Heart Transplant Raises Questions

For more than thirty years the elites in this country have made attempts, with varying degrees of success, towards nationalizing our health care industry. Whatever your view of the goal of "health care for everyone" you must give honest inspection to those counties where socialized health care has been established. Only through reasoned examination of the reality of these schemes can one expect to understand the effects, consequences, and costs (both monetary and societal) such top-down planning of the medical industry have for our own people.

TSYK has long fought this trend and argues that most of our present day problems within the health care system can be directly traced to the federal government's existing controls, regulations, and policies which affect doctors, nurses, and medical institutions.

The following AP article is but just the tip of the iceberg of what is wrong with bureaucrats making life and death decisions. Throughout the article I will make editorial comments in this type style and color.


By TOM COHEN
Associated Press Writer

January 8, 2000

TORONTO (AP) — A 79-year-old Canadian's new heart isn't really that new, and his operation has kindled debate on transplant surgery ethics.

Ray Nelson was 14 years older than what previously was considered the maximum age for undergoing a transplant. And the heart he received from a 55-year-old donor normally would have gone unused because of its advanced age.

Unlike Canada, the United States has no age limit for potential transplant patients or organ donors. Cases are based on whether the individual is healthy enough for the operation, and the condition of the organ to be donated. However, in today's cost conscious, HMO/government dictated system many decisions are based on a bureaucratic cost/benefit formula.

But Nelson's Dec. 27 operation led to questions in Canada, where fewer than 200 heart transplants are performed each year. Not addressed in this article but, well documented elsewhere (in TYSK among other places) is the fact that Canada has so few heart transplant operations per capita due to its socialized system. Many Canadians die for lack of adequate facilities to perform such surgery. Those that can afford it travel to the US for these life saving procedures.

"One has to wonder whether or not the process was being manipulated to provide some advantage to someone who otherwise might not be eligible," said Dr. Douglas Kinsella, a lecturer on medical ethics at the University of Calgary. Note that the following discussion will concentrate on the process of how this man was able to obtain a heart transplant! Dr. Kinsella is an academic elite looking at numbers and policy surrounding the operation rather than a medical practitioner concerned about the life of a human being.

Nelson, a director of the Alberta Treasury Branches, a government-owned financial institution, is well-known in provincial business and political circles. He is also a friend of Dr. Dennis Modry, an Edmonton heart transplant specialist.

Complications after a bypass operation last year forced Nelson, an active man who used to swim at least 50 laps a day, to be hospitalized in September. Ten days after his transplant at the University of Alberta Hospital in Edmonton, he was sitting up and talking.

Dr. Arvind Koshal, regional director of the hospital's cardiac science program, acknowledged the committee of cardiologists, social workers and others that approved the transplant took unusual steps. Read that sentence again. A committee made this decision. A committee that included social workers and undefined others. What is wrong with the doctor or doctors of this man's choice making this important decision? Do you want social workers and "others" deciding your medical treatment or, whether you should receive treatment at all?

While 65 had been considered the maximum age for a transplant, that was never "carved in stone," Koshal said. I can think of a remark regarding just what type of "stone" might be carved but, I'll assume the reader can imagine as well as I.

He said the transplant committee asked the hospital's ethics board for guidance in Nelson's case. The ethics board said that while age alone should not be the determining factor, it also noted that patients needing hearts far exceed the number of donor organs available. As many as 6,000 Canadians are considered possible candidates for a heart transplant.

After "rigorous debate," Koshal said, the transplant committee voted in a secret ballot to permit a transplant, but only if Nelson received a heart that would otherwise go unused. Rigorous debate held in secret! So Mr. Nelson's life depended on the forceful advocacy in his behalf. If you aren't appalled you should be. Of course, rigor on Mr. Nelson's part would have avoided the need for this secret debate.

Hearts from donors older than 50 normally get used only for "status four" patients, meaning emergency cases in which "somebody is going to die otherwise," Koshal said. "Hey, Manny. We got a warm one in the ER. You know where we can find an old heart? It's got to be over 50 ya know!"

When the heart of a 55-year-old brain dead patient became available, he said, no emergency cases were pending. Two independent cardiologists on the transplant committee decided the heart was not appropriate for others on the eligibility list, so Nelson got it, Koshal said. This sounds like playing the odds at the race track. It would seem Mr. Nelson's luck was running high this day.

Glenn Griener of the University of Alberta's John Dossetor Health Ethics Center questioned whether giving Nelson the heart "amounts to substandard medical care."

"I haven't seen a coherent rationale for using this organ," he said.

Kinsella said the transplant committee's lengthy review was unusual and seemed intended to counter any accusations that Nelson "jumped the queue" for a transplant.

To Koshal, the decision hinged on whether cardiac patients younger than Nelson could wait for "a better heart."

"It's not that we're giving him (Nelson) a bad heart," Koshal said. "It's that we're giving him one better than what he had and would give him a better quality of life."

Well now I'm a bit confused. Griener from the University of Alberta can't see a "coherent rationale" for the heart transplant — with this particular heart at least. Yet, earlier we learned there was great (secret) debate as to whether Mr. Nelson would get any heart!

While Dr. Koshal, the hospital's cardiac program director (a.k.a. top bureaucrat), eventually arrived at the reasonable conclusion that Mr. Nelson was better off with an "old" heart than with his sick ticker. The convoluted numbers games he played in reaching that decision should be frighteningly eye-opening to us all.

In a nut shell, the next occasion of a decision over a heart transplant will have to factor in the patient's age, the availability of an old (substandard is the proper term... they have a sliding scale for hearts printed in the National Health Care Manual), and the forcefulness of the patient's advocate in the secret debate that will held while the "old" heart and the patient wait.

I for one will not willingly trade our current health care system for Canada's, Britain's, or any other socialized system. The answer to today's health system woes is the elimination of government controls and intrusions not increasing them.

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AP-NY-01-08-00
Copyright Associated Press. All rights reserved.

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9 jan 2000