Sunday, March 25, 2012

Cheney's Transplant: Thoughts from a Recipient

It has been made public that Dick Cheney has received a heart transplant. Cheney is a polarizing public figure. I don't think I've met anyone who "kinda likes" the guy. The same thing went through my mind that I'm sure might have gone through yours: "Isn't he like 100-years-old?". Actually, he's 71, but still... That's pretty old. So at first I wondered if some cronies of his pulled the strings to get him the first, freshest heart they could find. I couldn't have been more wrong about the circumstances though.
The average person on the waiting list for a heart transplant waits about 6-12 months. Dick Cheney waited 20 months. I'm no celebrity, but I was immediately bumped to the top when I went on the transplant waiting list. Of course, a lot of things play into that.
1. How sick are you? Can your quality of life be sustained without a transplant? As horrified as I was to wake up with a tracheostomy tube, needing that device actually was helpful in being able to "bump" me up to the top of the list.
2. Your doctors. Certain programs are more elite, are participating in studies involving transplants and have more pull than others.
3. Your size. I almost got a transplant 2 days into being on the waiting list. The problem? I'm a small girl. I am approximately 5'0 tall. The tallest my donor could be was 5'4, which narrowed the donor pool exponentially.
4. Other health factors. Is that organ the only thing keeping you from living a healthy life? Are there other problems? Are your kidneys healthy? Are you mentally stable? Do they believe you will take your meds and do everything in your power to keep this new organ healthy? Potential recipients go through rigorous physical and psychological evaluations before being determined as "fit" for transplant. Cheney would of had to pass these tests to even get on the list.

There's obviously a lot of other reasons, some I'm sure I'm not even aware of that come together to give a person the very special gift of transplantation. Cheney obviously was a sick man. He had 5 heart attacks and was living basically on batteries. However, doctors apparently thought it was reliable enough to not bump him up. Or, maybe, Cheney simply refused to be moved up because he knew the media speculation it would cause. I'm sure he went to the best of the best hospitals. And who could blame him? I've always done the same thing. My family packed up and moved to Missouri at one time to make sure we had the best of the best, and we are just regular folks. If I had Cheney's money, I'd go to the best place money could buy.
Speculation is the Cheney had a rare blood type which could have delayed the transplant even further. Age had to have played a role in this transplant. When transplanting organs, there is a 6 factor matching system known as HLA typing. A perfect match is of course 6 out of 6. Some family members are a perfect match, and some only have 3 out of 6, whereas a complete stranger may be a better HLA match for a person. When I had my kidney transplant, we went through a swap process where my aunt in her 40's donated to a patient in their 40's. In exchange, that same patient had a donor in their 20's donate to me. Not only was the younger donor a better HLA match, but the doctors felt better about putting a younger kidney in a younger person. I can only guess that doctors would also want an age appropriate heart for Cheney (especially since the size of ones heart changes over time. And he will only need it for 20 or so years). So if you had an image of cold, evil Cheney taking a donor heart from a sick little 8-year-old boy, you can get that out of your head right now.
I have a little experience on being on the waiting list. I can honestly say, it feels like purgatory. My phone is always with me anyways, but the level of neurotic I reached with my phone was beyond ridiculous. It was always on the loudest ring volume it could be, even if that meant a drunk text from a friend would wake me up in the night. I started wondering if my phone was broken or if I didn't have service and that was the reason my call wasn't coming. Was there a mistake? Did they get my number wrong? Did they accidentally erase me from the list? Every scenario goes through your mind. You already feel like an unlucky soul needing a transplant. Maybe another unlucky scenario happened and it's going to cost me my life.
Obviously I'm younger, I haven't lived as full of a life. I probably had more anxiety and unfinished business that someone who is 48 years older than me. But I also only had to live with these feelings for 5 weeks. Anyone who can do it for 20 months deserves some praise in my book. Being on the waiting list is putting your life on hold. You can't plan a vacation. You can't be more than a few hours away from your hospital at any given time. I remember just wanting to spend the day in my apartment, alone but I couldn't take the risk of getting that call and not being able to get to the hospital. Yes, I understand he probably has a personal driver and a helicopter. But what if there's a mechanical malfunction? Hearts don't care if you were Vice President. They expire after a certain number of hours if you can't get to the hospital, get prepped, and ready for surgery. I'm sure you don't ever have 100% peace of mind. You don't ever feel secure. According to Maslow, we cannot reach our needs of love, belonging and self-esteem without first feeling secure.
I'll also play devil's advocate with those of you who think the status of Cheney played a role in him receiving a transplant at this age. I believe it's very probable that BECAUSE of his status in the public eye, he will feel the pressure to properly take his immunosuppressant drugs, attend his doctor appointments, and possibly maintain his heart even longer than someone younger who doesn't have such public pressure on them. And because of his wealth, he's seeing the best of the best, being thorough, and going get the finest care possible going forward. If you're the donor's family, and you put politics aside, do you want the heart going to someone who may not take care of it, or someone who is going use all their resources to keep this heart as long as possible? It may seem unbelievable, but I've heard many stories directly from doctors of patients not taking their dugs after a period of time, relying on a loved to know their medications and dosages, not refilling drugs because of the price, and even not going to the doctor after signs of infection or rejection set in. These issues are much less likely with a patient like Cheney.
Everyone is allowed their own opinion on this issue, but I feel I have an opportunity to offer a unique perspective. I admire someone who can wait that long, especially when they're in a position of privilege and power. It's extremely humbling being used to having everything at your fingertips and still not be able to fix a problem. His odds of survival after 1 year are a bit below 70% and around 60% for a 5-year survival rate. I believe doctors take an oath that most follow and all involved waited till a heart that was right for Cheney was available. And improvements are being made every day in the world of immunosuppressant drugs and transplantation. It's exciting to read about and be a voice to represent.

1 comment:

  1. Saw your link on Facebook and I just had to comment. Cheney actually got his transplant at the hospital I work at! Fun fact. And thanks for putting this perspective out there - I work in the neuroscience ICU where we take care of a good number of patients that end up being possible organ donors. I don't have as much experience with the recipient side, but I know it is DIFFICULT to get on the donor list. No way would celebrity status play into such a regimented, strict process. And you are right - 20 months? No way was that special treatment. He is definitely on the upper-limit of ages able to receive transplants, but that means he obviously has taken good care of the rest of his body. He is not the first 70-something to get off the donation list.
    So rock on Dick Cheney, I'm happy for the guy :)