Cheney’s heart transplant is about personal freedom

By Sondra L. Shapiro

I was taken aback by my less than enthusiastic reaction upon learning that former Vice President Dick Cheney had had a heart transplant. Was it his age — at 71, he was among the oldest transplant recipients — that upset me? Actually no, though news reports and pundits have pontificated on Cheney’s age.

The majority of heart transplants occur in 50- to 64-year-olds, according to the United Network for Organ Sharing. In 2011, 2,232 people received heart transplants; 392 of them were over the age of 65.

What had initially disturbed me was a wrongful assumption that he had received special treatment — that he was moved to the top of the heart transplant list. I soon learned that Cheney spent 20 months waiting for a heart, compared with the average wait of six months to a year. So, he actually waited longer than most.

The interest in Cheney and his heart did get me thinking about what individuals in need of a transplant must go through in deciding to go ahead with the surgery, how they and their families cope during the wait and after the surgery. Especially for those who are older. And finally, if this personal choice is anyone’s business anyway.

Suffering from congestive heart failure, Cheney had five heart attacks over the past 35 years. He had received bypasses, angioplasty, surgery on his legs and a pacemaker. After his last attack in 2010, he received an implanted left ventricular assist device (LVAD) to help keep his heart beating until a heart could be found for him.

Age is less of a risk today because the technology has improved so much. The survival rate for individuals over 65 is 84 percent in the first year — a high number to be sure. But should that be the only deciding factor when an older person is faced with the prospect of going through an organ transplant? There are intangible considerations associated with age that shouldn’t be labeled ageist for suggesting them. “Most centers wouldn’t put somebody on” at Cheney’s age, said University of Pennsylvania bioethicist Art Caplan in a CBS News report. “I’ve been arguing for a long time that the system should pay more attention to age because you’ll get a better return on the gift” since younger people are more likely to live longer with a donor organ, said Caplan, who has testified before panels on organ sharing issues.

There are more than 3,000 Americans waiting for a heart. More than 300 usually die each year before receiving one. The decision is literally a life and death one. Regardless of age, the person facing the journey — from the initial placement on the waiting list to hopefully receiving an organ — must go through an excruciating mental exercise, thoroughly examining the reasons and expectations of this life-altering event. I can’t even imagine.

While, I could hardly compare a heart transplant to the less risky or critical procedures I have faced, whenever a doctor suggests a medical course of action, I ask whether the benefits outweigh the risk, expense and the impact of the recovery.

For, me, it is always about managing expectations. If I have this procedure, how will my life realistically change? Will it be for the better? Can I be happy with the limitations of the results? If I had a bad knee, but was no longer very active, should I really get a knee replacement? If I got the knee replacement, would I become more active?

If I were faced with having to decide about a heart transplant at 71, I’m not sure I would want to go through with it considering the risks and expense compared to the years and benefits I might get out of it. Not to mention the strain I could put on family members. But, that’s just my initial reaction.

If it came to making a choice, I would try to be brutally honest with myself and run through the risks and benefits. In the end, it would be my decision and a very personal one at that.

So, at its core, Dick Cheney’s decision to go ahead with a heart transplant at his age is his own business. We can debate it ad nauseam. But it was his personal choice and it would be ours, if we were ever in his position.