House of Cards Season 4, episodes 4-6 Plot Summary and Key Dialogue. Setting Summary and Dialogue

Transcription

1 House of Cards Season 4, episodes 4-6 Plot Summary and Key Dialogue In the newly released season of House of Cards the topics of organ donation and transplantation become central to the unfolding plot. Scene Scene Time # 1. Episode 43 21:20 2. Episode 44 5:07 or Character Saxon VP Blythe Summary and Dialogue President Underwood is shot while interacting with a group of protestors after a campaign speech. He sustains a bullet wound to his abdomen destroying part of his liver. Set in the Underwood s hospital room, the surgeon Saxon briefs Vice President Blythe (now acting President) and Underwood s Doug Stamper. His liver is just not regenerating fast enough. What does that mean, exactly. He needs a transplant or he will die. How soon? Days. We ve made him status 1. I m optimistic we ll find a suitable liver. 3. Episode 44 17:34 We learn that President Underwood is number three on the national waiting list for a deceased donor liver. How long until he has a liver? Could be hours. Could be days. He s number three on the list. Number three? It s prioritized in terms of need and who was listed first as a status 1. He s the president of the United States. It s the law. 4. Episode 44 28:17 First Lady The First Lady addresses the press corps at the White House I d like to update you on the President s recovery. The President s medical team gave me a full assessment last night and they have come to the conclusion that the President is in need of a liver

2 5. Episode 44 34:15 transplant if he s to survive. I m asking the nation to pray with me that a healthy liver makes its way to Francis soon. Scene begins with the President s looking at a website on his computer. Website heading says, Living Donor FAQ. Among the items in the FAQ list is the highlighted statement. There is no waiting period to become a living liver donor. 6. Episode 44 43:25 7. Episode 45 3:39 Scene begins as the chief of staff and Saxon begin a conversation outside the President s hospital room. I d like to donate. My blood type is O. I m healthy. Let s do the tests. That s not the only criteria for donation. You re a recovering alcoholic. We don t accept I don t care about the rules. If I m a match, I want you to do it. Even if you were it wouldn t matter. He s too ill for a partial liver at this point. He needs a full one. I m sorry but we ll just have to wait and hope. The chief of staff is seen entering the office of the of Health and Human Services. The organ network. It answers to you? Yes and no. In a regulatory capacity. You have the power to modify the recipient list. That s up to the network. They have an expert committee. The President s life isn t going to be decided by a committee. Let me show you something. He was number three yesterday. Number one got a transplant making the President number 2. His chances are very good. But this man, Anthony Moretti, he s just hours away from dying. [she shows chief of staff computer screen of the liver waitlist]

3 Then let him die. It s not just the law. It s the ethics. Then change your ethics. Or you can resign and your deputy can make this call. And if he won t, then he can resign too. I will strip away this entire department until I find who I need. Now make the call. 8. Episode 45 19:00 Scene begins in a dark room as a youth pulls a gun out of its case, types something onto a computer, and then ends his life (ensuring brain death) 9. Episode 45 19:30 Scene begins with the press secretary addressing the press corps. Press President Underwood is currently being prepped for surgery to receive a liver transplant. Barring complications the surgery is expected to take hours. We ll update you about the progress if need be, but probably nothing more until the operation s completed. exits the surgery room to speak with Interim President Blythe Saxon The transplant s complete. Now we re closing him up. We ll see how he accepts the new organ. The chief of staff is seen in his office where he receives a call from the of Health and Human Services and informs him that she has just sent him an . The chief of staff pulls up the revealing a photograph of a family. What s this? The father you see there? That s who we bumped for the President. He died an hour ago. Father of two, loving husband. Delete it right now from your outbox. 10. Episode 45 26: Episode 45 38:22

4 I already did, but I wanted you to see his face, and the family he left behind.

5 About Living Liver Donation Let's take a few minutes to understand the benefits and the risks of living donor liver transplants. First of all for the patient, we understand it gives them the chance of life and a higher quality of life. Otherwise, they can be so sick. Are there particular risks for them and having a transplant from a living donor that would be any different than if it were a cadaverous liver? John Roberts: For the recipient, the patient who is going to get the transplant, there are different risks associated with getting a living donor transplant versus a cadaver transplant. A picture is worth a thousand words, but think of the blood vessels in the bile ducts entering the liver with a trunk. They have kind of a big round part of the blood vessels and bile ducts. As they come into the liver, they divide in branches very similar to the way a tree branches. When we take out part of the living donor liver, we leave the trunk of the tree and the branch to the part of the liver we leave behind because without it the donor couldn't survive. We can only use a branch to say the right side of the liver. We get the branch of the bile duct and the branch of the blood vessels to that side of the liver, and as with branches in a tree, the size of the branch is always less than the trunk, so you have a small branch versus a large trunk. In surgery, when we sew things together, it's easier to sew things together that are bigger, have a bigger diameter like the trunk of a tree, than things that are smaller in diameter like a branch. When we sew together the branches of the blood vessels and the bile ducts, there's a greater chance that things can go wrong. Most of those problems that occur are problems with sewing the bile duct together because it's very thin and doesn't have a very good blood supply. Patients who get a living donor transplant have an advantage in that they don't have to wait until they get really sick. They can get transplanted kind of on an elective basis, but the risk of complications related to where we sew together the bile duct is about twice as high as if you got a cadaver liver. That's the main difference between getting a piece of a liver and a whole liver. The branches we work with are smaller and there are more troubles associated with them. It doesn't mean that those problems lead to the recipient losing their new piece of liver, but it can mean more time in the hospital, more time with the radiologists as we try and take care of these problems and potentially a return trip to the operating room. But over time, all these things usually heal and it just means more time in the hospital and in the physicians offices until these things heal. Evaluation and Risks for the Donor Of course, as patients and families consider this, they should ask is the team at the top tier of experience with this sort of transplant. As surgeons like to say, people can feel that they are in good hands, that you're going to do the very best that's available anywhere. What about on the donor side? What are things for someone who's considering being a living donor? What do they need to consider so they go in with their eyes open? What evaluation happens to make sure that they're right for this procedure? John Roberts:

6 Well, the first thing we do with the living donor is to 1) send them what we call a health history questionnaire. It's a questionnaire that asks them about general health issues. We want to make sure that the patient is healthy. They have to be between the ages of 18 and 55, and they have to have a blood type that's compatible with the recipient. That means that if the recipient is type O, they have to be type O. If the recipient is type A, they could be type O or type A. So there are some rules in regard to blood type to make sure that they're compatible. If they're compatible and it doesn't look like they have medical problems, we have a number of things that happen. One is that they seek what we call an Independent Donor Advocate. In our institution, this is a social worker whose real responsibility is to make sure that the donor gets through the process with a good understanding of the issues regarding liver donation in general and issues regarding his or her specific case. They see an internist who looks at them for their general health. They see two surgeons myself and Asher who does the donor surgery to discuss their particular case. We do a lot of blood tests, and we do a number of X-rays. One set of X-rays is to look at the blood vessels to the liver to make sure we can safely cut out the right or left lobe of the liver, and then another set looks at the bile duct so we can make sure that the bile duct has the right anatomy to be able to donate a piece of liver. Not everybody has an anatomy that allows them to donate a piece of liver. That doesn't mean that their liver will ever cause them trouble. It just means that there is no way we can cut that piece of liver and safely give it to somebody else. There is a risk of death associated with donating a piece of liver. It's about one in 500. The risk of death of donating a kidney is about one in 3,000, so this is a riskier operation than donating a kidney. The stakes are usually higher for the recipient of the transplant because unlike kidney failure, where you have a dialysis machine, in liver failure we don't have that kind of machine that allows a patient to survive until they can get a cadaver organ. There also is a risk of complications associated with any surgery, and there are complications associated with this surgery. There's going to be pain related to having an incision, and people need to think that they're going to have to take some time out of their life until they get back to feeling normal. We have surveyed our donors and have asked them how long did it take you to feel 100 percent again? When the donors responded, about half of them said that within six weeks they felt back to 100 percent. Three quarters of the people felt they were back 100 percent by three months, and the last quarter took six months before they felt that they'd recovered back to 100 percent. When people talk about being 100 percent, that's a psychological feeling of feeling well, I'm doing everything I want to do. People are going to be changed because they now have a scar across their abdomen that they didn't have before. Those are the kinds of things that donors need to understand as they go forward with this surgery. Roberts, I know your team has immense experience comparatively in doing this, and since January of 2000, you've done over a hundred of these living donor liver transplants. You must feel that the donors really have given an incredible gift and have been very courageous as they've done this. John Roberts: Yes, I think we are always in awe of what the donors have done in terms of providing of themselves to the recipients. It really is a heroic act because people take on themselves not only a risk of death but also pain and suffering for their loved one to get the benefit of the liver transplant. You know, the donors have always impressed us in terms of their selflessness in doing that. We try to make sure that we protect the donor from injury and risk that's outside of the other risks that we know of for this operation. That's why we have an Independent Donor Advocate that really helps to make sure that the

7 donor understands the issues involved with donation and that there are not issues related to their personal life at work or finances that would suffer after they've donated. We really think the donors have done a lot, and we try to help the donors in whatever way we can to make this a positive experience. Well, Roberts, I want to congratulate you on the program you have at UCSF Medical Center. I know it's certainly exemplary, and I know you'd agree with me that we all wish there were more donor organs available from people who die who choose to make arrangements so that organs can be donated. Since there is that gap, it's really wonderful what you and the donors are able to do to fill it to give people continued life. John Roberts, chief of the Transplant Service at UCSF Medical Center, thank you so much for being with us. I really appreciate your time and your devotion to patients. John Roberts: Well, thank you for having me on, and I have to say that here at UCSF, taking care of both the donor and the recipient is really a team effort. I'm only a part of that, and it's the nurses and the doctors and other health care workers that really allow us to do well with taking care of these patients. Thank you sir. For information about the physicians and services at UCSF, please call the physician referral service at 1 (888) 689-UCSF or 1 (888) Recorded May 2008

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