Dick Cheney has a new heart (okay, not new but rather “pre-owned,” in the parlance of the used car trade), and his picture is all over the news. He’s doing well, the transplant team is high-fiving one another and another load of cash has cascaded through the transplant industry ($997,700 is the average U.S. cost of a replacement heart).
But one player has been forgotten, the man, or woman, unpaid, uncelebrated, who made this all possible: the anonymous donor of Cheney’s heart. He is interred in the Tomb of the Unknown, Cheney’s chest cavity. This is how we like our donors today — faceless, nameless and not embarrassing the living. It was not always so.
When South African surgeon Christiaan Barnard performed the first heart transplant in 1967 in Cape Town, the recipient was Louis Washkansky and the donor was a woman named Denise Ann Darvall. She had been fatally injured in a traffic accident. Darvall was 24 years old, a bank clerk and, best of all, a white person. McGill University anthropologist Margaret Lock writes that it was important that the first-ever donor must not be “colored.” Lock also notes that Washkansky and Darvall’s photographs appeared side by side in many news reports, and that in one photo Washkansky’s wife is seen looking sympathetically at Darvall’s father. (See Lock’s excellent book on organ transplants in Japan and North America, “Twice Dead.”)
It was a different story with Barnard’s second transplant. He went straight to the race card, serving up the heart of a “colored” man, 24-year-old Clive Haupt, to a white, retired, Jewish dentist, Philip Blaiberg, 58. Not that permission wasn’t obtained. Blaiberg said he didn’t mind getting a “colored heart.” Ebony magazine ran an editorial, dripping with sarcasm, in which it noted that if Blaiberg completely recovered, “Clive Haupt’s heart will ride in the uncrowded train coaches marked ‘For Whites Only’ instead of in the crowded ones reserved for blacks. It will pump extra hard to circulate the blood needed for a game of tennis where the only blacks are those who might pull heavy rollers to smooth the courts.”
Photos of donors, often young and robust, juxtaposed with photos of the recipients, often much older and Cheneyish, were common in those early years of transplants, but absent today. The transplant industry has come to understand that publicizing donors is an embarrassment, and we in the press have been lulled into ignoring them as a whole. I have been part of that press. As an editor I once ran an enthusiastic article about the wonders of transplantation that encouraged donation without any specifics about what happens to a donor.
The ambiguity of the donor’s role and condition has not been well covered. In 1968, 13 men at Harvard Medical School formed a committee to define a new set of criteria for death: brain death. The cardiopulmonary criteria — you’re dead when your heart stops irreversibly and you stop breathing — had served well for many years, but heart-dead patients do not make ideal donors. There is no blood flow to bring oxygen to their organs. But a brain-dead donor’s heart is still functioning. After death is declared, his ventilator is re-connected, and his heart will continue to beat, straight through the harvest (the transplant world prefers the euphemism “retrieval”) process. The Harvard committee gerrymandered the border between life and death for the purpose of providing healthier organs for those able to pay for them.
The brain dead share more traits with the living than with heart-dead patients. Like you and me, they get bed sores, contract infections and have heart attacks (and can be resuscitated). If pregnant, they can gestate the baby and give birth to healthy infants. They are gurneyed to harvest with their hearts still beating, and during the “retrieval” surgery will often exhibit soaring heart rates and blood pressure just like living patients who have not received enough anesthetic.
These problems remain largely unaddressed. The American transplant surgeon Denton Cooley said, “In my opinion the clinician can become too preoccupied with the rights of the dead, namely the donor, at the expense of the recipient. We should not jeopardize the possible survival of the recipient while we are waiting around to make a decision whether the cadaver, as you call it, is dead or not.”
The transplant business requires three groups: the recipients, who obviously benefit; the medical establishment in the middle, which profits from prestige and $27 billion in annual revenue; and the donors, who receive … I’m not sure what. No money, because it’s illegal to pay donors in America for organs. That is a topic for another day.