WASHINGTON — Spoiler alert: President Frank Underwood needs a liver transplant in this season of the Netflix series “House of Cards.”
He’s been shot through the abdomen, and a transplant is the only way he’ll survive. So Underwood’s chief of staff strong-arms a cabinet secretary into moving the president to the top of a waiting list for a transplant. The president gets his liver, and a man he leapt in line dies.
So, STAT wondered: Could the real president jump the line to get an organ?
In real life, the ploy would be highly illegal and, more to the point, should be impossible, according to the nonprofit that coordinates transplants across the United States.
The process by which patients are chosen for transplants is actually determined by a computer algorithm, which doesn’t know the identity of the recipient and is designed to be impenetrable to tampering.
“The computer would have no idea that he was the president, just like it has no idea how rich and famous someone else is,” said Anne Paschke, a spokeswoman for the group, the United Network for Organ Sharing.
The waiting list is also under intense security. UNOS has an in-house IT security team. Doctors can only input data for their individual patients. The agency audits every single transplant performed to make sure the proper procedures were followed.
But while the system is set up to be totally ignorant of anything but medical viability and need, those in the transplant world routinely contend with the myth that the rich and powerful get preferential treatment.
“We would never listen to anybody, including the president of the United States themselves,” said Dr. Ryutaro Hirose, a liver transplant specialist at the University of California, San Francisco, who sits on the UNOS liver committee. “This is how our allocation works.”
And so the system uses a series of objective variables to determine who gets a transplant. For a liver, the biggest is medical urgency. Also considered are donor-recipient compatibility and the proximity of the donor to the recipient.
Right now, there are more than 15,000 people in the United States waiting for a liver transplant.
It’s easy to say power and status don’t matter when the most powerful person in the world’s life is not actually in jeopardy. But is there a contingency plan in case the president needs a life-saving transplant?
STAT couldn’t find anyone who could say for sure. Paschke wasn’t aware of any such contingency. Neither could a senior administration official. Two former White House physicians didn’t return requests for comment.
The anonymous donations that the UNOS facilitates and the show portrays aren’t the only option, though.
A donor, living or dead, could dictate that he or she wants to donate organs to a specific person. In “House of Cards,” Underwood’s chief of staff, Doug Stamper, tries to offer his own liver but is told he can’t because the president needs a full, not partial, organ.
That little detail, true to life, was one of several that Dr. Joel Adler, a general surgery resident at Massachusetts General Hospital, said he appreciated.
But even a fan like Adler couldn’t get around the climax of the waiting-list subplot.
“Everything up until the skipping-the-line thing was pretty right as far as I know,” Adler said. “That’s the grossest inaccuracy.”
But there are inequalities to transplants. The problem is transplants are geographically based. And wealthier people can afford to travel across the country if it will help them get a transplant.
In 2009, for example, former Apple CEO Steve Jobs relocated to Tennessee for a liver transplant, Hirose said.