of it on here, which kind of surprised me. I did not even hear that it happened until I started to catch up on The Daily Show episodes over the weekend.
He was 71. There are thousands of articles about it, but apparently he was on the list for 20 months and got the call. Doctors are of course claiming that he received no special consideration.
Anyone have any thoughts? Does anyone know how getting listed/being matched for a heart might differ from kidney?
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My husband needs a heart transplant, he is 71 he stands no frigging chance, the heart specialist has discharged us. Perhaps if we had money and status it would be different.
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they always say 'no special consideration', i am having a hard time beleiving that- - some years back some celebrity who fried his liver drinking and doing drugs got a transplant, I can't remember his name, but it made me so mad- of course he was rich too.
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Cheney got a huge bonus from the oil companies just before he got elected, didn't he? He sold Americans out, in my opinion.
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As much as I don't care for Dick Cheney, I can't really believe he got special treatment. If he really was on the UNOS list for 20 months, I'd think that's probably about right for a heart. As for his age, well, I guess different tx centers have different rules about eligibility, a fact we all know too well!
He's just very fortunate that he has insurance that covered all of the medical expenses he incurred BEFORE the transplant. He's had so many heart attacks and so many procedures and surgeries. He's had this special wearable pump for quite some time that has kept his heart going; that must be really expensive. I'd bet that all of that stuff was more expensive than the transplant itself.
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As much as I don't care for Dick Cheney, I can't really believe he got special treatment. If he really was on the UNOS list for 20 months, I'd think that's probably about right for a heart. As for his age, well, I guess different tx centers have different rules about eligibility, a fact we all know too well!
I was under the impression that the wait for a heart is far, far longer than the wait for a kidney. After all, you can't have a living donor for a heart and any donor only has one, not two. I also believe the criteria for a heart is exponentially more stringent and most transplant centers actually do have an age cutoff (65 is the age I've seen mentioned most frequently). I'll never buy that he didn't get special treatment.
The one who fried his new liver drinking was Mickey Mantle, by the way.
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My husband needs a heart transplant, he is 71 he stands no frigging chance, the heart specialist has discharged us. Perhaps if we had money and status it would be different.
Oh, billy, I'm sorry. I had no idea. :(
MM, that's one of the key questions I would think is WAS he actually on the list for 20 months? Perhaps years of Bush and Cheney have made me paranoid, but I strongly suspect that was a lie. Agreed about the money spent on him and his notoriously crap health. I swear he's only alive today thanks to some Faustian bargain he made early on in life.
they always say 'no special consideration', i am having a hard time beleiving that-
I'll never buy that he didn't get special treatment.
These statements sum up my instinct as well. Transplant centres have been caught too many times engaging in shady behaviour. I read about a UCLA case where Japanese mafia members who were barred from even entering the country somehow got liver transplants. This is the danger of investing these doctors with this sort of power, too tempting to use it to turn a profit.
I don't like Cheney in the least, Whamo. I think he manipulated America for his own purposes, and seems to be continuing to do so today. Still, I don't believe in mixing morality judgments with medical judgments, but would imagine there had to have been a younger candidate who could potentially get more years out of that heart. I at least hope it was an EC heart, assuming there is such a thing.
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I really don't know anything about the heart transplant list, so I'm just guessing here. DD, I guess I was under the opposite impression in that the list for a heart tx may be shorter than that for a kidney simply because more people die while waiting for a heart.
I wouldn't be in the least bit surprised if his tx center bent some rules for him, but I don't want to be unfair in assuming that there are lies in this story simply because I don't like the man. But if he was eligible for a transplant, then billybags's husband should be, too.
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My husband needs a heart transplant, he is 71 he stands no frigging chance, the heart specialist has discharged us. Perhaps if we had money and status it would be different.
That sucks Billybags, as you know. ??? :cuddle;
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I found this from an LA Times article, quoting Cheney in an interview on the TODAY show: "I'll have to make a decision at some point whether or not I want to go for a transplant," he said in January 2011. "But we haven't addressed that yet."
Erm, so he had not even decided to go for a transplant in January 2011, otherwise known as 14 months ago, but he'd been on the list for 20 months?
source: http://articles.latimes.com/2012/mar/24/nation/la-na-cheney-heart-transplant-20120325
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I found this from an LA Times article, quoting Cheney in an interview on the TODAY show: "I'll have to make a decision at some point whether or not I want to go for a transplant," he said in January 2011. "But we haven't addressed that yet."
Erm, so he had not even decided to go for a transplant in January 2011, otherwise known as 14 months ago, but he'd been on the list for 20 months?
source: http://articles.latimes.com/2012/mar/24/nation/la-na-cheney-heart-transplant-20120325
Good catch. From what I've read here at IHD, it takes about that long just to jump through all the hoops necessary to GET listed, much less start accruing time.
Here's a list of criterion at the Mayo Clinic in Jacksonville:
http://www.dcmsonline.org/jax-medicine/2002journals/Feb2002/transplant.htm
Age
Age limit is perhaps the most controversial aspect of candidate selection for heart transplantation. The age of 55 years has traditionally been the accepted upper limit beyond which heart transplantation should not be considered.4 However, with advances in surgical and immunosupression techniques, older patients are often considered for transplantation. Heart transplantation in patients as old as 72 years of age have been reported.5 However, a study comparing carefully selected heart transplant recipients greater than 65 years of age to those between the ages of 55 and 64, show that although survival is similar, the number of hospital days and infections during post-transplant year one is significantly greater for the older group. In addition, patients greater than 65 years of age had more severe functional limitations after transplantation and had difficulty returning to full functional capacity. Patients between the ages of 60 and 65 should be carefully scrutinized, because the incidence of co-morbidities that would limited life expectancy or quality of life increases with age. These co-morbidities include cerebrovascular disease, peripheral vascular disease, renal disease, hepatic disease, pulmonary disease, osteoporosis, malignancy, benign prostatic hypertrophy, diverticulosis, obesity, loss of mental acuity and deceased rehabilitation potential.
Another list of criterion, this one from Johns Hopkins:
http://www.hopkinsmedicine.org/transplant/referring_physicians/patient_selection_criteria/heart.html
Absolute contraindications for adults and children include, but may not be limited to:
Major systemic disease
Age inappropriateness (70 years of age)
Cancer in the last 5 years except localized skin (not melanoma) or stage I breast or prostate
Active smoker (less than 6 months since quitting)
Active substance abuse
HIV
Severe local or systemic infection
Severe neurologic deficits
Major psychiatric illness or active substance abuse that cannot be managed sufficiently to allow post-transplant care and safety
So does anyone here still think this was on the up-and-up?
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Oh geez, the LAST think I want to do is to defend Darth Vadar, but I do have the following thoughts...
Sure, his spokespeople could be lying through their teeth about him being on the list for 20 months, although I'm not sure most people would see a vast difference between him having waited 20 months or the 14 monts from Jan 2011 to now. And it is also entirely possible that he WAS listed 20 months ago but still hadn't decided whether or not to go through with it. The wording in the interview was a bit ambiguous. How many times have we here on IHD counselled people to go ahead and get listed so that they can be accruing time, knowing that they can always say "no" in the end? Maybe that's what Dick Cheney did. Just guessing.
As for the age limit, well, he wasn't transplanted at either Johns Hopkins or at Mayo Clinic, so their rules are moot. He was transplanted at Inova Heart and Vascular Institute in Virginia, and they don't have a specific upper age limit.
http://www.inovaheart.org/heart-care/transplant-program/home/#eligible
How much time it takes to jump through all the hoops to get listed varies greatly, but I'd imagine that Mr. Cheney had a whole army of people helping him, and I'd bet he didn't need a referral for all the required tests like I did! And I'd bet that the tx center made very sure they didn't let his case fall through the cracks like mine did. It took me from Feb to end of July to get everything done to get listed, mostly because the tx center lost bits of paper and I lost time there, and I had to get a referral just to THINK about getting listed. LOL! Bet Mr. Cheney was spared those particular delays. ::)
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Oh geez, the LAST think I want to do is to defend Darth Vadar
Someone's got to! :)
I am with you in that I really, really don't want to defend this monster, but I am also committed to not letting my personal opinion about his moral character cloud my judgment. It is definitely not about what type of person he was because I don't want to go there anymore than anyone else.
I had considered that maybe he got listed before making the decision, but I am not hearing that in the quote. He said we hadn't even addressed it, which makes it sound like he had not even discussed pros and cons with doctors. Also, I was told that "wanting it" was part of the committees decision, and I read something similar in an anthro article. If the doctors on that committee (the one in the article) were any indication, you have to prove how much you want this or they will keep you off the list. I know this is not Cheney's committee, but still. Where are the lectures about how they have to play stupid mind games with us in order to determine that we are really going to take care of this organ? Would they really put someone on the list who did not seem fully convinced that he wanted a heart transplant? Hearts, in my understanding, have to be implanted much more quickly than kidneys. Also, with heart but not kidney, how sick a person is comes into consideration. His complaints don't seem to center around feeling especially ill. My sense from reading articles was that he just got sick of the damn portable device because it was interfering with his quality of life. Here is Jezebel's write-up, and it takes a more humourous view, so obviously not meant to be taken completely seriously, as the title alone indicates. http://jezebel.com/5896213/dick-cheney-receives-new-hopefully-more-empathetic-heart (http://jezebel.com/5896213/dick-cheney-receives-new-hopefully-more-empathetic-heart)
We all paid for his transplant, someone may have paid with his or her life. I don't have the answer, clearly, I just feel that with everything I know about how transplant allocation works, this has alarms going off in my head. In the end, I am interested in the discussion more than who is right or wrong, and am enjoying reading the different opinions.
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As for the age limit, well, he wasn't transplanted at either Johns Hopkins or at Mayo Clinic, so their rules are moot. He was transplanted at Inova Heart and Vascular Institute in Virginia, and they don't have a specific upper age limit.
http://www.inovaheart.org/heart-care/transplant-program/home/#eligible
Right there at the link you provided it says:
Patients with any of these conditions may not be eligible for a heart transplant:
Advanced age
Age IS a consideration, though they don't explicitly state their upper limit on their website. So what do they consider 'advanced'? Eighty? Ninety? Does Inova just disregard the medical literature regarding age and outcomes? Do you think they're that much of an outlier from other reputable transplant programs?
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DD, you are right that they consider age when they make eligibility decisions, and like you, I don't know how they define "advanced age". I know that there has been some movement in the renal tx community toward making transplants more available to older people, so perhaps they are thinking the same in the realm of heart tx, too. The medical literature regarding age and outcomes seems to be in flux when it comes to renal tx, so maybe the same is true with heart tx. I am not sure.
Actually, what surprises me most about this isn't so much the true waiting time or age disqualifiers, rather, what makes me wonder is how they deemed Cheney to be "healthy" enough for the tx. He had his first heart attack at age 37, and he has had coronary disease for literally decades. That has to wear on a person, so frankly I'm surprised that they thought he'd survive tx surgery at all! The pump he had installed is usually a bridge to tx, as dialysis is a bridge to tx for many hopeful renal patients. Although, I am given to understand that this pump can be used permanently.
I've read that the age-related risk isn't so much in the surgery itself but is instead of the increased risk of infection. The info posted on these facilities' websites seem to indicate that most heart tx in older patients are successful but that it is infection that poses the greatest risk to these patients.
I'd love to hear more from Inova, but I doubt they'll say anything because of privacy issues.
PS I found this article that may shed some light on this but will probably serve to merely create more questions! LOL!
http://abcnews.go.com/Politics/dick-cheney-heart-transplant/story?id=15998479
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My brain was in high gear last night, and I kept thinking about people who get "special consideration" when it comes to transplantation.
How would "special consideration" even work? Are we implying that UNOS would faff about with the waitlist and maybe falsely add accrued time? For what benefit? Could someone really pay UNOS to get a donor heart, jumping the queue? Wouldn't UNOS have to be involved in these shenanigans? Anyone want to hazard a guess?
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My brain was in high gear last night, and I kept thinking about people who get "special consideration" when it comes to transplantation.
How would "special consideration" even work? Are we implying that UNOS would faff about with the waitlist and maybe falsely add accrued time? For what benefit? Could someone really pay UNOS to get a donor heart, jumping the queue? Wouldn't UNOS have to be involved in these shenanigans? Anyone want to hazard a guess?
Well, in Dick Cheney's case, he is the former VICE PRESIDENT. If UNOS had to be involved, and I don't know that they would need to be, don't you think that a single call to UNOS saying Dick Cheney wants a heart. Yes, that Dick Cheney. No, I'm not kidding, when can we get it, I'm scared for my loved ones would suffice? If the Vice President is telling a government contractor to faff, then they will faff til they can faff no more.
Now with celebs, I think it's more a matter of overlooking the (often numerous) indications that they should not be on the list. I know people feel that they know celebrities and they have all sorts of emotions surrounding them, but George Best? Even my liberal GP (the South African) knew it was a mistake to give him a liver. He couldn't even give up alcohol to save one of the most incredible careers the world has ever known, how was he going to give it up when he had to come to the realisation that many arrive at, that a transplant was not going to solve all of his problems, and that there are many days especially in those early years when you feel like utter crap.
Then, the aftermath of that is that the doctors make these mistakes (and as I said, I think they are understandable on some level) and then have the cheek to use them as examples of why your average individual with a history of alcoholism should be kept from getting an organ. Excuse me, that was your mistake, not ours, why do the rest of us have to pay for it with this demeaning scrutiny.
From what I have experienced in listing, the hospital controls the date. Some places list you and let you accrue time before you officially pass your eval. I am currently putting a paper together for Economic Anthropology that argues that the lack of standardization across the country allows those in power in the medical establishment to make up their own rules and manipulate the system when it benefits them. Who had heard of Inova hospital before this? Who wants to be labeled as the hospital that turned away a beloved footballer, or baseball player, or actor or technological innovator? What transplant surgeon doesn't secretly thrill to the idea that of all the doctors in the country, this person chose ME to save their life. If anyone else came into that hospital with Dick Cheney's health history, they would either be told outright that they obviously don't take good enough care of themselves or they would be stalled and sent in circles until they either gave up or died.
I don't know precisely how the listing process works and what falls to UNOS and what is under control of hospitals, though, so would welcome any insight from others.
I just wrote in another topic that I was cynical. I meant it. :)
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I, too, thought about the publicity that a hospital would get should they transplant a high profile figure, but not once have I heard "Inova" in the public media. They kept saying "a Virginia hospital", and I had to do an online search to find out which hospital transplanted him, and the only reason I cared about THAT nugget of information was because I wanted to learn more about their pre-eval criteria. So in this case, I don't really think that publicity for (or against the hospital should they have turned him away) Inova was a driving force.
If I were to be cynical, I could say that perhaps there were people at UNOS or Inova who didn't much care to save Cheney's life and offer him a new heart. I suppose that if in one case a hospital would fall all over itself to save a big-name patient, the reverse could be true...a hospital might not want to get involved with a controversial and almost universally hated patient like Mr. Cheney.
I could well be wrong, but I can't imagine UNOS and OPTN not being involved in some way with the allocation of every organ. Otherwise, how could a hospital just HAPPEN to get a heart that just HAPPENS to match Cheney? It's UNOS and OPTN that keep tabs on all prospective recipients and all available organs. If a hospital wanted to go rogue and work outside the system, I'd have thought that the wait time for their patients would sky rocket because UNOS and OPTN are there to coordinate procurement and allocation, thus making more organs available to more people. Now, there ARE exceptions to regular UNOS/OPTN policy, but even those exceptions are outlined in their policy documents.
As for George Best, I was living in England when that whole thing took place, and when someone with that degree of alcohol abuse gets a new liver on taxpayer's money, well, I didn't know anyone over there who thought that was a good idea. My question is this...does someone who qualifies for Medicare yet is very wealthy use their own money to finance something like a heart transplant? Did Medicare pay for it, or did Mr. Cheney himself? He could have used his book money, LOL!
I'd love to know the answers to these questions, but no one seems to be asking them. I'd also like to know how Steve Jobs got a liver transplant with his history of cancer. I have to wonder if the post-tx drugs allowed his cancer to return with a vengence. Maybe Mr. Jobs insisted on a tx despite the risk of cancer, and his center didn't want to turn away Steve JOBS! Anyone know? Again, no one seems to be asking these questions.
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Of course there would be people who did not want to save Cheney's life, but when you receive those donation pleas from Rush, don't you think there are many, many willing to look past that for the "greater good" (as they might justify it)? I don't know if Inova was mentioned, but if you found out via a google search, the info is out there and anyone who cares will know it. If you are a wealthy, unfit war profiteer who needs a new organ, now you know whom to call. If you were trying to run a hospital, would you rather have the outraged but ethically above reproach candidates in your debt, or the billionaire? We are in the midst of the most hyper-market-driven atmosphere our country has ever seen. All things can be explained by the market - it is more of a religion, and a fanatical one at that.
I asked two days ago of my economic anthro prof "Can you think of an instance where a company paid for research to be done, and the results were not what the company wanted but the information was still published?" and he quipped "Not without the witness protection program!" This man is impossibly well-connected (the prof, not Cheney, though that's true, too). He knows not only all the anthropologists from his Harvard days, but also received an MBA from there which is the breeding ground for all of those Wall Street barons. He finds the world of business and marketing so fascinating just because they operate in an entirely different culture.
Anyhow, *I* have been talking about Steve Jobs. People outside of transplant are not discussing that case because they do not realise how the eval works. When I was pitching my study proposal to the class, I had to tell them "I am so immersed in this, I need your help telling me where I am being unclear because I just do not realise that this is not common knowledge." On here I could just say "Steve Jobs, liver transplant, can you believe it" and most people would get it. The class did not get it. In fact, my prof did not even know there WAS an eval stage that was allowed to take morality into account. It says it can't, but if you pick it apart, it most certainly can and does. I don't think it was Dick Cheney's name they wanted - it was his power and money. How the hell did he get away with all that he's got away with so far? I'm telling you, Faustian bargain. And some very dodgy nonsense that will probably come to light long after he dies.
I don't think Cheney used his own money for anything. He was a federal employee for ages and ages. In his mind, he has every right to his fancy healthcare. But I don't see the money as the point. It's the heart that went to him when it could be used have gone to someone younger and with a better record of health compliance. Steve Jobs also had a sort of history of non-compliance. I will go dig up the article that led me to believe that once again, the list is for sale in many respects.
I need to really concentrate on cleaning (underlying message: stop being so damn fun to talk to) but I am going to see if I can find out how hearts are matched. In the case of liver, my understanding is that you really only need a compatible blood type. It is not the same as kidney, that I do know. Also, with the other organs, how sick you are comes into play. Was Cheney really that sick? Close to death sick? I think he could have been bumped to the front of the queue on those grounds, and they would have to take his doctor's word for it.
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Cariad, I don't have any intention of reading Steve Job's biography to discover the timeline of his illnesses, but maybe you know...was he cancer free for the requisite 5 years before having his liver transplant? If not, what did his hospital risk in transplanting him despite his cancer history? Did they put his life in danger in their attempt to save it? If so, why? Did they willingly put their reputation at risk (along with their stats) just so they could tx Steve Jobs? Maybe that's exactly what they chose to do. I'd love to find out.
Re Cheney, I have to admit that I really do think he was that sick. He's been ill with cardiac problems for nearly 40 years, and my understanding is that he had undergone just about every possible intervention/procedure short of tx, the last one being the pump. I still think it is likely that those on the list above Cheney who were as sick or sicker may simply have died, paving the way for Cheney to advance more quickly up the list. Only the good die young, you know. LOL!
I absolutely agree that we are extremely "market-driven", but I am not sure how this mindset influences the availability and allocation of organs. Maybe it does, but I'd still love to know exactly HOW a rich, influential person can jump the queue. Did Inova contact UNOS and tell them they had a high profile patient who needed a heart, and did UNOS cooperate with them in finding a heart ASAP, or did they tell Inova to wait in line like everyone else?
People are going to believe what they want to believe. As I get older, I'm more and more convinced of that. Half of me wants to believe that Cheney is truly a non-fictional Darth Vadar and was able to use his money and influence to get what he wanted. The other half of me wants to believe that the people at UNOS act in good faith because I am on their list, and I don't want to be treated unfairly because I happen not to have said money and/or influence. That leaves me stuck in the middle, more curious than anything. I love a good conspiracy story as much as the next guy, but I'd like to see some scenarios based in evidence. It's one thing to claim that Cheney jumped the queue but it's another (and more interesting) to discover if he really DID, and if so, HOW?
Who would want to clean house when she could spend a pleasant afternoon reading OPTN's thoracic organ allocation policy?
http://optn.transplant.hrsa.gov/PoliciesandBylaws2/policies/pdfs/policy_9.pdf
Now, Cheney DID have a LVAD, and that is one of the criteria listed by OPTN. So, I think he WAS sick enough. Unlike kidney patients, it seems that cardiac patients are allocated a status, basically defining how sick they are. It looks to me like Cheney was status 1A since he had an LVAD. They begin talking about ABO typing on page 18 (a big hunk of this document is about lung tx).
Interestingly, the rules regarding accruing wait time are vastly different from those regarding renal tx. If you accrue waiting time at a lower status, you cannot carry that time over if you are upgraded to a higher status. Maybe it is this fact that has led to some confusion about how long Cheney was listed. (See page 19 for this information.)
I'm going for a walk now! I've already cleaned my house...
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After a brief Google search, it seems the average wait for a Status 1 Heart Transplant candidate is 6 to 36 months. So a 20 month wait doesn't seem to indicate by itself any bias or special treatment. Given media reports of Mr. Cheney's pre-transplant condition and medical history it would seem Status 1 was probably appropriate.
BTW, many might disagree with Mr. Cheney's stated political views, but given that an American Vice-President really has virtually NO official influence on policy, it's hard to pin the blame on him for anything that happened during the Bush Administration. The only official duty a VP has is to break a tie vote in the Senate which has happened very rarely throughout history. At best he was an unofficial advisor to the President who alone must take the credit or blame for his actions. Despite John Stuart's satire, the former President Bush would have been laughed off the stage if he had tried to blame some gaffe or bad decision on Mr. Cheney even if it had been Cheney's idea. And I think calling him "a monster" is certainly nothing more than a childish ad hominem attack.
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And I think calling him "a monster" is certainly nothing more than a childish ad hominem attack.
War profiteers are monsters. Dick Cheney is a war profiteer extraordinaire. What Bush could or could not get away with blaming on him is irrelevant to the conversation. I really do not want to derail this discussion, as I've said several times, by getting into Cheney's history, but don't you think it's a bit hypocritical to criticize me for an ad hominem attack by calling me childish? ???
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I really do not want to derail this discussion, as I've said several times, by getting into Cheney's history...
I agree so will make no more comments on the subject in this thread.
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After a brief Google search, it seems the average wait for a Status 1 Heart Transplant candidate is 6 to 36 months. So a 20 month wait doesn't seem to indicate by itself any bias or special treatment. Given media reports of Mr. Cheney's pre-transplant condition and medical history it would seem Status 1 was probably appropriate.
Yes, I agree with this. I remember seeing him interviewed on TV talking about his LVAD and thinking that I wished something like this was available for dialysis patients (and they're working on just this thing!). I didn't know what the average wait time for a Status 1 heart tx candidate was, though, so thanks for that info. "Average" wait times are misleading as they vary so much from geographical area to geographical area.
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Cariad, I don't have any intention of reading Steve Job's biography to discover the timeline of his illnesses, but maybe you know...was he cancer free for the requisite 5 years before having his liver transplant? If not, what did his hospital risk in transplanting him despite his cancer history? Did they put his life in danger in their attempt to save it? If so, why? Did they willingly put their reputation at risk (along with their stats) just so they could tx Steve Jobs? Maybe that's exactly what they chose to do. I'd love to find out.
I still have to dig up the article that suggested he was non-compliant, apparently he was famous for refusing anything but alternative remedies. If you or I were known for that, what are the odds that someone would offer us a transplant of all things? Must be nice to know what it's like to have people respect your own health choices. I honestly never had that luxury. I don't really know the answers to your questions as I know very little about Steve Jobs and don't really want to know more. I do have a brush-with-Steve-Jobs story but it's too long and a bit boring to get into here. I lived in San Francisco and there's just no avoiding some people there!
Re Cheney, I have to admit that I really do think he was that sick. He's been ill with cardiac problems for nearly 40 years, and my understanding is that he had undergone just about every possible intervention/procedure short of tx, the last one being the pump. I still think it is likely that those on the list above Cheney who were as sick or sicker may simply have died, paving the way for Cheney to advance more quickly up the list. Only the good die young, you know. LOL!
Yes, I can certainly see where you would believe that. I certainly know that it is well within the realm of possibility, but I also believe that there are a rare few in America who hospitals believe should not have to suffer like the rest of us serfs.
I absolutely agree that we are extremely "market-driven", but I am not sure how this mindset influences the availability and allocation of organs. Maybe it does, but I'd still love to know exactly HOW a rich, influential person can jump the queue. Did Inova contact UNOS and tell them they had a high profile patient who needed a heart, and did UNOS cooperate with them in finding a heart ASAP, or did they tell Inova to wait in line like everyone else?
Well, the first step is to get in the queue, isn't it. And in that regard, we are the only developed country that asks at an eval "how much money do you make?" In any other circumstance surrounding your health or anything else, wouldn't you shoot back with "well, let's see, I make none-of-your-business annually, or one twelfth of none-of-your-business monthly"? That right there is saying that we believe that your very right to live is connected to how much money you have. If the market is the answer to all questions, isn't the market saying that people who do well in it should live longer? Also, there is the money that it takes to get to the hospital with the shortest wait time or the most lax listing rules or whatever you need. People say "he could afford to pay to go to Tennessee (Steve Jobs) so he got a liver" as if we should not examine what this says about this country. How did those Japanese mafia members ever get transplants? According to reports that I've skimmed (I cannot get the 60 Minutes report to play on my computer) they cut a deal with the FBI and agreed to give information *and* as much as 1mil to UCLA (although The Telegraph says 50,000 quid, actual number really doesn't matter). Look, little Japanese boys and girls, crime really does pay in America so long as you share your ill-gotten gains with them! From The Telegraph, and The Telegraph is not exactly Labour-friendly as you know. This is not The Daily Kos in other words: http://www.telegraph.co.uk/news/2058177/Japanese-mafia-dons-donated-50000-after-jumping-queue-for-US-liver-transplants.html (http://www.telegraph.co.uk/news/2058177/Japanese-mafia-dons-donated-50000-after-jumping-queue-for-US-liver-transplants.html)
People are going to believe what they want to believe. As I get older, I'm more and more convinced of that. Half of me wants to believe that Cheney is truly a non-fictional Darth Vadar and was able to use his money and influence to get what he wanted. The other half of me wants to believe that the people at UNOS act in good faith because I am on their list, and I don't want to be treated unfairly because I happen not to have said money and/or influence. That leaves me stuck in the middle, more curious than anything. I love a good conspiracy story as much as the next guy, but I'd like to see some scenarios based in evidence. It's one thing to claim that Cheney jumped the queue but it's another (and more interesting) to discover if he really DID, and if so, HOW?
I totally hear you. I don't think fiddling happens very often, but it clearly does happen. There is no patient like Dick Cheney, and they know this. You and I are a dime a dozen and I accept that. I cannot look to a transplant hospital or UNOS for my sense of worth, and while I do believe the system is mostly fair, I don't believe that there have not been some deliberate exceptions. I don't honestly believe we will ever definitively answer the question of whether he was given special treatment or not, let alone the how. I am interested in what people suspect, and then if there are facts one way or the other, great, let's look at them.
Who would want to clean house when she could spend a pleasant afternoon reading OPTN's thoracic organ allocation policy?
:rofl;
Now, Cheney DID have a LVAD, and that is one of the criteria listed by OPTN. So, I think he WAS sick enough. Unlike kidney patients, it seems that cardiac patients are allocated a status, basically defining how sick they are. It looks to me like Cheney was status 1A since he had an LVAD. They begin talking about ABO typing on page 18 (a big hunk of this document is about lung tx).
Interestingly, the rules regarding accruing wait time are vastly different from those regarding renal tx. If you accrue waiting time at a lower status, you cannot carry that time over if you are upgraded to a higher status. Maybe it is this fact that has led to some confusion about how long Cheney was listed. (See page 19 for this information.)
Now this is the info that I think needs to be better understood. I believe all other organs save kidney take level of sickness into account, and it may seem cut-and-dried, but I think this is where doctors can manipulate. He did have that device, true, is it like dialysis in other countries where your wait time starts with the day you acquire this device? If so then OK, I can see how there would be no question as to how long he'd been on the list. I find it overly complicated that you cannot carry your time from one status to another, but that's US policy for you.
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Oh no, I just lost my long post! Ack!
I have a lot more questions about Steve Jobs' tx than Cheney's. I don't understand how Jobs ever got on the list, what with his history of non-compliance AND pancreatic cancer.
As for Cheney, I've looked at OPTN's policy about when waiting time can begin being accrued, and it is very ambiguous. I don't really believe that there is any question that Cheney was eligible for a Status 1A listing unless it was a lie that he had a LVAD, but I remember him talking about it and thinking that such a thing for kidney patients was under early development (AWAKS), so I think he was telling the truth. The policy does state that a heart tx candidate with Status 1A can have their status modified under certain conditions (adjusted down and then back up), so maybe this explains some confusion about his wait time. But one thing I had not thought of that you've brought up is the possibility of his cardiologist massaging some information to get him on the list sooner. Maybe it wasn't so much UNOS/OPTN or the hospital that helped him jump the queue, rather, it was his own physician.
I don't know if we will ever know the truth, the whole truth and nothing but the truth, and even if we did, I don't know if we'd ever believe it.
I'm afraid I can't help but draw some parallels between Mr. Cheney and the countless numbers of IHD members who have also suffered for many years with an incurable disease. It seems like Mr. Cheney has undergone more medical interventions and procedures than I could even imagine, and I don't like to see anyone suffer so much over such a long period of time. I wouldn't ever declare that any IHD member should be ineligible for a tx because of their age or because they "haven't suffered enough", and I can't bring myself to do the same to Mr. Cheney. In this particular instance, I am going to choose to believe that Mr. Cheney has suffered for long enough and that he and all of this healthcare team followed the rules and got him a new heart by fair means, otherwise I won't be able to sleep tonight. LOL!
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The heart donor was the atttorney he shot in the face. No? Maybe it was one of those Gitmo prisoners. No? Hmmmmm! I didn't know he had a heart.
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The heart donor was the atttorney he shot in the face. No? Maybe it was one of those Gitmo prisoners. No? Hmmmmm! I didn't know he had a heart.
My favorite quote that I've seen so far came off Twitter: Dick Cheney gets heart. Bush to meet The Wizard about brain this afternoon. @AralBalkin
I have a lot more questions about Steve Jobs' tx than Cheney's. I don't understand how Jobs ever got on the list, what with his history of non-compliance AND pancreatic cancer.
They both had sketchy health histories. I don't know that Steve Jobs was non-compliant, I only know that I've read some speculation, but it had nothing to do with his transplant and the word non-compliance was never used. That is what it would be labeled for us mortals needing a transplant, though. Dick Cheney's health record would also be used as a weapon by some transplant hospitals. He was quite fat, and we all know that fat automatically means unhealthy, lazy, and unworthy. On this very forum we saw that argument with regards to a woman's husband. I agree that his health history would suggest that he would not make a good transplant candidate.
I'm afraid I can't help but draw some parallels between Mr. Cheney and the countless numbers of IHD members who have also suffered for many years with an incurable disease. It seems like Mr. Cheney has undergone more medical interventions and procedures than I could even imagine, and I don't like to see anyone suffer so much over such a long period of time. I wouldn't ever declare that any IHD member should be ineligible for a tx because of their age or because they "haven't suffered enough", and I can't bring myself to do the same to Mr. Cheney. In this particular instance, I am going to choose to believe that Mr. Cheney has suffered for long enough and that he and all of this healthcare team followed the rules and got him a new heart by fair means, otherwise I won't be able to sleep tonight. LOL!
I don't see the parallel just because Dick Cheney inhabits a world of privilege that almost no one else in this country will ever know. That makes such a difference in many spheres including health care. Nowhere have I said that he "hasn't suffered enough" and that is not a criteria for transplant. If someone goes into fulminant liver failure I would never suggest that they are less deserving of a transplant because they only suffered days as opposed to the years and years that some in organ failure suffer. However, how sick one is IS currently used as criteria, and that is not the same as trying to measure suffering, but is every bit as nebulous. Something concrete like an implantable device or the day one starts dialysis is far less vague, but as we know here, if your wait time only starts when you start dialysis, wouldn't that encourage some on the cadaver list to get on dialysis earlier? I don't know, because dialysis was so ghastly for me, that it would encourage me, but in the case of needing a heart pump, wouldn't you say "let's get that device implanted as soon as possible so I can accrue time before I get too sick?"
I just want to be perfectly clear that I have no special information about any of this. And I have said repeatedly that it should not be about what type of person he is. I know you understand my position, MM, because I know you will actually read what others have written before responding, and will admit it upfront when you haven't. I actually defended Cheney's heart transplant to a certain extent in class. My only question that I am looking at is how morality comes into the transplant allocation process, like it or not, and how rich=morally upstanding in America's current climate. We spent no time bashing Cheney. I said that I read in one article that 332 people over the age of 65 were given heart transplants, and 330 people died waiting. Now, to me, that is basically putting bait out for people who do not read critically and saying "See?! If we just kick all the oldies off the list, no one else has to die waiting for a heart." The math looks so enticing, but everyone here knows that it is much more complicated than that and completely unfair to make that assumption.
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How your privileged status affects your healthcare is an interesting topic. Steve Jobs and Dick Cheney were/are both men of power, money and influence, but one is dead and the other has been ill for almost all of his adult life. Having money and influence didn't stop them from getting sick.
Cheney had his LVAD implanted in July 2010, and if that was the date that his tx wait time began, that would indeed make it about 20 months on the list before he got his heart.
I know that in Australia, you can't get on the list for a cadaveric kidney until you've actually started dialysis, and thank God that's not the way it is done here. I cannot imagine that anyone would want to begin dialysis early just so that they could start accruing time, especially in light of the evidence that shows that early initation of dialysis is quite harmful. I can't imagine an Australian nephrologist agreeing to that strategy. I guess it is possible that an American cardiologist might push for LVAD before it was clinically necessary just so the patient could get on the list earlier, but you don't have to have an LVAD to get on the list, although you have to have an LVAD to be listed as Status 1A. But let's say that this is indeed what happened, that Mr. Cheney got an LVAD just so that he could start accruing time. It still took from July 2010 to now to get a heart, and per Willis' info, that's about right. I'm not entirely sure where Mr Cheney's money and privilege helped him in this regard.
And that's really the question. It's easy to say, "Oh, he's rich, so he gets a heart." But my question is HOW exactly does money help? In Mr. Jobs' case, I guess he had the money to have a private jet so that he could get a liver at any tx center in the country at a moment's notice. But he still had to be on the UNOS list. And despite his money, he still got cancer, and I'd bet you anything that his post-tx meds killed him. Money didn't really innoculate him from any suffering, and the same goes for Mr. Cheney. I guess that while I do understand that money talks, I'm just not sure what it said or if anyone really listened any harder.
The question of morality in organ allocation is an interesting one, and what is even more interesting is that there is any question at all. Do you have any speciific examples of how power and money affected the allocation process? There are several areas to look at. There is the area of eligibility. Did Cheney's power and money make him "more eligible"? Well, according to Inova, there is no upper age limit, and since he had had an LVAD for well over a year, I can't say that power and money made him "more eligible". Then there is the area of allocation, and maybe THIS is where his money and power had some influence, but in exactly what way, I don't know. And that goes back to my original question, which is HOW does one beat the system?
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And that's really the question. It's easy to say, "Oh, he's rich, so he gets a heart." But my question is HOW exactly does money help? In Mr. Jobs' case, I guess he had the money to have a private jet so that he could get a liver at any tx center in the country at a moment's notice. But he still had to be on the UNOS list. And despite his money, he still got cancer, and I'd bet you anything that his post-tx meds killed him. Money didn't really innoculate him from any suffering, and the same goes for Mr. Cheney. I guess that while I do understand that money talks, I'm just not sure what it said or if anyone really listened any harder.
The question of morality in organ allocation is an interesting one, and what is even more interesting is that there is any question at all. Do you have any speciific examples of how power and money affected the allocation process? There are several areas to look at. There is the area of eligibility. Did Cheney's power and money make him "more eligible"? Well, according to Inova, there is no upper age limit, and since he had had an LVAD for well over a year, I can't say that power and money made him "more eligible". Then there is the area of allocation, and maybe THIS is where his money and power had some influence, but in exactly what way, I don't know. And that goes back to my original question, which is HOW does one beat the system?
I don't think I have much to add to this beyond what I've already said. The specific example of the Japanese mafia receiving livers ahead of Americans waiting on the list I think is pretty clear. They apparently went through the FBI. Hard to think of anyone with easier access to the FBI or any other area of government that could intervene on his behalf than a former defense secretary and vice president. Let me ask, MM, in your heart of hearts, do you really believe that this country would let Dick Cheney die on a heart transplant waiting list? The history of the world is one in which leaders claim divine right to their position. This is just a worldview that seems to make sense to people in this country (even though we don't put it into practice on a regular basis) and of course England. Did you see the movie The Queen? If not, you should! So well done, and really fair in my opinion. Obviously, I cannot say what is accurate and what is not as the commoner-observer that I am, but HM's Personal Secretary does tell Tony Blair at one point in the film to essentially go easy on her because she was raised to believe that God himself wanted her in that role. There are people in every country who are deemed more important than the rabble.
George Best - I went back and looked up a few articles and his surgeon stated right before he died that he should not have been given that transplant. And as I've said, well, you cannot undo it and now you've gone and done a tremendous violence to those of us who will need transplants in future. (To be clear, I don't necessarily think that Best should have been denied a transplant - I have a huge issue with condemning someone to death for a mental illness, the overarching category that addiction falls into.) I think having that name and being given the benefit of the doubt where the rest of us have to argue these doctors straight down to the ground should not be underestimated. Frankly, I am surprised that no one came forward to offer him a live donation, but live liver donation still goes relatively unrecognised. Maybe they don't do those in England much. I have been thinking about the fanaticism that surrounds Welsh celebrities in Wales. I have never really seen anything like it. Tom Jones may be rather a kitschy joke to us, but in Wales I cannot imagine that they would leave him to die on a transplant list. It just wouldn't happen!
I don't think I am going to be able to answer the how question to your satisfaction. I think influence means something at Cheney's level and with that level of power, I just don't see that it would be that difficult to make a simple call to UNOS or a hospital or whatever. I don't think anyone could convince me that your average person with Cheney's health history would be let on the list. I think that he can reach anyone at any level of government (with the possible exception of Barack Obama) by just picking up a phone. This is not something that you or I will ever be let in on, what transpired. Age is taken into consideration at that hospital, and the oldest person to ever receive a heart was 72. For heaven's sake, at 71 Cheney has already outlived my grandfather and my uncle who died just last year. He gets more time than, for example, the Arizona man who had 6% heart function left and was saying on MSNBC back when Jan Brewer cut some funding or other "I'm a good person". (It was a nightmare to watch.) He's probably dead. Dick Cheney is alive. To quote Kurt Vonnegut, so it goes.
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LOL. I don't have much to add, either, so I'll let this discussion die a natural death. But before I do, you asked me a direct question, and I will answer. Yes, in my heart of hearts, I DO think that this nation would let Mr. Cheney die on the heart tx list. Why not? He is old and sick, and dying despite his long fight with cardiac disease wouldn't be greeted with a great gnashing of teeth. He is not generally beloved, and he no longer has anything to offer. While I despise the idea of Japanese gangsters jumping the queue and getting liver txs here in the US, and while I condemn it in the strongest possible terms, I can see (but cannot condone) the FBI hoping to trade medical care for information. The gangsters had a carrot, something to offer. I don't think Mr. Cheney has anything to offer any longer, so yes, I think this nation would let him die a natural death at the ripe old age of 71.
Yes, I saw The Queen. Dick Cheney is no Queen Elizabeth. LOL!
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Thanks for the reply. I can see that we come at this from two fundamentally different views. I mean, yes, I have to give it the anthro treatment which means analyzing the crap out of everything, but I do think Americans have more of that 'power and wealth are the will of God' than most admit. Cheney has his own set of information to offer, but I think the billions of dollars would be incredibly attractive to a transplant hospital. Government is so strictly hierarchical, and a certain level of respect for your superiors is forced on most federal employees, at least from what I've seen. I have to wonder what other countries would think if Cheney had died waiting for a heart. I have to think they would be unanimously gobsmacked.
I was told in my last meeting with my transplant coordinator (the one who got me listed, not the research one) that they can 'argue on your behalf' at UNOS. The question I had asked was if I could keep my waiting time if the transplant were to quickly fail. I thought that was interesting. Whom do they choose to go to bat for, and whom do they just send back to dialysis? I don't know. Maybe it's very fair and maybe it isn't. I would love to ask my surgeon how communication between him and UNOS works, but I don't want to interrogate him. My aunt's former neighbour was a heart transplant surgeon. If I ever see her again (not likely, but possible) I will ask her what she thinks about Cheney getting the transplant. And you know you all will be the first to get the transcript of THAT conversation.
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I want to add another thought here about privilege. Perhaps it is our god-like worship of celebrities, the very rich, and the very powerful that causes the people IN THE MEDICAL SYSTEM to give varying degrees of leeway to those they perceive to be in a "special" category. Look at how the media went bonkers over Michael Jackson and now Whitney Houston. I have nothing against them (RIP), but people like that (and yes, Dick Cheney and the Queen) cause a sense of social subservience and deference to just occur naturally.
Think about those times when most of us have experienced being in close proximity to famous people. They just dominate everyone around them. The more famous, rich, or powerful they are the more this phenomena is going to rear its head. I have met a few famous people myself and can still remember in vivid detail the entire experience of each one...and in a couple of these cases they were people I now find despicable! (Richard Nixon and Jessie Jackson for the curious.) Having lived in Southern California when I was very young I can still remember at least half-a-dozen "sightings" of Hollywood celebrities. And I can only presume that the more personal the contact is the greater this effect is going to be.
Just something to think about...
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Willis, your post engendered a sudden thought...
Now, I'm just babbling here, but it occurs to me that when we talk about celebrities, I wonder what it must have felt like to be Dick Cheney's tx surgeon or even just his cardiologist. These types of people sometimes think of themselves as celebrities. What a heady feeling it must have been to know that Dick Cheney's life was quite literally in your hands. I wonder if these rockstar surgeons ever feel that sense of "social subservience and deference".
It makes me wonder if instead of Mr. Cheney getting special treatment, he got the "usual" treatment because the tx people had the power. I had a consult with a cardiologist at my tx center last year, and I've never met a more arrogant man. I just don't see him giving ANYONE special treatment. LOL! We've all met these arrogant medical types... ::)
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Well, I was just a young soldier at the time, but being within 5 feet of the President while he made small talk with his family and worked out dinner plans as if the 20 other people around him weren't even there gave me quite a lesson. From very young age we are all encumbered with the traditions of the President (or the Queen) and those are so deeply ingrained I find it hard to believe that anyone not "at the top" and in daily contact will not succumb to the power of the position. I never met a Vice-President, but I'm sure such an encounter would only be fractionally different.
Look at that doctor who was convicted in the Michael Jackson case...surely he knew what was right and medically proper, but Jackson was in charge! I think I heard that he had gone through dozens of doctors. They all had to do Michael's will or, like the Queen in "Alice in Wonderland," it would be "off with their head." The doctor who was present at his death was just unlucky to have been there when the music stopped.
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My opinion on Cheney's transplant depends on so many factors. He could have received a heart from an older donor. There are so many different factors with a heart transplant that it truly comes down to only a handful of people that can take that specific heart, whereas potentially hundreds could take any given kidney.
Jerry Richardson received a heart transplant a year or two ago at my local center. He owns an NFL team and waited six months. At the time, the average rate for a heart in Charlotte was two months due to a high number of patients dying after being placed on the list.
In regards to Steve, he was not compliant with the pancreatic cancer initially. He did not want his body "invaded" surgically. He also had a rare form of pancreatic cancer that may have allowed flexibility in the transplant requirements.
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My opinion on Cheney's transplant depends on so many factors. He could have received a heart from an older donor. There are so many different factors with a heart transplant that it truly comes down to only a handful of people that can take that specific heart, whereas potentially hundreds could take any given kidney.
My research showed the opposite - they do not HLA-match hearts or livers, nor do they even do a cross-match. This seems to have to do with the very short, allowable cold ischemic time for those organs. So, unlike kidneys, if you share a blood type with the donor, you can be offered the heart. The fact that Cheney was let on the list at all says a lot about our value system in this country.
MM, I think the cardiologist you met would probably treat Cheney differently. I don't think people of Cheney's wealth and privilege would accept that treatment from a doctor, and Cheney probably had these people screened in some way first. I highly doubt that the transplant people had any real power in that relationship, in fact I would bet my last dollar against it. Considering what sort of brazen fraud some people in this country have managed to perpetrate I just don't see getting your name bumped up on a UNOS list to even be an obstacle. I don't think there was much question that Cheney would be let on the list (where another with his same stats would be denied). Also, I read that you must be no older than 69 when you start on the list. Must investigate further, but Cheney was certainly cutting it fine if that is the case. He was born Jan. 30, so about to turn 70 when he said he had not yet made up his mind whether to get a transplant or not.
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I sent Dr. Lorena Bobbit to operate on Dick Cheney. I never heard back. I wonder how that went?