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Pa. governor has surgery

Pennsylvania Gov. Robert P. Casey underwent a high-risk, experimental heart and liver transplant that was to have concluded late Monday night at the University of Pittsburgh Medical Center.

The surgery began less than a day after doctors determined that the Democratic governor needed both transplants and just hours after his name was entered on a waiting list for donor organs. According to the United Network for Organ Sharing (UNOS), the official national clearinghouse that maintains the list of patients needing transplants, the median wait for a new liver is 67 days and for a new heart 198 days. Casey, 61, had said he would seek no special priority on the list.

"The governor's life was in imminent danger," said John Armitage, director of adult cardiac transplantation at the center, who performed the heart transplant. Armitage spoke at an early afternoon news conference after completing his part of the double operation, which he said began at 7:25 a.m. and went well. As Armitage spoke, transplant surgeon John J. Fung was performing the more complicated liver transplant. A hospital statement later said the liver had been put into place by 6:25 p.m. and the entire procedure was finished sometime after 10 p.m.

Only six heart-liver transplants have been done in the United States, and most patients have not survived more than a few months. The first such patient, however, lived 6{ years. She was Stormie Jones of White Settlement, Texas, who became a national celebrity in 1984 when she received the new organs at age 7. She died in 1990 when her immune system finally rejected the replacement heart. A 62-year-old man who underwent a double transplant in Britain last year is said to be doing well.

Casey's surgery began shortly after Casey signed over his gubernatorial powers to Lt. Gov. Mark Singel.

Because the operation followed so quickly after Sunday's announcement that Casey needed the double transplant, questions were raised over whether the governor might have been given preferential treatment over others waiting for donor organs. Similar questions have been raised in the past when Pittsburgh's Transplant Institute, headed by the sometimes flamboyant transplantation pioneer Thomas Starzl, admitted wealthy and powerful patients, including members of the Saudi royal family.

Esther Benenson,a spokeswoman for UNOS, which operates under a contract with the Department of Health and Human Services to ensure fairness in making donor organs available, said it is illegal for hospitals to give favored treatment to "the rich and famous." She said the governor's brief wait "does appear unusual" and that officials are investigating the circumstances. "So far, however, we see no violations of UNOS policy," she said.

UNOS policy, however, does not explicitly cover people who need two or more new organs, said Brian Brosnick, executive director of the organ procurement organization that supplies the Pittsburgh region, the Center for Organ Recovery and Education.

"This is a gray area in our practice," Brosnick said. In the absence of a national policy, "we've taken the position that somebody who needs multiple organs takes precedence over somebody who needs one organ."

It was for this reason, he said, that Casey _ the only person in the area who needed a heart and a liver _ was first in line when that combination suddenly became available. The donor of both organs was a 34-year-old man whom hospital officials did not identify. He was deemed a suitable donor because he had the same blood type and body size as the governor.

Nationwide, according to UNOS, 3,057 liver-only transplants were performed last year and another 2,657 people are waiting for suitable donors. The number of heart transplants last year was 2,173 and the waiting list currently numbers 2,813.

"We're coming to a point where the public does need to get involved in these policies," Brosnick said. "Maybe this case is going to trigger the discussion."

Casey suffers from a hereditary disease called familial amyloidosis, in which the liver makes an abnormal form of protein called amyloid and sends it out in the bloodstream to other parts of the body, where it accumulates in fibrillary tangles. Nerves, intestines and the heart muscle are often affected. In Casey's case, his heart muscle has become thickened and less able to pump efficiently. In 1987, Casey had quadruple bypass surgery.

In recent months Casey had lost weight, doctors said, apparently as a result of amyloid deposits building up in his gut. A transplanted liver with no genetic defect would make no abnormal amyloid.

The governor was admitted to the center's Presbyterian Hospital on Saturday to be evaluated for a liver transplant when doctors found his heart to be so severely damaged that they decided to replace both organs.

The Pittsburgh doctors said Casey's prognosis should be good because, unlike most others needing liver transplants, the governor's liver performed its normal functions well and his body is not debilitated by a deficient liver.

Casey is a longtime Pennsylvania political figure who emerged from the state's hard-coal region of Scranton to build a reputation as a fighter.

The father of eight, he has pushed for programs for consumers and children but is perhaps best known outside Pennsylvania because of his efforts to restrict the availability of abortion services. He signed Pennsylvania's 1989 Abortion Control Act, among the most restrictive in the nation.

Casey's stance came to national prominence last year when he sought to address the Democratic National Convention in New York on his abortion views but was denied the floor.

Casey was elected governor in 1986, edging out Republican William W. Scranton III, son of a former governor and the state's lieutenant governor. He was reelected by a wide margin in 1990.

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