House of Cards: Chapter 45
March 21, 2016 6:25 AM - Season 4, Episode 6 - Subscribe

The President needs a liver, but he's second on the list. While Doug wrestles with his conscience for about three seconds, Claire inserts herself in the G7 summit, cutting Kathy Durant out of the equation to get Petrov to agree to an energy plan.
posted by Etrigan (11 comments total) 1 user marked this as a favorite
Without getting spoilery, I have to say that the Doug storyline pretty much kept me guessing from this point of the season onward.

I also have to say that if there were to be some sort of Better Call Stamper I would watch the shit out of it.
posted by CheesesOfBrazil at 6:31 AM on March 21, 2016 [3 favorites]

He creeps me out. No thanks.
posted by computech_apolloniajames at 7:06 AM on March 21, 2016 [3 favorites]

I feel like Doug's internal dialogue consists of "Something must be done; this is something, therefore we must do it" on infinite loop.
posted by Etrigan at 7:14 AM on March 21, 2016 [3 favorites]

CheesesOfBrazil, I am glad that you find Doug that interesting! (No sarcasm - it's good to be reminded that my point of view is not the only one around.)

I was very glad to see the end of Frank's hallucinations, I am pretty tired of negotiations with Petrov, and overall I found this episode pretty boring. At least Dunbar's being honest, but that's not going to get her very far in this world, at least in the current circumstances.
posted by minsies at 11:04 AM on March 21, 2016 [1 favorite]

I also have to say that if there were to be some sort of Better Call Stamper I would watch the shit out of it.

No kidding. He is by far the most interesting character in the show for me, though this isn't his top season. LeAnn is a close second, and I would watch every second of the Doug and LeAnn Show.
posted by Dip Flash at 5:06 PM on March 21, 2016

When Health Secretary Lee emailed him that photo of the guy who died after Frank took his liver, I was like, "See, that only works with a person with a normal conscience. Doug is not that person. He will not care one bit."

I heard an interview with Michael Kelly, the actor who plays Doug, and he sounds like an absolute sweetheart--like the anti-Doug. I loved the episode in Season 3 where Doug's brother brings his kids to visit--those are Michael Kelly's own children and you can totally tell by the way they interact with him. It's adorable.

So I have a question for Americans: what really happens if your president needs a life saving organ transplant? Would he really have to wait on a list for one? I tried to google and came up with nothing.
posted by hurdy gurdy girl at 11:52 PM on March 21, 2016 [1 favorite]

Tried to do some research on that question. Here's what I've got:

Organ donation in the US is handled by the Organ Procurement and Transplantation Network, which is run by the United Network for Organ Sharing. In theory other non-profit organizations could get involved, but nobody ever has. The rules governing who gets what organs in what order are debated on councils before becoming effective, and subject to a few goals and guidelines established in the National Organ Transplant Act.

Rules for organ allocation vary by organ. For an adult needing a liver you're assigned either 1A status (roughly: dead within the week), or given a score based on your current liver function. Let's assume that Underwood qualified for 1A status. Within that category, candidates are ranked by total waiting time in 1A status. When a liver becomes available, you get bonus points if you're an exact blood type match as well.

When a liver becomes available, there's a specific order it'll be offered in. First to 1A candidates in the donor's region, then high scoring non-1A candidates in the region in descending order. At a certain threshold score, if it hasn't been taken, it'll be offered nationally to 1A candidates, then descending score, then regional low-scoring candidates, etc. Pediatric livers are offered to pediatric candidates in a given category before adult candidates, but otherwise the same.

There are no provisions whatsoever for considering the identity of the recipient.

So whether Frank is at the top of the list for a given liver depends on the age and region of the donor, blood type matches, and wait times of the other 1A candidates in his region or nationally, depending. It's not clear to me if the donor in this case was a minor or an adult.


a) since 2000, the secretary of the department of health and human services has ultimate authority over organ transplants. Prior to 2000, organ transplants were just regional. The show got this right - that's exactly who Doug went to. It's possible in real life that decision could have been made openly - depends on situation, exact injury, and who's in the relevant offices I imagine. I don't think you could do this silently - officials involved in allocating liver transplants would know that Frank had skipped the line.

b) The department of defense has it's own organ transplant guidelines which conflict with the civilian guidelines. I haven't found any of the details, but it's probably safe to assume that their system allows them to prioritize based on military need, that the president could be included here, and that the president would naturally go to the top of the list. However, if they can't divert a liver from the civilian system (I genuinely have no idea), then it's probably moot. Most of the military sourced livers are probably in the middle east or hospitals in Europe, so even if one did pop up it wouldn't be a great fit due to the large transportation needs.

c) None of that applies to directed donations. Doug might be the only one who actually knows him who's willing to step forward, but I bet if this situation played out in real life a number of individuals would step forward out of patriotism.

Bonus tidbit:

There exist rules for the allocation of undirected kidney donation by living donors, which strikes me as an incredibly altruistic act and I wonder how often it actually happens.
posted by vibratory manner of working at 1:51 AM on March 22, 2016 [13 favorites]

There exist rules for the allocation of undirected kidney donation by living donors, which strikes me as an incredibly altruistic act and I wonder how often it actually happens

I haven't listened to it, but I heard a preview for a series of episodes on the podcast Strangers about a woman who decided to give a kidney to a stranger. Here is a link to the show page for the first episode. From the little clip of her that I heard in the preview, Elizabeth (the donor) sounds like an interesting woman.
posted by sparklemotion at 9:03 AM on March 22, 2016 [1 favorite]

Wow, thank you for that thorough and very educational comment, vibratory manner of working! That was so interesting.

And what a story, sparklemotion. I'm looking forward to listening to it.
posted by hurdy gurdy girl at 3:22 PM on March 22, 2016

Let's not romanticize the idea of live liver donation too much though.
posted by Cookiebastard at 7:51 AM on March 30, 2016

There exist rules for the allocation of undirected kidney donation by living donors, which strikes me as an incredibly altruistic act and I wonder how often it actually happens.

I've met a couple of British guys who've done this, at a training day for people who were preparing to go into schools to tell kids about the blood, bone marrow and organ donation systems. So while it's very rare, it does happen. One of the guys in particular was on a mini-crusade to persuade others to do the same, and was in the habit of running marathons, triathlons, etc. to make the point that one can still lead a full and active life one kidney lighter. He was pretty inspiring, and came across as one of the kindest and most genuine people I've met.
posted by metaBugs at 2:58 PM on April 9, 2016

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