Medical ethicist Art Caplan has a column today about whether Dick Cheney should have received a heart transplant — not because of his politics, but because of his age (71):

Cheney is not the first person over 70 to get a heart transplant. He is, however, in a small group of people who have gotten one. Why did he? Cheney has an advantage over others. It is not fame or his political prominence. It is money and top health insurance. Heart transplants produce bills in the hundreds of thousands of dollars. The drugs needed to keep these transplants working cost tens of thousands of dollars every year. Organ donations are sought from the rich and poor alike. But, if you do not have health insurance you are far less likely to be able to get evaluated for a heart transplant much less actually get a transplant.

The timing of Cheney’s transplant is ethically ironic given that the battle over extending health insurance to all Americans reaches the Supreme Court this week. If the President’s health reform bill is deemed unconstitutional, those who are wealthy or who can easily raise money will continue to have greater access to heart, liver and other forms of transplantation than the uninsured and underinsured.

It is possible that Cheney was the only person waiting for a heart who was a good match in terms of the donor’s size, blood type and other biological and geographical factors. If not, then some tough ethical questions need to be asked.

This medical ethical dilemma stems from the fact that we have a transplant shortage because not enough people agree to have their organs donated when they die. In a nation where 2.4 million people died last year, there were only 14,415 donors (that’s less than 1%), according to the United Network for Organ Sharing. That’s nowhere near enough to help the 72,000 patients waiting for organ transplants, including 3,100 on the heart transplant waiting list.

What we need is a system where you don’t have to opt-in to become a donor. That should be the default decision. When you die, you’re done with your body, so let’s chop it up and let someone else use your liver, lungs, eyes, skin, etc. The system should be set up so that you have to make an affirmative decision to deny life to others, or we’ll assume that you want to save someone as your last act.

Even if it is Dick Cheney.