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Dick Cheney's heart transplant at 71 spurs age debate By CBS News Staff, CBS News, March 26, 2012, 9:42 AM

Dick Cheney received a heart transplant at the age of 71 after battling congestive heart failure. After suffering a total of five heart attacks in his lifetime, Dick Cheney received a heart transplant at the age of 71. Jeff Glor spoke with CBS News medical correspondent Dr. Jon LaPook on what the surgery could mean for the former vice president's health.

(CBS/AP) Did former Vice President Dick Cheney get special treatment when the 71-year-old got a heart transplant on Saturday? Doctors are saying it's unlikely the Republican septuagenarian was bumped ahead of thousands of younger people who were also in line to get a new heart.

"You can't leapfrog the system," said Dr. Allen Taylor, cardiology chief at MedStar Georgetown University Hospital. "It's a very regimented and fair process and heavily policed."

More than 3,100 Americans are waiting now for a new heart, and about 330 die each year before one becomes available. When one does, doctors check to see who is a good match and in highest medical need. The heart is offered locally, then regionally and finally nationally until a match is made.

Cheney's case reopens debate about whether rules should be changed to favor youth over age in giving out scarce organs. As it stands now, time on the waiting list, medical need and where you live determine the odds of scoring a new heart - not how many years you'll live to make use of it.

"The ethical issues are not that he had a transplant, but who didn't?" Dr. Eric Topol, a cardiologist at Scripps Health in La Jolla, Calif., wrote on Twitter. Cheney received the new heart Saturday at Inova Fairfax Hospital in Falls Church, Va., the same place where he received an implanted heart pump that has kept him alive since July 2010. It appears he went on the transplant wait list around that time, 20 months ago.

Cheney had severe congestive heart failure and had suffered five heart attacks over the past 25 years. He's had countless procedures to keep him going - bypasses, artery-opening angioplasty, pacemakers and surgery on his legs. Yet he must have had a healthy liver and kidneys to qualify for a new heart, doctors said.

"We have done several patients hovering around age 70" although that's about "the upper limit" for a transplant, said Dr. Mariell Jessup, a University of Pennsylvania heart failure specialist and American Heart Association spokeswoman. "The fact he waited such a long time shows he didn't get any favors."

Jessup and Taylor spoke Sunday from the American College of Cardiology's annual conference in Chicago, where Cheney's treatment was a hot topic.

Patients can get on more than one transplant list if they can afford the medical tests that each center requires to ensure eligibility, and can afford to fly there on short notice if an organ becomes available. For example, the late Apple chief Steve Jobs was on a transplant list in Tennessee and received a new liver at a hospital there in 2009 even though he lived in California.

That's not done nearly as often with hearts as it is for livers or kidneys, said Dr. Samer Najjar, heart transplant chief at MedStar Washington Hospital Center. Each transplant center decides for itself how old a patient it will accept, he said.

"Most centers wouldn't put somebody on" at Cheney's age, said University of Pennsylvania bioethicist Art Caplan, who has testified before many panels on organ sharing issues.

"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" because younger people are more likely to live longer with a donor organ, Caplan said.

There have been other recent reports of successful heart transplants in septuagenarians.

In Canada, a man described as a home builder and philanthropist received a heart transplant when he was 79 at the University Hospital in Edmonton, Alberta, Canada. He lived for more than a decade with the organ, dying in 2010 at age 90.

In Texas, a 75-year-old retired veterinarian received a heart last year from a 61-year-old donor, but he had been a marathon runner and was presumably healthier than many of his peers.

Cheney will have to take daily medicines to prevent rejection of his new heart and go through rehabilitation to walk and return to normal living. He was former President George W. Bush's vice president for eight years, from 2001 until 2009.

About 5.8 million Americans suffer from heart failure and other 57,000 will die of it this year.

Teen put on heart transplant list after earlier denial

By Elizabeth Landau, CNN

Updated 3:34 PM ET, Wed August 14, 2013

A teenage boy with a failing heart had been denied a chance at a heart transplant. But that decision was reversed this week, turning his family's frustration to joy. Anthony Stokes has been at Children's Healthcare of Atlanta at Egleston since July 14, according to CNN affiliate WSB-TV. The hospital told his family the 15-year-old was ineligible for a spot on the heart transplant waiting list because of "noncompliance," family friend Mark Bell told CNN.

An August 7 letter from the hospital, which Bell provided to CNN, said that "Anthony is currently not a transplant candidate due to having a history of noncompliance, which is one of our center's contraindications to listing for heart transplant."

Noncompliance generally means that doctors doubt that a patient will take his medicine or go to follow-up appointments.

In a statement Tuesday, Children's Healthcare of Atlanta said, "While there has been misinformation circulating, Children's cannot discuss the specifics of this case or any other case due to privacy rules."

The hospital earlier had said it was working "closely with the family" to find solutions.

Children's Healthcare of Atlanta at Egleston is in good standing, according to the United Network for Organ Sharing, the nonprofit organization in charge of transplant coordination in the United States.

Assessing compliance for potential transplant recipients is important because if a patient doesn't strictly take all required medicines as directed, he or she could die within weeks of leaving the hospital, said Dr. Ryan Davies, a cardiothoracic surgeon at the Alfred I. duPont Hospital for Children in Wilmington, Delaware, who is not involved with this case.

But Bell said a doctor told the family that Anthony's low grades and time spent in juvenile detention factored into that assessment.

"The doctor made the decision that he wasn't a good candidate because of that," Bell said. "I guess he didn't think Anthony was going to be a productive citizen."

Anthony's mother, Melencia Hamilton, told CNN affiliate WGCL-TV that doctors said Anthony would live only three to six months if he didn't get the heart transplant.

In the meantime, the story became public in local media. The Southern Christian Leadership Conference's Georgia chapter got involved because Anthony's family called, and the organization has "a longtime relationship with the child," said the Rev. Samuel Mosteller, the chapter's president,

Mosteller said Anthony was judged based on "tattoos and an ankle bracelet" from a "juvenile agency." Bell said the detention was because Anthony got into "an altercation to protect his younger brother."

On Tuesday, Bell said, a doctor delivered the groundbreaking news to the family: "He said that Anthony has been approved to receive a heart. He put him on the transplant list."

Bell said doctors told Anthony he'll likely receive a new heart in about three to four months, but that this timetable could change.

Anthony had no health problems before this summer, Bell said; the heart problem is not congenital. But he started to have trouble sleeping and then complained about his chest hurting. His mother took him to the hospital because of the chest pains.

Bell said Anthony is excited and his mother overjoyed after the hospital's reversal. The teen is now considered top priority for a heart transplant; he just has to wait for one to become available.

The complexity of transplants Federal records show that 3,400 people were on waiting lists for heart transplants in 2012, but only 2,000 of these procedures were performed. While waiting for a heart transplant, 331 people died.

Dr. David Weill, medical director of Stanford University's Lung and Heart-Lung Transplant Program, said it's not unusual for patients to be rejected from organ transplant lists because of noncompliance -- in other words, if they are seen as people who won't follow instructions about taking medications and seeing doctors.

At Stanford, Weill's group evaluates about 300 patients per year for lung transplants and turns down about 1% to 2% because of noncompliance. It's about the same for heart transplants as well, he said.

As part of the evaluation process, organ transplant patients undergo a complete psychosocial evaluation so doctors can get a sense of whether they and their families will follow through with a complicated medical regimen, Weill said.

"A few times a year, we run into people who can't," he said.

A patient would not be turned down solely for having served prison time or having bad grades, Weill said, but "we would want to look at the entire picture."

Some patients have been denied because they don't have anyone in their lives who can take care of them and accompany them to appointments. After a heart transplant, patients are too sick to do these things alone, Weill said.

"When we fear that someone's not going to do well, it's because the patient couldn't comply with the regimen or they don't have any support in their life," he said.

Psychosocial factors don't change a person's priority on the waiting list, but they could lead a person to be denied a spot on that list, he said.

The trouble with teens

Arthur Caplan, head of the division of medical ethics at NYU Langone Medical Center, noted that patients have to adhere to a lifelong regimen after receiving an organ transplant -- showing up at medical appointments, taking medications, monitoring changes in health -- and teenagers in general don't have a good track record of following orders.

Teenagers aren't automatically ruled out for heart transplants, but "the consequence that 'you are going to die if you don't take these medicines' is far from the mind of a 17-year-old," said Davies, the cardiothoracic surgeon.

Instead of denying Anthony a spot on the transplant list, Caplan suggested that the boy should be counseled and worked with intensively so he understands what's expected post-transplant -- that is, if the teenager can get a heart.

Bell said the family didn't press the doctor on what led to overturning the decision regarding the transplant list.

Personally, Bell attributes it to "the handiwork of God and the media pressure."

In a video released by a family friend to CNN affiliate WSB before the reversal, Anthony plays chess and looks longingly outside his hospital window.

The hospital did not comment on what led to doctors' change of heart.