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Governor Casey's Timely Transplant

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The news at Pittsburgh's Presbyterian University Hospital was almost too good to be true. On June 13, within hours of announcing that Pennsylvania Governor Robert P. Casey would require a risky heart-and-liver transplant, doctors located donor organs of the right tissue, blood type, and size for the governor.

The downside: Doctors knew that if they operated on Casey, they risked charges that the rich and powerful get organs right away, while poorer patients die waiting. "We were concerned about people's perception that this smacks of favoritism or conspiracy," says Dr. John Fung, one of Casey's surgeons.

PRIORITY LIST. But doctors overcame these concerns and tended to the patient. The 61-year-old Casey, suffering from a liver disease called amyloidosis, had reported to the University of Pittsburgh's renowned Transplantation Institute for tests on June 12. A day later, doctors announced that proteins produced by Casey's liver had nearly destroyed his heart. Within hours, Casey was on the operating table, and Pittsburgh's medical team, headed by transplant pioneer Dr. Thomas E. Starzl, was sewing the heart and liver of a 34-year-old murder victim into the governor. The next day, the two-term governor was awake, and doctors were giving him a 90% chance to survive a year.

Then the questions began. "People have asked, `Was this fair?"' says Wanda Bond, spokeswoman for the United Network for Organ Sharing, a transplant watchdog group in Richmond, Va. Indeed, why did Casey get organs so quickly, when the average wait for a heart is one year?

The answers: The governor's heart could have given way any day, the hospital said. Further, Casey needed two organs, not just one, placing him on a priority list. "We don't give preferential treatment to anyone," says Jeffrey Romoff, president of the University of Pittsburgh Medical Center.

The issue of fairness is a crucial one in the burgeoning transplant industry. Each day in the U.S., an average of six people die while waiting for a new heart or liver, while more than 100 possible donors die without volunteering to make their organs available to others. The gap between supply and demand is largely a result of mistrust, transplant specialists say. Even though federal law prohibits the sale of organs, many potential donors fear that the system benefits rich patients and jet-setting surgeons. Says Laurence C. Swasey, community-education liaison at the New York Regional Transplant Program: "I have to fight this myth all the time, that only the wealthy get organs."

High-profile cases such as Casey's, while highlighting the technology, only complicate the sales job. Nonetheless, modern technology and new drugs that keep the body from rejecting organs have made transplant surgery far more commonplace. Some 16,000 major organ transplants were performed last year.

Insurance companies buy into the procedure; even at an average cost of $148,000, a heart transplant costs less than several years of treatment and medication. Casey's transplant bill, estimated at $250,000, will be paid by the same Blue Cross coverage held by 80,000 other state employees.

BIDDING WARS. As the $550 million industry grows, hospitals throughout the country are wooing hundreds of surgeons from transplant meccas such as Houston and Pittsburgh with million-dollar contracts.

But none of the specialists can do much without a steady supply of organs. Often, they come from down-in-the heels towns, such as Monessen, Pa., a town with a shuttered steel mill and a booming drug trade. It was there on June 6 that William Michael Lucas, an unemployed 34-year-old, received a fatal beating. A week later, his respirator was turned off in time for his heart and liver to go to Governor Casey. Speaking to the press after the operation, Lucas' mother, Frances, said it made her "feel good" that her son's organs were giving life to someone. But such charity alone won't sustain the growing demand for transplant organs. For this, the public must be convinced that the priceless merchandise flows both ways--that a governor's organs could give life to an unemployed man in Monessen.WAITING FOR A NEW LIFE

WHO More than 32,000 people await organ transplants. At least 6,000 need new

hearts and livers.

THE ODDS One-fifth to one-third of the waiting list dies each year, even though

some 50,000 qualified donors die annually. About 50% of those on waiting lists

get a transplant.

THE COST The average heart transplant costs about $148,000. A liver transplant

runs $235,000 on average. Most insurance companies cover the procedures.


Keith L. Alexander and Stephen Baker in Pittsburgh

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