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Transplantation in 2012: Still dispelling myths

In 1986, my father, a radiologist, advised me not to go into transplantation; his 60’s vintage medical education taught him “that stuff never works.” By the time he passed away in the mid-90s, Dad knew better. How ironic that even now, a quarter century later, so much misinformation remains regarding what it is we do. The Dick Teresi article/book regarding “the ice-water test, beating heart cadavers” and “blurring the line between life and death” resurrected long-ago-disproven factoids and half-truths in a very public forum, forcing us all to defend the ethics and science underpinning donor care. Saturday, word that Dick Cheney (lauded in some circles and notorious in others) had received a heart transplant at age 71 brought out the usual squawking about unfair organ allocation and a rigged system. Yet, in 2011, 14% of heart recipients were over 65 years old, and he had spent a longer-than-average 2 years on a VAD and transplant waiting list. Was his claim for a transplantable heart less valid than the 332 others of similar age that received cardiac allografts last year?

Our profession enables us to participate in marvelous doings, things unimagined even a few years ago. It is as important as ever that we remain committed to the highest ideals, helping keep a curious public appropriately informed.

Robert S. Gaston

Comments

Thanks for the post Bob; the sad article to me further illustrates the absolute failure of the current American Press to separate news from commentary, and truth from hyperbole. The plummeting sales of the NY Times mirrors it's current transfiguration into a tabloid. It is incumbent on the Medical Community to rapidly respond to these failed for profit information rags with fact, unqualified references, and a direct rebuttal. If not, Medicine in general and Transplantation in particular will be fodder for these News fish wraps that like to play their version of the TV political gameshow Crossfire to boost sales.

I would add that I was dismayed last week during audio released from the Health Care Mandate debate that two conservative Supreme Court justices used transplantation as their example for the "horror" of mandating expensive health care, specifically casting it into a context of "why should everyone have access to a liver transplant or a heart transplant?" We need to object loudly to the assumption in such a question that transplantation is not absolutely justified as one option for the therapy of end stage organ failure. Transplantation as a therapy choice needs to be managed by physician experts in these fields with the same attention to evidence-based outcomes as should drive diagnostic testing and drug therapy choices. In such a context, transplantation comes out well. For these justices to suggest that transplantation is a significant driver of the current health care cost spiral is simply false and manipulative, essentially propaganda that fueled last year's drama in Arizona to cut Medicaid spending on transplantation and a recent threat to do the same in Illinois. Transplantation should not be the scapegoat for health care costs.

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