TOPICS > Health

Heart Transplants: How Do You Get One?

March 26, 2012 at 12:00 AM EST
Former Vice President Dick Cheney's heart transplant this weekend raised new questions about how the organ transplant waiting list operates. Margaret Warner and the University of Chicago's Dr. Allen Anderson discuss the waiting list system and why people with cardiovascular disease are living longer nowadays.
LISTEN SEE PODCASTS

TRANSCRIPT

GWEN IFILL: The news this weekend that former Vice President Dick Cheney received a heart transplant is raising questions about who gets on the waiting list and how.

Margaret Warner has more.

MARGARET WARNER: Now 71 years old, the former vice president has a long history of heart troubles. He’s had five heart attacks since the age of 37, and has received virtually every kind of medical intervention available, from stents to bypass surgery to, most recently, an artificial heart pump.

He waited 20 months for the new heart he got Saturday, somewhat longer than the average. And he’s older than most transplant recipients. A Cheney family spokeswoman said late today that he is awake and talking and doctors are pleased with his recovery so far.

Some 3,100 people are currently on the waiting list for a heart transplant. About 2,000 can expect to receive them each year.

And for more on all this, we turn to Dr. Allen Anderson, a transplant cardiologist and director of the Heart Transplant Center at University of Chicago Department of Medicine.

And, Dr. Anderson, welcome.

Let’s start first of all with. . .

DR. ALLEN ANDERSON, director, Heart Transplant Center, University of Chicago Department of Medicine: Thank you.

MARGARET WARNER: . . . how unusual is it for a 74 — 71-year-old with Mr. Cheney’s heart history to get a transplant?

DR. ALLEN ANDERSON: I don’t think it’s that unusual anymore. It used to be unheard of.

I think now, certainly, the vast majority of people are younger than the age of 70. And that is right around the age that most of us think it’s very difficult to find suitable candidates. But they do exist. And probably 3 to 5 percent of patients transplanted might be around that age.

MARGARET WARNER: Now, the Cheney family spokeswoman did say that the doctors think he’s doing well.

What are the risks that a doctor looks for and a patient looks for right now in the coming days and really weeks?

DR. ALLEN ANDERSON: Well, he’s cleared several hurdles right now. He survived to get a transplant, which everyone doesn’t. He’s awakened, presumably, and doing well after the transplant.

So those are some significant hurdles. The next thing that you will — that people will be looking for are things like the development of infections, signs of early rejection, which are uncommon, but do happen, and then really just to avoid the complications of illness that occur in the hospital setting.

MARGARET WARNER: Now, transplants used to be really quite out there in terms of medical technology. Now you’re describing expanding the universe of who gets them.

When did they become more widely available so that, say, 2,000 Americans are getting them each year, and why?

DR. ALLEN ANDERSON: Right.

Well, I think the big change occurred in the 1980s, when better immunosuppression became available. And that’s really when transplantation as a field took off, because it actually worked for the vast majority of people who survived to get the organ. And the technology has gotten better.

And so, nowadays, it has become, I wouldn’t say a routine, but it’s well within the field of what modern medicine does. And now that we’re seeing patients with heart pumps, which is a very rapidly expanding population, it changes the options for what we can do for patients with very advanced heart failure.

MARGARET WARNER: You mean because they can, as Mr. Cheney did, keep going on this artificial heart pump until one is available?

DR. ALLEN ANDERSON: That’s right.

These — the artificial pumps have historically been used to allow us to bridge patients who need transplantation, but are going to die before they receive transplants. Because they worked so well in that population, we have begun — and because we have got better pumps now, we’re actually using these pumps for permanent therapy for people who are not good candidates for transplant, who would rather not have a transplant.

And so that’s really seen a change in what we can do for patients who basically have terminal disease, and now. . .

MARGARET WARNER: Now. . .

DR. ALLEN ANDERSON: Yes.

MARGARET WARNER: No, I’m sorry. I didn’t mean to interrupt you.

But, OK, so who — if a patient and his doctor or her doctor decide he or she wants a transplant, then who gets to the top of the list? Who gets picked and why?

DR. ALLEN ANDERSON: Right.

Well, the timing of transplant really depends on several factors. It, first of all, depends on the severity of one’s illness. It depends on their blood type and their body size and whether or not they have any special issues that might require special matching of donors to recipients.

And so certain blood types are more likely to get transplanted. Certain blood types have a longer wait period. And the severity of illness really depends on how the patient is doing. Patients with heart pumps are given intermediate priority on the transplant list after 30 days. Everyone on a heart pump will get 30 days of the highest priority time.

And then they drop to the middle priority, unless they develop a complication related to the VAD, which would then allow them to be at the highest priority.

MARGARET WARNER: Now, the Cheney — doctor — I mean, Mr. Cheney’s doctor said that he had exerted no special influence to receive this heart and that the system, the donor system, could not been manipulated. Is he right about that?

DR. ALLEN ANDERSON: I think so, yes, particularly given the fact that he waited 20 months on a VAD, or a heart pump, for this transplant.

That’s longer than the typical person waits. That’s longer — it’s quite variable across the country. But, in our region, that would be a very long wait — or, in our program, that would be a very long wait. We would probably have a person like that transplanted — see them transplanted in six to 12 months, depending upon other issues.

So, I think that’s unlikely to have happened.

MARGARET WARNER: The head of the organ donor network said today or said over the weekend that now fully a third — no, 15 percent of those on the list, the wait list for a heart transplant are now 65 and older.

Do you expect that to increase, given — as baby boomers age and as this becomes more widely available?

DR. ALLEN ANDERSON: I think that’s true.

I think the vice president is the classic example of what happens with cardiovascular disease today. He has survived a much longer time than one might have predicted when he developed his problems because of the advance of technology and therapies that are available. And so that’s exactly what you’re going to see. Patients are taking care of themselves. They’re living longer. They’re generally healthier.

And as you generally see in the American population, people are doing better at older ages. So, I think that’s something to be expected. There is an upper limit, I suspect, but this is not surprising.

MARGARET WARNER: Dr. Allen Anderson from the University of Chicago Medical School, thank you so much.

DR. ALLEN ANDERSON: Thank you.