This beautifully written story takes readers on an incredible journey and does a great job describing how this potentially innovative approach to heart transplants works. It also achieves the rare feat of showing readers exactly what this innovation might mean in terms of additional costs to the health system. Where it fails, though, is in parsing the evidence so that readers are able to separate the emotions around people dying on the waiting list waiting for a heart from the evidence supporting this new transplant method. We applaud the story for making a complicated topic crystal clear. We just wish more clarity had been brought to the science.
This was one of the most thorough explanations of costs we have seen in a story, especially in a person-driven feature such as this. “There’s also the issue of cost. A typical heart transplant in the U.S. costs about $787,000 including hospital stay and anti-rejection drugs. An Igloo cooler costs $35 compared with the heart box, which is sold in Europe for about $200,000. The interior is not reusable so there’s an added expense each time a hospital does such an operation.”
The story does attempt to point out that there is not yet any evidence that this method is better than the conventional method, It says, “Early signs from two European experiments involving 54 patients are encouraging. There has been 97 percent survival a month after the operation and few episodes of rejection and heart-related complications. But since there were no comparison groups in either study, it’s impossible to know whether a beating heart transplant is actually better.”
However, that caveat is overwhelmed by the emotional story of a patient who is portrayed as having been saved by the new technique, when in fact that patient likely would have had a good outcome with the conventional methods, too.
The harms are never quantified in any way or even raised as a possibility. For example, could the mechanical system possibly damage the delicate blood vessels within the hearts? Could warm organs be more susceptible to infections during transport? The story should have asked about the adverse events that have been observed so far or are theoretical possibilities.
The story does point out that there is not yet any evidence that this method of transporting donor organs is superior to the standard method, but the caveat is overwhelmed by the emotional tale of a single, apparently successful case. The story also does not point out that the European results were presented at a medical meeting and apparently have not been published in a medical journal that would subject the report to more stringent peer review. Readers should have been more clearly notified of the lack of independent scrutiny of the claims of the manufacturer and the results of tests funded by the manufacturer.
We feel that because the story played so much on people’s emotions that it ultimately had the effect of disease mongering. “No longer will patients be limited by location. Doctors could make cross-country heart runs without worrying about how long it takes. Hearts are now given first to people on the waiting list who live near where the donor is hospitalized. If there’s no match, then the circle widens until a recipient is found. … It may also potentially help ease the organ shortage crisis. Some 3,000 Americans are currently on the heart transplant waiting list. Last year, 359 died waiting for a heart — almost one person a day.” We are introduced to one of those people who was saved, Andrea Ybarra, in the first sentence. And even her heart is paraphrased, saying “Lub-dub. Lub-dub. Lub-dub.” Later we are told that UCLA’s Dr. Richard Shemin, “performed Ybarra’s operation on his 39th wedding anniversary.” All of this tends to overshadow the limited evidence that is presented for the technique’s efficacy.
We wish that a greater effort had been made to talk with people who were not connected to the study or to the technique in some way. You have to wait until the very end to see one quote from a doctor who is the chief of heart transplants at Johns Hopkins University. Because the story is so long, dense with information and emotional in nature, we feel that this one outside source is not enough to outweigh all the glowing reports from other physicians quoted in the story.
The story does compare the two techniques, but it tells us nothing about survival rates from the existing “cooler” method. Instead, it presents the issue as a potential panacea for people dying on the heart transplant waiting list.
The story establishes that this is an experimental method.
If it works, this indeed would be a novel approach, and the story makes this clear.
This story does not rely on a news release.