On Sunday, doctors for Pennsylvania Gov. Robert Casey predicted it might take more than a month to find a suitable donor to provide a heart and liver to save Casey's life.
By Monday morning, however, one team of surgeons at the University of Pittsburgh Medical Center was finishing up Casey's heart transplant and another was preparing to give him a new liver.
The rare double-transplant was made possible by the quick location of a local donor and the decision to place the 61-year-old governor ahead of almost a thousand Pennsylvania residents awaiting a heart or liver transplant.
Before surgery was complete Monday, the Center for Organ Recovery and Education (CORE) in Pittsburgh, the agency which had procured and allocated the organs for the double-transplant, was peppered by questions about favoritism. Had Casey's political status played a part in his getting the transplant organs so quickly?
"Everybody's been questioning us all day on whether there was any favoritism," said a weary-sounding Brian Brosnick, the director of CORE. "I wish to God Mr. Casey was a steelworker from the valley instead of the governor."
Brosnick said he tried to defuse the suspicion Monday by introducing three transplant patients to the media who had received hearts within 36 hours of being placed on a waiting list.
"They weren't movie stars, they weren't celebrities, they weren't politicians, they were just plain old Pittsburghers," said Brosnick.
Gov. Casey, Brosnick explained, was moved to the top of the waiting list because there is no national policy on how to handle patients awaiting multiple organ transplants. In the absence of such policy, the six transplant centers served by CORE have decided to afford a special status to double-transplant candidates.
The reason is largely immunological.
"Giving a patient a different heart now and a different liver later would mean you'd be fighting two different immunological systems," Brosnick explained.
With 31,317 Americans now awaiting transplant organs, a federally mandated waiting list has been compiled which awards points for such factors as medical urgency, proximity to the donor (hearts remain viable for only about four hours), blood type and size compatibility.
Organ procurement agencies must offer an available organ to local transplant centers first, then to centers in its multistate region and finally to all centers nationally.
Gov. Casey got pushed to the top of the list because of the availability of a local donor, because of the special standing afforded heart-liver candidates and because his doctors believed his weakened heart placed him in immediate danger.
A similar decision was made last year for a Tampa Bay woman who received a heart-kidney transplant at Tampa General Hospital, said Jane Ferguson, the hospital's transplant coordinator.
"Because patients get more points for each organ they need, the dual-transplant person added to the waiting list most recently could well be the next person called for transplant," Ferguson said.
Officials at the United Network for Organ Sharing, which monitors organ procurement and allocation, said Monday they were aware of no improprieties involving the Casey transplant.
Brosnick acknowledged that some subjectivity did enter into the decision to use the organs for the governor. He said he discussed with Casey's surgeons Sunday night the fear that the serendipitous transplant might undermine public faith in the transplant system and hamper organ donation.