Opinions on Dick Cheney getting a heart transplant?

[cariad]

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?

[billybags]

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.

[glitter]

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.

 

[Whamo]

Cheney got a huge bonus from the oil companies just before he got elected, didn't he?  He sold Americans out, in my opinion.   

[MooseMom]

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.

[Desert Dancer]

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.

[cariad]

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.

[MooseMom]

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.

[natnnnat]

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.    

[cariad]

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

[Desert Dancer]

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?

[MooseMom]

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.

[cariad]

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

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.

[Desert Dancer]

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?

[MooseMom]

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

[MooseMom]

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?

[cariad]

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.

[MooseMom]

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.

[cariad]

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.

[MooseMom]

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...

[Willis]

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.

 

[cariad]

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? 

[Willis]

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.

 

[MooseMom]

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.

[cariad]

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

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?

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.