Dr. David Nelson
Special to The Sun
EDMOND
August 27, 2007 08:38 am
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This is the last of a weekly series of columns by Edmond doctor David Nelson, who highlighted how medicine was portrayed in the new Monday TNT television series “Heartland.”
“Heartland,” the TNT pilot series about transplantation, has ended. This was transplant medicine’s first full-time foray into prime time. The show established an important beachhead for transplant issues from which this series can later evolve or a future, different series can be developed. “Heartland” provided a public service because it highlighted the plight of thousands of Americans waiting for life-saving organs.
The show provided accurate medical information, provided a good introduction to the organ donation process and presented newsworthy issues that are hot topics in the real transplant world, such as transplant tourism.
However, TNT’s portrayal of transplant medical drama was often unrealistic. For example, when a young girl’s newly transplanted heart was failing, Dr. Grant thoughtfully sat at the bedside like a horse and buggy doctor before antibiotics. In real life, this scene would have looked like a trauma room in full swing.
In addition, the show’s hero slowly unraveled with every episode. Dr. Grant’s credibility as a leader, physician and patient advocate was mortally wounded as his ghostly encounters escalate from seeing, to talking and finally to debating patient management with them. His drinking, cigarette smoking and womanizing weren’t presented as serious problems but also served to diminish his character.
The strong performance by ever-present procurement coordinator, Kate Armstrong, was a major asset to the show, but clouded the relationship between transplant centers and organ procurement organizations. OPOs are independent of transplant centers. Procurement coordinators work for OPOs and medically manage the donor, communicate with transplant teams and are vested with the final authority and responsibility for managing the procurement process.
In real life, Kate Armstrong’s over involvement with physicians at St. Jude’s would represent a conflict of interest that would risk favoritism on behalf of St. Jude’s patients, at the expense of patients wait listed at other hospitals served by the OPO.
“Heartland” or other future transplant shows have the opportunity to explore broader socio-economic issues confronting American health care, which are readily available for examination in the ever-present tension between utility and equity in evolving transplant allocation policy.
Utility basically means how much mileage can we get out of a transplanted organ for a particular donor-recipient match. Equity means providing equal access to organs to everyone. The balance between these two imperatives is a work always in progress in transplantation. As the gap between what is expected and what can be afforded in health care widens the competing interests of equity and utility will become the dynamic that drives health care policy, just as it currently drives organ allocation.
“Heartland” was groundbreaking entertainment that successfully supported the cause of organ donation and transplantation. Bravo to TNT for tackling such complex material and for trying to make a difference.
DAVID NELSON is chief of heart transplant medicine at the Nazih Zuhdi Transplant Institute within the Integris Baptist Medical Center.
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