Shots - Health Blog
Sun March 25, 2012
Cheney Operation Underscores Heart Transplant Issues
Former Vice President Dick Cheney is recovering from a heart transplant he received Saturday at Inova Fairfax Hospital in Falls Church, Va.
The operation makes Cheney among more than 2,300 Americans who get heart transplants every year.
Heart transplantation has come a long way since Christiaan Barnard stitched the heart of a young woman into the chest of a middle-aged man in South Africa in 1967. That transplant recipient died 18 days later. Today, recipients can expect to get a decade or more of life from their new hearts.
"When patients are chosen carefully and they're in the care of a practiced transplant center, their outcomes can be truly remarkable," says Mariell L. Jessup, a heart expert at the University of Pennsylvania.
Few details about Cheney's case have been released. But heart transplant recipients are typically matched with donors with a similar body size and the same blood type. Hearts are in short supply, and more than 3,000 people are on the waiting list. So hearts generally go to the sickest person who is closest geographically and has been waiting the longest.
"These are all decisions that are made by experienced transplant cardiologists and surgeons, sometimes in the middle of the night on phone calls trying to make decisions for individual patients," says Mary Norine Walsh, the medical director of the heart transplant program at St. Vincent Heart Center in Indianapolis.
In the Washington area, the median waiting time is nine months. Cheney waited 20 months, an aide said in a statement. The donor was not identified.
But most recipients are between the ages of 50 and 64. Cheney is 71.
"In general, once the patient is over 65 or 70 they become excluded from heart transplant," Jessup said.
There are lots of reasons for that. One is that older patients are less likely to survive the operation, and more likely to die soon after even if they do.
"More of these patients are more likely to die within the first 30 days than patients who are younger," says transplant surgeon Scott C. Silvestry of Washington University in St. Louis.
Heart transplants are especially difficult for patients like Cheney. Over his lifetime, Cheney had five heart attacks, one quadruple bypass and several other heart operations.
"You know, every time we go in and out of a person's chest, it makes the next operation slightly harder," Silvestry says.
Younger, healthier candidates are also more likely to get more years out of hearts, which are scarce.
"I think all of us would agree that there probably is not a hard stop, because you might find an especially fit and vigorous 70-year-old, 71-year-old that would arguably be a good candidate," says cardiologist Clyde W. Yancy of Northwestern University.
One reason for that is people are living longer and staying healthier longer.
"Need is driving it dramatically. I mean, the baby boomers coming into this age group are pushing the envelope on what therapies we now offer patients into their 70s, which didn't used to be done," says Walsh.
Some patients with severe heart failure are staying alive longer thanks to mechanical pumps like the one Cheney had implanted in 2010.
"With the successes we have had with those, as I think is most obviously evidenced with our former vice president, there are now increasing options for older patients who have terminal heart failure," says cardiologist Savitri Fedson of the University of Chicago.
But some question whether doing transplants on older patients is ethical.
"Those of us who have been around for a long time, and I put myself in that category, need to step aside for younger people if there's a real scarcity of organs," says Robert M. Veatch, a bioethicist at Georgetown University.
Everyone agrees that the older the patient, the harder the recovery can be. The first year after a transplant is often arduous and most fraught with danger. Rejection and infections are the biggest threats.
Cheney will probably be in the hospital for at least several weeks. Then he faces months of recovery and rehabilitation, and living the rest of his life on powerful anti-rejection drugs.