1. Who gives out hearts?

In exploring whether former Vice-President Cheney might have received preferential treatment when he got a heart transplant recently, many of the reporters covering the story referred to what the New York Times called “a national system that tracks donors and recipients by medical criteria.” Two doctors were then quoted as saying, as one put it: “It is not possible to game the system.”

Fair enough, but who runs the system? Who sets the criteria, and who signs off on who has met the criteria? Who decides close calls? Is there a form that gets signed by a majority of some committee, or is there one king of hearts? And are actual names attached to the patients, so that whoever was making the decision could have seen that Vice-President Cheney was an applicant for the heart in question?

Because transplants are done urgently once a donor becomes available – often after his or her sudden death in an accident, when apparently there are only hours to spare before the heart is no longer viable – is there some kind of operations center, where these decisions are signed off on and coordinated? Can’t some reporter take us there and have us meet the people playing God?

A few days after the Cheney operation, the New York Times shed some light on how transplants of another type of organ – kidneys – are decided. The Times reported on a controversy brewing over whether to establish a single registry to oversee matching kidney donors with recipients. But I’d still like to see a story on who’s making these life-and-death decisions and how. Ditto liver transplants. And, again, not just the processes but the people in charge as well as those on the front lines.

As the science around these transplants continues to advance, and as more patients continue to live longer and seek new hearts, livers or kidneys because they have survived other maladies, the rules and the people involved in these decisions are only going to get that much more important.