July, 1995
Mickey Mantle transplant:
battling perceptions of preferential treatment
There is still a significant segment of the public that is suspicious about the fairness of organ transplantations. The feeling is the rich or the famous have a better chance at life-saving organs.
This public doubt is an issue that public relations counselors are dealing with again.
Baseball great receives help
New York Yankees Hall of Famer Mickey Mantle was admitted to Baylor University Medical Center in Dallas on May 28th. At the time, no one knew the extent of his medical problems, and it didn't make a ripple in the press.
"Then, a news station that prides itself on breaking the big stories, somehow got word that he was going to require a liver transplant, and KABOOM!" says Jennifer Coleman, Vice President of Public Affairs for the Baylor Health Care System.
"To medical writers, a liver transplant is an interesting story. To sportswriters, it was a revelation, especially those from New York, where he played," she says.
"I have been here 15 years, and have handled stories ranging from the exhumation of Lee Harvey Oswald, to celebrity patients, including Barbara Bush, Marilyn Quayle and John Tower. This case has probably generated the biggest press crush," Coleman says.
When the medical center's clip service used the key words "Mantle" and "Baylor" to search the database, all 18,000 sources they monitor had run a story at least twice. The tape of the television coverage is over eight hours long.
A quick match creates PR problems
Mantle's physician had to keep in mind that the family was part of the audience, too. So in his first statements to the press, the doctor was conservative about how long it might take to get an organ.
He said the average wait could be one month. Then, the next day, there was the news that Mantle had received a liver.
Once the expectation had been set that there would be a wait for an organ, it was surprising when Mantle got one right away.
"We had set up the context that it could be at least a month. The doctor was saying that had been our experience. It could be anywhere from five hours to one month when the patients are in this status category," Coleman says.
"The immediate outcry was that Mickey Mantle got a liver the next day. In fact, he had gone on the list two days prior to getting the donor," Coleman says. He is a male with type O blood. He had the best chance to find a like donor, she explains.
On Thursday, June 8th, at 4:30 a.m., Mantle went into surgery. News coverage began at dawn with the network morning programs.
"We had doctors ready at 5:30 a.m. to accommodate Good Morning America and Today. We had all the sports stations and CNN, too," she adds.
News conferences were held that day and the next at 9 a.m. and 1 p.m. At 9 a.m., the reporters needed something from overnight. The afternoon time was picked because of the doctors' schedule, and it seemed to work for both coasts.
Coleman says competition was so intense among local TV stations that someone called the hospital switchboard and offered an operator $20 to "lose" the phone messages from the competing stations.
Media focuses on women and children still waiting
"Immediately, the news coverage started showing little children or tiny, little women, implying that Mickey got their liver. In one absurd case, they implied Mickey got a woman's heart and lung! It was ridiculous. Some media started hauling out all these pitiful examples of small children and people who didn't even live in the Southwest Organ Bank area," she says.
A teenager from Boston was shown as someone who could not get a liver. He felt badly that the former ballplayer received one and he didn't.ÿ
"The intricacies of the allocation process were sacrificed immediately to the idea that this was just like the case of David Crosby, Jim Nabors, and now, Mickey Mantle. Much of the media made no effort to correct an understandable emotional response from families who were still waiting for organs."
Jennifer Coleman
Baylor Health Care System
Coleman explains it this way: the organ bank collects the organs. Its staff relays information about the organ and the donor to UNOS in Richmond. UNOS monitors the waiting list, and compares it to available organs. If a donor appears in the collection area of the Southwest Organ Bank, the computer turns out a list of appropriate candidates at all the transplant centers in that collection area, and looks at the highest priority cases.
For this area, for this blood type, for this severity, it came up Mickey Mantle.
Countering the public's perception
When it became clear the news organizations were focused on whether Mantle received preferential treatment, the Baylor team organized to get their messages out.
"When we got word that Mantle received an organ, we were well aware that questions were going to be raised. But we weren't going to let PR concerns treat this man any differently than we would anybody else. We told our story every chance we could get," says Coleman.
Baylor's strategy included:
Representatives of the organ bank were present at all the press conferences.
They explained organ allocation and severity. The organ bank had also prepared a news release which was distributed to the media.
UNOS reviewed the process and gave its approval.
"If we say someone is the highest priority, the hospital has to be able to back that up," says Coleman. UNOS audits the institutions.
UNOS sent a statement that also was distributed at a press conference, saying that everything had been done properly.
Former transplant patients who had gotten their organs quickly told their stories.
These patients had received their organs within a few hours or a few days.
The first day, the Lively Livers, a transplant group, attended the news conference to talk about transplant issues.
That day, the husband of a liver transplant recipient called and said his wife would be happy to help Baylor. She had received her liver transplant on Thanksgiving Day within five hours.
"He wanted to help people to understand that celebrity status has nothing to do with it," says Coleman.
The woman couldn't get to Baylor on the day of Mantle's operation, but she did appear at a news conference the following day.
"The media actually picked up on these stories, and that's when the tide began to turn," says Coleman.
At the first news conference, two former transplant patients who work in the area of organ donation were present.
"We wanted to shift to that topic," says Coleman. "We wanted them to talk about organ donation," she says.
Reaction from public is emotional
The appearance of someone getting a life-saving operation because they are wealthy or famous is an infuriating idea for many Americans. It strikes at people's basic sense of fairness, and reinforces the popular belief that if you have power and money, you don't have to live by the rules that everyone else does.
"The calls from the public were very disturbing," says Coleman.
One man said he was "taking his name off the donor list because the system is corrupt." Of course, there isn't any donor list, but it illustrates the intensity of the calls from the public. And, the response that people were having was hurting the whole system.
"People might be less likely to donate," she says.
Typical was a letter to the editor of The Dallas Morning News:
'Real' heroes wait
As a volunteer at Children's Medical Center, I am aware of the agonizing wait the children with diseased livers experience seeking a transplant donor. That Mickey Mantle's deteriorating liver should propel him to the top of the list for a liver transplant is deplorable. My sympathy and compassion are for those with diseased livers due to hepatitis, viral infections, etc. not substance abuse, i.e. alcohol, who are moved down on the list while celebrities such as a Mickey Mantle and a David Crosby are given priority.
Perhaps one should not be surprised. After all,the name is what counts! Meanwhile, the "real" heroes keep waiting.
Besides the doubts about how Mantle got his liver so quickly, there were also questions as to why a man who had abused alcohol for years and who had cancer, too, was given a transplant.
Here are excerpts from a second letter:
Sorrow and anger
My wife is in early stages of liver failure and will require a transplant within a year or so. She does not (and has not) taken any form of alcohol or used any illegal drugs. The doctors told us about the waiting list for months, about being at the top for only two weeks, having to wear a beeper and having to be at the hospital in less than two hours, and if no suitable donor organ is found, then having to start back down at the bottom. They told us the screening process includes looking at lifestyle habits which may have contributed to the failure.
.... My wife and I are just normal middle-class people, not famous or special, just raising our family the best we can. Our girls deserve to have their mother around to help them grow up. I am hoping that her transplant will happen as quickly as with these "celebrities."
The first day, Baylor received about 20 negative calls. The second day about 15 calls, and over the weekend about seven. "And, then we got no ugly calls," says Coleman.
In all, they received about 30 letters from people who were upset. Most of those were dated near the time of the transplant.
"We made a big point to talk about our criteria for transplantation, and how we wouldn't transplant a drunk. But we would transplant someone who had gone through rehab and had been sober at least six months, and who would undergo what the physicians call 'a brainwashing' before he left here about his responsibilities," says Coleman.
"We were trying to explain to people that Mickey Mantle was raising the awareness of the need for people to donate organs. There are lots of things we suggested to the Mantle family that they could do in support of organ donation," she adds.
For the most part after the first few days, Coleman says people dropped the issue of preferential treatment.
"All of a sudden, journalists got on our side. People who called the talk radio stations with venom about it, were told it was a closed issue. On one show, a doctor from another hospital called. He said he also does transplants, and he knows what the people at Baylor are going through. That got the journalists to start cutting off callers," she says.
After that shift in public opinion, Coleman says the letters to the editor were positive.
"We feel like we really explained the issue, just by throwing everything we could at the news media early on, and educating them," she says.
"We had just about everybody who could validate, do it," she says.
Crisis communications preparation worked
"We were better prepared than many institutions might be, because we put a lot of time and effort into media crisis preparation. We have media trained over 300 people," says Coleman.
The doctors that were interviewed were briefed quickly before the press conferences, as to what background material would be distributed and who else was scheduled to appear.
"Not all doctors are amenable to being directed, let alone are talented in being able to talk to the media, but we were blessed in both areas," she says.
Family agrees to releasing medical details
"We talked about all of it, because we had to make the point that he was a very sick man. His family agreed to it," she adds.
"They were caught so off-guard by this illness. These are normal people like you or me. The real reason he got the transplant was not the cirrhosis. It was the damage to the liver done by hepatitis that he got through a blood transfusion during surgery to correct past sports injuries. They didn't mind us talking about his condition, because it vindicated their dad," she says.
Coleman says everything they released said: hepatitis, cancer, and cirrhosis.
"The doctor told me that was the order of the reasons for the transplant," she says.
However, that message was somewhat lost to the media because of Mantle's widely- publicized drinking problem.
"Well, is the donor still alive?"
Perhaps one of the most unique moments came when Dr. Goran Klintmalm, who had been up most of the night, was standing at the podium after the transplant, and solemnly said:
"This donor contributed seven organs that have gone into six different people. It shows how he made a contribution to humanity."
He looked around to take questions.
A sportswriter asked: "Well, is the donor alive?"
As the audience broke into laughter, the physician struggled to maintain his composure, and said, "So, you're a sportswriter, Mike?"
"It showed how we were dealing with reporters who were medical writers and who knew all about liver transplants, and we had a group of sportswriters who knew only Mickey Mantle," says Coleman.
Who's the donor?
The question of the donor's identity came up quickly, which Coleman says is totally out of bounds.
A woman from New Jersey called news organizations and said it was her son, who had died in Texas and was an organ donor.
"We could have told the media if that was the person or not, but the rules of the game are that you do not talk about that, unless the donor family explicitly wishes to come forward, and the recipient family explicitly asks to meet the donor's family," says Coleman.
Then the organ bank plays a role of taking anonymous letters between the two. If they want to meet, the organ bank will take it to the next step, she adds.
"We just couldn't reveal the information. I have received some terribly sad letters from people who are just certain that their beloved person is the donor. I can't say yes or no," Coleman explains.
Many people don't realize that organs harvested in the service area stay in the area.
"It's been very tempting to pick up the telephone and tell these people that it's not their loved one," she says.
The public relations staff members were even hesitant to talk about how many organs had been donated, because some reporters were calling funeral homes asking if they had received any bodies on a certain date that were missing a number of organs.
Some funeral directors confirmed they had received bodies on that day. It was a path that people were willing to take to try to find the donor.
Baylor listed many of the reasons that the donor is not identified. "Dr. Klintmalm said that although it has never happened at Baylor, he was aware of a case where the donor's family approached the recipient's family and asked for money," says Coleman. If the donor was a family's breadwinner, a recipient might feel responsible to help out financially.
"There are lots of tried and true reasons to let the system work," says Coleman.
She adds that a donor's family needs to grieve, and the media should let them alone. "It's hard enough for the Mantles to go through this shock, but think about the grieving family, wherever," she says.
More techniques to handle press pressure
The Baylor team has developed techniques to deal with the media on these high-profile cases.
Voicemail for weekend updates.
As the first weekend approached, Mantle was progressing well. They did noon press conferences on Saturday and Sunday, and used the voicemail in the PR department to leave condition updates over the weekend.
"It would say that the message was being updated at whatever time; Mr. Mantle's condition is this; and then we gave them something to use, such as the fact he was sitting up in bed or watching TV. It was about a two-minute update," she explains.
Find a medical illustrator.
"There were people who came to cover the story who thought there were two livers in the body," she says.
Prepare now so you don't have to fight your own administrative staff on how the story should be handled.
"We've had enough high-profile cases and have media trained them, so they realize there are effective ways to deal with the media," she says.
Remember to keep your internal audience up-to-date.
Your medical staff and employees are a source of information for many people. Their friends and neighbors will be asking them what's going on, as will other patients.
Baylor did a daily Mantle update on their staff e-mail system.
"It gave everybody a positive thing to pass along when people asked them questions," Coleman says.
On the first day, for example, the message was that Mantle had received the transplant, and that UNOS had examined the hospital's procedure in allocating it to him and validated the process.
"By the end of the week, we were down to reporting that he had eaten chicken fried steak and carrots. It gave everybody a positive thing to pass along. The grapevine can work for you. If someone is talking about chicken fried steak, they are not talking about preferential treatment," she adds.
Reporters wanted patients still waiting
In the case of a transplant, the media may want to talk to patients who are on the waiting list for organs.
Coleman says it would have been a breech of confidentiality to release the names of people waiting for transplants.
But Baylor has an apartment complex on campus where some patients live who are recovering from transplants or who have to be near for testing while they are awaiting transplant.
The media accosted people going in and out of their apartments: "How do you feel about Mickey getting a liver ahead of you?"
Security was alerted to keep reporters out of the area.
Get your own message out
The massive publicity in a case like this undoubtedly can be beneficial for your institution.
"It has made the public aware that there is more than one Baylor in Texas," says Coleman. There is Baylor in Houston, which is the college of medicine. And, there is Baylor University in Waco, which owns the Health Care System in North Texas.
"It helped make the point that there is a Baylor in Dallas," she says. And, thanks to the some of the network reporting, a national audience learned that Baylor is consistently ranked in the top three liver programs in the country, and one of the highest success rates, and is known for its research.
"The coverage got out a lot of good messages, after the initial tide against us turned," she says.
Transplant patients and the media: publicity can be a double-edged sword
The news media has become more interested in organ donor awareness stories in the last year, according to Yvette Monet, Coordinator of Public Relations, William Beaumont Hospital in Royal Oak, Michigan.
Stories like Mickey Mantle, and the father who received his daughter's heart last summer at William Beaumont have generated a great deal of interest in transplantation.
Monet says patients who are awaiting organs are approaching Public Relations more frequently, offering to tell their stories to the media, in hopes it will draw attention to the need for donors.
She had such a situation in November of last year, when she was a approached by a 45 year old man who was hospitalized with cardiomyopathy. He had been in William Beaumont since August awaiting a heart transplant.
"He called and offered to go on camera or talk to a print reporter. Ultimately, a local TV station and a newspaper decided to follow his story until he received a heart," she says.
The reporters would call every other day to check on his status.
"Finally, on a Friday night in January, he did receive a heart," she says. They waited until the following Wednesday, and he was interviewed following surgery.
"It was a great organ donor awareness story, showing how much he had been helped," she says.
That weekend, an investigative reporter from the same TV station wanted to do a followup story. "He had contacted a family across the state, whose 18-year-old son had been in a snowmobiling accident, and died the same night our patient received his heart," says Monet.
"It had been reported that the teen donated his organs, but of course, it didn't say where," she adds.
"The reporter put two and two together, and asked them if indeed their son's heart had been given to our patient here at William Beaumont," she says. "The family was still in shock. Their son had died. They did tell the reporter that their son's heart had been given to our heart patient. They agreed to go on camera," she says. "The mother was obviously under a lot of stress and grief, and said she would like to meet our heart transplant patient, and 'feel her son's heart beat once again within our patient's chest,'" says Monet.
The newspaper reporter who had been following the transplant patient, then called and asked Monet if she could arrange for the two families to meet so the paper could get a picture of the woman putting her hand on the patient's chest. "I was stuck in the middle," says Monet.
She called the patient and told him of the newspaper's request. He felt he owed the donor's family something. If they wanted to meet him and invite the media to cover the meeting, they were welcome to do so.
"He promised to participate, even though he seemed a little uneasy with the idea," she says. "I was really uncomfortable at this point inviting the media to cover such a meeting, because it was such a recent occurrence, and because the mother was obviously still grieving," says Monet.
She felt it was just too soon.
"And, once we let the media in the door, the mother's actions could have been unpredictable," she adds.
For advice, she talked with the local organ procurement organization. The director said that typically in Michigan, the donor's family and the recipient wait for one year after the transplant. She asked the procurement director to step in and contact both families and to advise against the media coverage. She also asked him to make arrangements for a private meeting between the two, if both were comfortable with that.
"I called back the newspaper reporter and told her that the deceased's family was still very upset and that it would be more appropriate if the meeting were to be private," she adds.
Prepare your patients for all the possibilities If they do allow (or seek out) news coverage, patients should be aware of what it entails.
1.Advise families that once you open the door to media coverage in a potential organ transplant situation, you need to consider th e feelings of the future donor's family. How would that family feel if another reporter would put two an d two together and call them asking for an interview? "It's not just yourself and your family you need to consider. Others are involved, too, " she says.
2. You can't just work with one media outlet. "If you open the door to one, you need to consider all the medi a requests that one interview might generate," she says.
3.Is the heart patient's health stable enough to accommodate mu ltiple requests?
4.How would the patient feel about being interviewed or photographed shortly after the transplant surgery? "They don't always look their best, but the minute the media he ars that there has been a transplant, they want to know the earlies t they can come in," she says.
5. Reporters often ask on-the-record questions about a patient's financial situation, especially when the wait for a transplant involves a lengthy hospital stay. "Is the family willing to reveal information about their financial information?" she asks. "Reporters may be looking for the angle that the transplant has sucked all their financial resources dry," she says.
6.If you do one interview, and the interview generates multiple news requests, you might want to do a news conference to accommodate all the requests at once. William Beaumont recently did a husband-wife kidney transplant.
"The wife matched her husband's tissues better than anyone in the fa mily. In that case, we did three news conferences, before, during surger yand after to see them reunited," she says. William Beaumont does heart transplants and kidney transplants. :-)
2006-09-25 23:02:43
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