Opinions on Dick Cheney getting a heart transplant?

[MooseMom]

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!

[Gerald Lively]

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.

[cariad]

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.

[MooseMom]

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?

[cariad]

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.

[MooseMom]

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!

[cariad]

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.

[Willis]

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...

 

[MooseMom]

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...

[Willis]

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.

 

[lawphi]

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.

[cariad]

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.

[Gerald Lively]

I sent Dr. Lorena Bobbit to operate on Dick Cheney.  I never heard back.  I wonder how that went?