http://nbcpolitics.msnbc.msn.com/_n...recovering-at-hospital-after-heart-transplant
I wasn't sure he had a heart. BUH DUM PISH!!!!!
What? Nothin'? 😉
D712
I wasn't sure he had a heart. BUH DUM PISH!!!!!
What? Nothin'? 😉
D712
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Dick Cheney Heart Transplant
Started by doctor712
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deleted126335
I don't have a socialist bone in my body, but giving a heart to a 71 year old man because of who he used to be makes we want to storm the winter palace or at least join occupy wall street.
Dude, if medicare is paying for this, I really take issue and there really is something to means testing. But if he is paying for this himself, I have no problem. It would be interesting to know who is fitting the bill.
The CHIEF CRNA probably instructed the SNRA what the anesthetic plan should be. Cause ya know, in DC they want cost effective health care.
Foxtrot (Genesis reference perhaps?),
I would imagine his insurance is provided by our good old US Gov't, like my father who is a retired Fed. And my sister who is retired as well. Why would he pay for this out of his pocket? I just don't see that. I'm sure they found the usual co-morbidities and justified that once they give him a good heart he'll live another 20 years, give or take 15. 🙄
I know that aged Kidney patients do very very well following a transplant, when they come off dialysis (just submitted a paper on this). So there's an argument for that, right? I don't know the details on hearts and how they fair following transplant, but I'm sure the notion that these hearts should goto 30 year old patients, more utility in the donation. However, when I was writing this thing, we had to approach surgeons for their opinions on donation, and despite the obvious idea that a 70 year old patient won't last as long as a 30 year old patient, MORE THAN ONE surgeon told me that age just simply isn't taken into account. (I called BS with my co-author but what the heck do I know). As a matter of fact, I THINK I was told that age simply isn't taken into account in kidney guidelines. Not sure about that one, wrote it last year.
Anyone have thoughts on marginal organ donation for these patients? Instead of tossing a marginal heart or marginal kidney, what about using them in the aged who are otherwise SOL? And save the young organs for young peeps? Another argument may be out of respect for the aged, you know, they've been around and deserve something from society. (stating an argument, not looking to support or argue this idea, no need for more flaming at the moment).
D712
I would imagine his insurance is provided by our good old US Gov't, like my father who is a retired Fed. And my sister who is retired as well. Why would he pay for this out of his pocket? I just don't see that. I'm sure they found the usual co-morbidities and justified that once they give him a good heart he'll live another 20 years, give or take 15. 🙄
I know that aged Kidney patients do very very well following a transplant, when they come off dialysis (just submitted a paper on this). So there's an argument for that, right? I don't know the details on hearts and how they fair following transplant, but I'm sure the notion that these hearts should goto 30 year old patients, more utility in the donation. However, when I was writing this thing, we had to approach surgeons for their opinions on donation, and despite the obvious idea that a 70 year old patient won't last as long as a 30 year old patient, MORE THAN ONE surgeon told me that age just simply isn't taken into account. (I called BS with my co-author but what the heck do I know). As a matter of fact, I THINK I was told that age simply isn't taken into account in kidney guidelines. Not sure about that one, wrote it last year.
Anyone have thoughts on marginal organ donation for these patients? Instead of tossing a marginal heart or marginal kidney, what about using them in the aged who are otherwise SOL? And save the young organs for young peeps? Another argument may be out of respect for the aged, you know, they've been around and deserve something from society. (stating an argument, not looking to support or argue this idea, no need for more flaming at the moment).
D712
The main difference between kidney and heart transplant for older pts is supply. There are no living heart donors, and only one organ per pt. I remember the stat that only 2% of people on the heart txplt list get a graft.
i think i just always assumed his VAD was destination therapy, rather than a bridge.
So why is he less deserving than the prisoner serving life I saw get a heart? Seriously, Ive done a 99 yr old hip fx, given a new kidney to an 80 yr old...When I was a resident, many of my staff, trained in foreign countries would just shake their heads and say "this would never happen in my country."
AMEN- 👍
I believe it should be the CHIEF DOCTOR CRNA instructed the RESIDENT ANESTHESTETIST. You should get it in the most confusing terms as possible that way you dont give away your secret to the public.
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I am not sure what you are talking about when you said Genesis reference? Please explain.
The point I was making was not whether if he should have had the operation. That is irrelevant. What I am interested to know is whether or not medicare paid for it. In case you haven't heard, medicare is going broke. Do you know how much a heart transplant runs? I looked this up and it is about $700,000.00. Cheney is a millionaire many times over and can afford to pay for the transplant. My point is, there are many super wealthy people who are collecting medicare and social security. Granted it is a system they paid into, but did they pay in more than they are costing the system? Most of the time there is a deficit between what they paid in and what is paid out. This would be all fine and good if the system had a surplus of money but it doesn't. And those of us in Gen X and Y are paying into a system in which we are not going to reap any benefits because there are not enough of us to pay for the surplus of aging baby boomers with the current system in place. If you don't believe this, you haven't done your research. Age is not as much of my issue with transplantation, rather how does medicare continue to pay for such things? We all have to start asking ourselves these questions because they are going to be facing all of us pretty soon.
That is hilarious!!
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deleted126335
Anybody on this board ever put hert in a 71 year old? 65 year old?
Heh 🙂
It wouldn't surprise me at all if rich/powerful people somehow get preferred treatment when it comes to organ transplants, but today someone offered me another explanation for how the Chenys and Jobses and Evel Knievels never seem to die on waitlists -
Super-rich people can be on more waitlists in a wider geographic area, since they can hop on a private jet minutes after being notified and flown at 600 mph straight to the donor site's nearest runway. This explanation makes sense to me, and since it doesn't need a conspiracy to work, I tend to believe it.
No, didn't do any transplants as a resident and none since.
I take that back, I've done exactly one ... my first oral board stem, does that count? Kind of pissed me off seeing that stem, of all the cases fate could've given me, it had to be one I'd only read about ...
I have been involved with roughly 3 heart transplants. During my PICU rotation we had no first surgical assistant at night. So myself and the CTA surgeon transplanted a heart in a 10 year old. He even let me throw a couple of sutures in the aorta. As a CA3 I have done 2 heart transplants with a fellow of course during cardiac call. Never that old.
I understand that it looks bad; however, wanst he the one highest (possibly only) person on the list that matched the time and organ type? He also waited 20 months. I just dont want to jump to conclusions that because he's powerful it was ill-gotten.
PS: Do you need to be a special type of anesthesia doctor to do organ transplants? Fellowship? They seem as though they would be extremely technical...
PS: Do you need to be a special type of anesthesia doctor to do organ transplants? Fellowship? They seem as though they would be extremely technical...
This is correct. They get multiple lists. There was an uproar when Mickey Mantle got his liver in the 90's. I subsequently worked with those surgeons and that OPO- there was no funny business. UNOS is not easily gamed, and if they discover anything peculiar, programs can be shut down.
I did a lung TX a few weeks ago- the guy had been listed for like 48 hrs. He was not famous.
Heart, lung and liver transplants would be more challenging cases than kidney, pancreas. Small bowel and abdominal walls aren't being done in very large numbers yet. Same for face (see recent thread). You don't have to have a fellowship to do these cases but a cardiac fellowship might be helpful for heart/lung transplants. At my old program the critical care anesthesiologists did the liver transplants but again that's not any kind of requirement.
Mickey Mantle was on the list for one day. The national average is roughly 365 days.
Foxtrot,
Genesis reference: the band had an old album entitled Foxtrot. I'm a huge fan, thought you might have been too, but I'm thinking maybe you're a military guy or you just like the compound word Foxtrot. : )
Anyway, I respectfully disagree with the issue at hand here. I bolded the main points. If Dick Cheney -- or any other Federal employee paid into a system, I don't care how much money they have sitting in the bank, insurance is insurance for a reason. Now he's using his insurance. Period. So, we're going to penalize people with money from using every last ounce of their benefits? Do we charge rich people more for milk, because they have 100,000,000 in the bank? More for basic cable? Or for the same car I own if they want to own it? But we should make them pay/more for a surgery - despite his own situation that he has gobs of money - even though I'd argue the average lifelong G employee is NOT sitting on 100,000,000$, or 1/1000 of that?
You yourself gave short shrift to the fact that he "granted paid into it...", yeah, isn't the point of paying in the fact that he...can use his insurance? I don't find much debatable here except the dude's politics. Other than that, pay in...use it up. And I'm sure he paid a LOT more into social security than the 20 year mail carrier. You say there's usually a deficit between what they pay in and take out, that goes for everyone though right, or just the rich? It's not Cheney's fault the system isn't working and Gen Y MAY be SOL. You don't want him to have medicare, then he should get a refund of all the funds he paid in.
Medicare is there for the rich and poor, it's as simple as that. I mean, despite his wealth, the dude gave much of his entire life to public service, and now we're going to deny him medicare TX because of his bank account? That's no incentive for people to go out there and make it in America. To state the obvious, I'm not the one doing a 6 hour heart case after going to med school and residency and fellowship to get paid bupkis on a medicare case. But I am SO not down for the wealthy to fix that problem considering they paid in for 50+ years. That sounds SO not kosher.
D712
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the problem is we arent running out of milk and eggs, we are running out of health care dollars. im probably the most socialist person on this board (still not saying much, i know) and even i can see the writing on the health-care wall of the future.
WHy didn't you bold the other part of my statement, where I described the nobody that got a lung in 2 days.
It wasn't news because he's not famous.
Maybe, instead of punishing the rich for paying their share, we should be looking closer at the 5 pack a day medicare using smoker who has already had a tube put in his throat and radiation AND still refuses to stop smoking so needs a complete laryngectomy? Now THAT is where I think we should be rationing healthcare dollars. 100%. 2 ENTS in that room, attending anesthesiologist, resident anesthesiologist, support staff, a main OR for hours...all because this dude KNOWS he and his cancer causing habit are getting free treatment.
D712
D712
Kidneys and hearts are probably the less challenging cases from the point of the anesthesiologist.
I've had a patient transplanted on her second day listed for an apap OD. It's important to understand that for OLT, the list is not a line. Its based on an assessment of death risk (Meld). Wait times are bimodal.
Also, there are huge differences between the OPOs. Get listed in Tenn. and Florida.
As much as it pains me to admit it, Cheneys transplant was probably legit.
Of course it was. 20 months is significantly longer than the average wait time for a heart transplant.
But probably not deserved
Come on, "deserved" isn't the right word.
I thought Dick Cheney was basically the mouthpiece of Beelzebub himself as VP. But if the man was eligible, he was eligible.
I too had always just assumed his Heartmate was destination therapy, but if UNOS says 71 year olds can get hearts, then I don't see any reason why this 71 year old shouldn't.
We can argue about the ethics of 70-somethings getting organs, but not about this specific one. I'm sure he didn't game the system, the system is ungame-able, unless you consider the Steve Jobs-style multiple center listings with private jet at the ready. But in that case, don't hate the player, hate the game.
I've done heart transplants in patients older than Cheney. There are a couple of papers showing that 65 isn't a contraindication to successful transplant. What we'll never know is the quality of the donor organ. What usually happens is that these older recipients get organs that have been rejected for younger patients (like LVH, lower quality EF, CAD in the donor heart). He seemed to be in pretty good shape with the Heartmate II, losing a lot of weight which probably made him a better candidate.
I mean he certainly wouldn't need an a-hole transplant
yeah i bet, fulminant hepatic failure tends to get you bumped up the list quicker. mickey mantle had alcoholic cirrhosis and disseminated malignancy, he was transplanted before the days of MELD scoring and he died within 2 months of transplant. i can almost guarantee he was a poor candidate for transplant, and i only hope he received an extended criteria liver to get one after less than 24 hours, but im sure he got one from a 20 year old head trauma.
