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'If I only had a heart'

Listening to the Tin Man

by Jeffrey P. Kahn, Ph.D., M.P.H.
Director, Center for Bioethics
University of Minnesota

In a twist on the "Wizard of Oz" story, doctors in Louisville, Kentucky, announced last week that they implanted a mechanical heart inside a severely ill man. The patient is doing better than expected. And since the surgery, doctors said the first totally implantable artificial heart had passed the milestone of a half million beats and continued to work well.

But what exactly do we expect to get from mechanical hearts or other artificial organs -- replacement parts to make us good as new, a bridge to human organ transplant, or something in between? These are important questions to answer, not only for the patients who may be offered artificial organs but also for the society that will end up footing the bill for these remarkable, and remarkably expensive devices.

Desperate means for desperate patients

From what little we know about him, the patient in Louisville was desperately ill, unlikely to survive more than a few weeks with his own failing heart, and not eligible for a regular heart transplant. So he was offered the highly experimental artificial heart as one of only five that the Food and Drug Administration (FDA) is allowing to be implanted, in an effort to collect information about how well it works in humans.

Even the doctors, with their understandable enthusiasm over the success so far, say the patient undoubtedly faces complications, which may well be serious and life threatening. So the device is not yet the answer to the needs of the thousands of patients with severe heart disease, and may never be.

We should really view those who do receive artificial hearts as pioneers who accept the risk in order to help researchers learn how to improve the devices for future patients. Patients should see their participation in such highly experimental research the same way, since it is easy to be blinded by the hope offered by seemingly magical medical innovation.

At what price progress?

Sometimes even lifesaving innovation comes at too high a price. As one of the doctors involved in the surgery remarked, at $70,000, we ought to ask what benefits we should expect and are getting from this artificial heart. Researchers aim to double the life span of patients, which sounds like real benefit, but in a patient likely to die within 30 days, is an additional month worth $70,000? The doctor remarked that such an outcome would be worth the price, and maybe that makes sense from his and the patient's perspective, but it's not clear if it makes as much sense from society's standpoint.

In a time of constrained medical care and ever-rising costs for even basic needs such as pharmaceuticals, how much should we be willing to pay for 30 more days of life, especially since society will inevitably bear at least part of the cost?

Implanting artificial organs is the kind of gee-whiz medicine that everyone loves -- it cheats death, shows how our knowledge and innovation can overcome our human frailties, and makes us feel like we're on the path to immortality. We are moving toward a day when we'll replace organs as needed until we resemble the "Six Million Dollar Man," who, by the way, seems a better deal all the time.

But is that really what we're after, and at what price? We had better decide what the rules are for effective use of our health care dollars, or we'll be making ever more impressive replacement parts for a few without realizing how much it is ending up costing the many.

Visit the
"Ethics Matters" Archive
where you'll find other columns from Jeffrey Kahn
on a wide range of bioethics topics.

"Ethics Matters" is a biweekly feature from the
Center for Bioethics and CNN Interactive.



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