I’m a huge House of Cards fan. Though I haven’t read the book, I have seen the British mini-series version right after the first season was up. I love it.
For those who haven’t watched, granted at times it’s slow but it’s very interesting & well worth watching.
Kevin Spacey & Robin Wright are so messed up but so perfect in their roles as the power hungry couple Frank & Claire Underwood.
Now, if you haven’t watched this 4th season, please read no further….It contains several spoilers. You’ve been warned!
First of all, I predicted something was up after the assassination attempt with the way they were spinning it & the condition Frank was in.
I actually was excited to see where they took it & how they were going to blow this out.
That said, I thought the research on the episodes was actually poorly done.
I understand the whole arc with the writing & why they played it out the way they did, but even some sense of realism interjected would have been nice.
It could have also been easy to achieve that with basic research.
I know a few liver transplantees both in the online space & in real life but I’m not presuming to know all about transplant itself, but I don’t have to.
Yet even I (as a lung transplant patient) picked up on some pretty obvious omissions & blunders.
What showed the biggest lack of research is how they portrayed Frank’s listing for transplant in the first place & the poor explanation even in an abbreviated sense.
There is no status 1 itself. Here is a document that actually shows how UNOS decides listings & scores for liver transplant. It’s not that long, it’s actually easier to follow than how they score other organs in some aspects.
There IS a status 1a. That is reserved for sudden & severe onset total liver failure & immediate death within hours or days.
It is an exception to the regular MELD scoring scenario when that fails to reflect just how sick & near death someone is.
Priorities for livers are decided by a MELD (Model for End Stage Liver disease) Score. The higher the MELD score, the higher priority is given in listing.
Outside his gunshot wound, Frank was not critically ill otherwise. So this is a less than likely scenario where he’d ever be a status 1a.
Less than 1 percent of liver transplantees can even be listed with a status 1a which would add on to or override their MELD score.
Since his counterpart on the list that was #1 on the list, his counterpart would have to have been a 1a as well, but he clearly wasn’t from any of the chatter in the situation.
He was simply waiting for a liver like Frank & was ahead of Frank because he was actually sicker than Frank was. There was no extenuating circumstance here or for Frank except that their livers were failing. So this status 1 elevation makes no sense.
While living donors are used for liver transplants, they are harder to match & carry a few more risks to the donor.
Often (no surprise), the media (as a whole) oversimplifies how complex the matching system is for living donors & transplant recipients alike.
Even in setting the stage post-transplant, House of Cards oversimplified the recovery by a gross degree.
One look at the Mayo Clinic website would have told them to inject a bit of actual believability & realism into the equation.
A few more days stay in the hospital would have been warranted. This would have given Claire more than enough time to continue to manipulate the current political situation she was so desperate to ram through while Frank was waiting for his transplant.
The average stay for a patient is at least a day or two in intensive care & then another 5-10 days in the hospital beyond that.
This does not include any prescribed rehabilitation or other after care outpatient services the doctor orders for a transplant patient.
Most patients might be able to resume some normal activities after a few months but even if it takes them up to 6 months, that’s a pretty standard average to them even feeling remotely recovered.
Furthermore, Frank had about 6 pill bottles in his bathroom.
Most of us at least within the first year have double or triple that number we have to take in anti-rejection meds, anti-fungal medicines, steroids, anti-virals, & other transplant related drugs.
In addition, some of us do have to resume or start GERD (acid reflux/heartburn) meds, blood pressure medications, or other things we were taking for other problems prior to our transplant (or if they occur after).
Some of us may become diabetic after transplant because the anti-rejection drugs & steroids raise glucose levels too high.
So — sorry, 6 pills is like using candy cigarettes & expecting us to believe they are real. Nice try, no dice.
I also love how Frank took his own blood pressure with the old-school cuff & monitor but had no stethoscope with it or no phone, paper, or diary out to actually measure or take the reading & store it some place. (There’s also a whole regimen of taking weight & temperature & other vitals that was entirely missing).
Just inflate & deflate the cuff & bam, the numbers are there. God, if only it worked that way. That was good for a laugh though.
Now, on to the Stamper situation….
Again, I understand the storyline they were blowing out with this & why they took the approach they did.
Showing abuse of power to the Nth degree is of course part & parcel of the Underwoods & the magic of this show.
In 2014, quite the firestorm was raised over a little girl who desperately needed lungs. Actually, after her transplant, rules were changed in pediatric scoring.
Now in this case, Sarah’s parents pleaded with Health & Human Service Secretary (HHS) (then Kathleen Sebelius) to intervene on their behalf. She refused to, actually but then a court ordered she do so.
In this scenario, Stamper threatens to gut & fire everyone in HHS until they find someone who will manipulate & bump Frank from #2 on the list to #1.
After a time, the threat actually does work.
OPTN (Organ Procurement & Transplant Network) & UNOS (The United Network for Organ Sharing), the two organizations who oversee the registry, both function independently from the government even though they are bound by contract to the HHS.
So the HHS isn’t really making or overseeing these situations unless it’s an extreme case. Thus, the Stamper scenario would still be highly unlikely because there was no extenuating circumstance for them to intervene on. Frank needed a liver because he was the President. It’s not compelling or unique enough for them to weigh in on.
(See OPTN for more information on wait times & how organs are allocated).
He wasn’t actively being cheated out of one, or had a listing rule that had given him questionably less priority (those would be instances where HHS might find themselves involved or be asked to intervene).
But of course, that would make for less dramatic TV & perpetuating myths makes for more sexy television (especially in a dramatic series).
The one medical issue that did seem somewhat accurately portrayed was the problem with his ammonia levels affecting his brain. That is a real issue. It’s called hepatic encephalopathy. This is more often found in cirrhosis patients, but sometimes also requires dialysis so they can help clean these wastes from the blood.
Maybe I missed it, but I saw no dialysis machine in Frank’s room, even when he was on life support.
It also seemed with as severe as Franks’ case was his outcomes in surviving this transplant were actually lower with this complication thrown into the mix.
He should have had a more eventful recovery with more hurdles.
More attention should have been paid to his recovery throughout the remaining episodes. I know they touch on it with the air travel, but that & other than him holding his side from time-to-time little attention is given.
But of course, I know this is TV.
I’m not even going to go into the nice little side story on making the donation & Doug meeting up with the wife…although it does seem to bring a softer side & some sweetness to some other dark moments.
The other soft spot was the recipients of Meechum’s organs meeting the President. Though we all know that most likely would never happen either, nice as it was.
Still I enjoyed the season overall.
Now, I have a year to wait for another season…
I’d be curious to see how some of my liver transplant buddies felt about all this, too.
An interesting perspective! I have no clue at all about the transplant process, but I did find it a little annoying that Frank seemed to recover without pretty much any complications. As if anyone could really withstand even as much stress as Frank put on his body after such a procedure.
And I thought the organs were donated by the same boy whose liver Frank received. I thought the mother he met with was the boy’s mother, not Meechum’s. Although I might be wrong – might warrant another viewing!
All in all, I thought the inaccuracies were worth it. This season was so much better than season 3. Loved the epic ending – gave me chills. Frank and Claire are so – dare I say it – evil! So awesome. Great post!
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Well I know he didn’t get meechums liver but it seemed to me he organized that meeting for not only his donors but meechums recipients and meechums mother – I could
Be wrong tho lol
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And I do agree on the season although the ending of season 4 I felt could have been stronger but still enjoyable for sure 🙂
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Yeah, it still wasn’t perfect, but the way they both broke the fourth wall… together! Such a devious power couple.
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Just rewatching season 4 episode 7, and wanted to point out to you that in the first scene with Frank, where he’s taking his meds in the bathroom, you can clearly see about 9 bottles on the sink, not counting the one he sits down. When they show the full bathroom you can see that theres at least 11 of them. Not to discount your other points, I don’t know anything about that, just wanted to point this out.
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Thanks for pointing that out! Sometimes there are things that are missed because there’s so much going on. Good to know, that’s closer to real on that point then 🙂