The intense life of a doctor at a busy hospital always makes for good TV material. "ER," "Grey's Anatomy" and "House M.D." exposed us to the high-pressured world of medicine as doctors grapple with difficult life or death decisions every day. These emotionally charged dramas make medical science fascinating, and the personal dilemmas of the multi-faceted cast of doctors and nurses keep viewers engaged week after week.
When I first heard that NBC had a new medical drama, "Heartbeat," based on real-life cardiothoracic surgeon Kathy Magliato, I couldn't wait to tune in and take a look at what they would cover. As the founder of the Children's Cardiomyopathy Foundation, I was curious to see how the main character, Dr. Alex Panttiere, would handle cardiomyopathy and heart transplantation in the pilot episode. The show wavers between drama and comedy. After the first few minutes it was clear that this was not a medical show grounded in reality. Unfortunately, the show missed an opportunity to educate viewers about a chronic heart disease and its life-threatening complications. Instead, the writers gave viewers a flawed look into the heart transplantation process and inadvertently made a gifted doctor appear insensitive, unethical and unprofessional.
In the first episode, a 29-year old female patient with familial cardiomyopathy in advanced congestive heart failure needs a heart transplant. Dr. Panttiere is determined to find a donor heart and is elated when she can inform her patient that Mrs. Agostino, a fellow patient at the hospital, has been declared brain dead and the family has agreed to donate her organs. As Panttiere is prepping for surgery she is told that the hedge fund director who donated millions to the hospital will get Mrs. Agostino's heart for his dying father. A frustrated Alex runs down the hall yelling, "I'm going to oncology to find a heart!" At the end, the troubled ex-boyfriend of the girl with cardiomyopathy dramatically commits suicide so she can get the heart she needs. While this may make for good TV drama, it is not how it works in the real medical world.
Can a doctor divulge who the donor is to her patient? Can a millionaire buy a heart from a hospital? Can a surgeon shop the hospital for a heart from a dying patient? The answer is no to all three questions. Since April is National Donate Life Month, I wanted to share the real truths about organ allocation, patient privacy and the heart surgery that saves lives. According to the U.S. Department of Health and Human Services Organ Procurement and Transplantation Network site, there are more than 120,000 people in the U.S. waiting to receive an organ, and 22 people die each day while waiting for a transplant.
Finding a Donor Heart
Unlike how it is portrayed in "Heartbeat," there is a very systematic process to how donor hearts are allocated, and doctors have no influence over this process even if a suitable organ becomes available in their hospital. Organs get allocated under a strict protocol managed by the United Network for Organ Sharing (UNOS), a national clearinghouse for organs. Patients in need of a transplant are first listed with UNOS. When an organ becomes available, UNOS generates a ranked list of transplant candidates using an algorithm that takes into account blood type, tissue type, medical urgency, waiting time, and geography. Because there is only a 4-5 hour window for a donor heart to be transplanted, UNOS is split into 11 geographic zones to give priority to listed patients within a 500 mile radius of the organ.
Fair but Imperfect Process
UNOS was established by the U.S. Congress through the National Organ Transplant Act in 1984 to prohibit the sale of human organs, which means the wealthy banker in the show would not be able to "buy" a heart for his father in heart failure. There are specific rules about donor allocation, but the process is not perfect. Hypothetically, if a patient is affluent and has access to a private jet, he or she could list at multiple transplant centers in different regions and fly out to the first center that has an available organ.
When a donor organ becomes available, the surgeon receives basic information about the donor, such as blood type, age and location of the organ. However, I asked a pediatric cardiologist and parent of a child who underwent a heart transplant to clarify on whether a doctor can reveal the identity of the donor to their patient like Dr. Panttiere does on the show. Joseph Rossano, MD, the medical director of the Pediatric Heart Failure and Transplant Program at The Children's Hospital of Philadelphia explained that even though the transplant team has details on the donor, it is considered confidential information that should not be disclosed to others. "It would be a breach in patient confidentiality and violate Health Insurance Portability and Accountability (HIPAA) rules," says, Dr. Rossano.
Joseph Hillenburg, whose son had a heart transplant due to cardiomyopathy at 2 months old, agrees. "We were not told who the donor was and were given no further information other than general location and blood type." Hillenburg, who is a member of the UNOS/OPTN patient affairs committee, adds, "UNOS, the donor hospital, and the donor's local Organ Procurement Organization (OPO) are aware of the identity of the donor, but this is all kept confidential."
Gift of Life
Towards the end of the episode, Dr. Panttiere performs a heterotopic or "piggyback" transplant where her patient's heart is left in place and connected to her ex-boyfriend's donor heart. Two hearts beating as one is a clichéd Hollywood ending without much medical basis. "A heterotopic heart transplant is a footnote in history," says Dr. Rossano. "There is no advantage to the procedure now, and it is much more complicated than a traditional transplant."
"Heartbeat" abounds in medical inaccuracies, but the human elements of the story are still valid. There are many dedicated physicians like Dr. Panttiere who are completely invested in saving their patients. Also, waiting for a donor heart can be an emotional roller coaster for families because there are simply not enough donor organs. Organ donation is a tremendous gift of life; one organ donor can save eight lives. While there were several missteps in "Heartbeat," its focus in the first episode, at least, starts a conversation about the seriousness of cardiomyopathy, the difficulties of waiting for a heart transplant, and the importance of organ donation in saving lives.
For more information on how to sign up to be an organ donor, visit UNOS.