For want of a heart

Dorothy Dowling

October 09, 1991|By Dorothy Dowling

MY FRIEND JOE is dying!

Barring a miracle, he will be dead by the time you read this. The cause of his premature demise will be listed as "cardiac insufficiency." The reason will be apathy and ignorance.

The truth of the matter is that Joe's heart has already failed. Multiple cardiac infarctions have all but destroyed his heart muscle. For the last month this 48-year-old physician, a loving husband and father of three, has been kept alive solely by a heart pump. This high-tech machine does for Joe what his own heart used to do -- it pumps blood and oxygen through his body.

For Joe this means being tethered to a machine by wires running through his groin and right leg. Should he develop an infection in that leg, which is quite likely at some point, he would be disconnected immediately from all the wires, and death would follow. Initially, the pump was hooked to his other leg, but an infection there two weeks ago necessitated the switch.

Joe's only chance for survival is a heart transplant. The pump is merely a temporary solution to a permanent problem. Within the next month doctors will be forced to disconnect this device, and Joe will die within hours.

His death will be unacceptable! It will be totally unnecessary. He will die because there are no hearts available for transplant. Because of the very critical nature of his condition, he is at the top of the list for an "A-Negative" heart, but none can be found. Many factors play into this. Some of these we can't control; others, we can. For instance, we can't control the fact that a significant percentage of young, prospective donors are dying of AIDS, rendering their organs virtually useless for transplant purposes. We also cannot control the fact that successful tissue matches occur in only 40 percent of donated hearts, unlike other organs where tissue-typing is a less significant factor.

However, we can, and, indeed, must control the supply o available donor organs. Simply stated, Americans have to be educated early about the tremendous need for volunteering as donors.

After age 55, hearts are not acceptable for transplants. If you consider how many people in this country are over that age, and presumably more likely to die than their younger counterparts, you begin to see the scope of the problem. In addition, perhaps we need to look elsewhere for some new ways to approach an old problem. In Europe, for example, all people are assumed to be organ donors unless they specify otherwise; in this country just the opposite is true.

Then there's the delicate issue of the family's right to "just say no," even after a loved one has recorded his or her desire to donate. For instance, my husband's driver's license has the word "DONOR" clearly imprinted on it in large capital letters, but, should he die, I have the right to circumvent his wishes and have him buried with his heart, kidneys and corneas intact.

As Joe lies in his hospital bed, listening to the whoosh of the pump that is keeping him alive, surely the irony is not lost on him. He is a decorated Vietnam veteran who saved many a life as a physician in war. He is experienced in the "triage" system that gives primary care first to those who have the most critical yet survivable injuries. When he returned to the states, he did some more military medical work at an inner-city hospital.

But now he lies near death. What happens to him is not so much dependent on medical effort, for Joe has an excellent chance for complete recovery and a normal life if he gets a heart. If we ignore Joe and others like him now, the dilemma will surely come back to haunt us.

Dorothy W. Dowling writes from Ruxton.

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