Newsletter 1/2012

Waiting for a New Heart

By Andreas Unger

Psychologist Gerdi Weidner examines how heart transplants can become unnecessary. An article from the latest Humboldt Kosmos.

In 2008, photographers Urban Zintel and Stephanie Fuessenich spent weeks monitoring a patient having a heart transplant. The image on this page shows the donor heart in sterile packaging waiting for the transplant surgery.
In 2008, photographers Urban
Zintel and Stephanie Fuessenich
spent weeks monitoring a patient
having a heart transplant. The
image on this page shows the
donor heart in sterile packaging
waiting for the transplant surgery.

Photo: Urban Zintel and Stephanie
Fuessenich

There was this statistic that Gerdi Weidner found strange: almost one in ten patients on the waiting list for a heart transplant is eventually taken off that list again – due to “spontaneous improvement” of their condition. During a coffee break at a conference, she asked a heart surgeon what he knew about these people. The physician seemed to find the question odd. “I don’t worry about them. They simply don’t show up on my operating table.”

A recovered patient is no longer a patient, so the doctor says: next, please. Obvious, thought the surgeon. Curious, thought Gerdi Weidner. These people had to have a story to tell. Why had they got better? How were they living? How had their lives changed in the previous months? What could we learn from their experiences? And why on earth was nobody asking them?

Without yet knowing it, on that day ten years ago, she had stumbled on a fascinating research topic.
Gerdi Weidner is a professor at San Francisco State University, and has been a visiting professor at Johannes Gutenberg University Mainz for more than ten years. In her office on the fourth floor of a nondescript modern building just behind Mainz main station she examines psychosocial factors and behaviours that affect chronic illnesses. Together with Heike Spaderna she initiated the study “Waiting for a New Heart”, in which 17 research institutes and clinics are participating. Weidner is a psychologist, not a surgeon. Her research question is not “How do we optimise operations?” but “How do we improve the condition of patients on the waiting list?” What habits increase the well-being of people with cardiac illnesses? She and her colleagues have already found a number of answers: maintaining social contacts and a helping of optimism improve health so greatly that a donor heart is sometimes no longer necessary and the patient can be taken off the waiting list.

The operation: the photographers have caught the precise moment when the doctors remove the diseased heart and immediately replace it with the donor heart. After the successful operation the patient has a rehab period of several weeks – during which he celebrates his second birthday.
The operation: the photographers
have caught the precise moment
when the doctors remove the
diseased heart and immediately
replace it with the donor heart.
After the successful operation
the patient has a rehab period
of several weeks – during which
he celebrates his second birthday.

Photo: Urban Zintel and Stephanie
Fuessenich

“When I was a student, discussion of psychosomatic medicine and chronic diseases in Germany still centred mostly on psychoanalysis”, says Gerdi Weidner. Very elaborate, but difficult to prove. Only a semester abroad in the USA in 1976 put German-born Gerdi Weidner on the right track: she discovered the potential insights offered by empirical and quantitative methods in psychosomatic medicine. She is particularly fond of recounting the story of how two cardiologists in California were once inspired to examine the mental states of their heart patients more closely: One day they wanted to replace the ageing seat cushions in their waiting room. They noticed that these cushions were particularly worn down at the front – indicating that patients sat in a tense, forward-leaning position. Their working hypothesis: people with cardiac illnesses were more stressed, more nervous, more restless, perhaps also more excitable and aggressive than the average person. That’s how the cardiologists began to take an interest not only in the hearts, but also in the life circumstances of their patients. Threadbare upholstery as an example of quantitative research – “examining phenomena like that, that’s what I wanted to do too”, says Weidner.

From 1984 to 2001, she worked as a professor of psychology and preventative medicine at the State University of New York at Stony Brook; then she became vice president and director of research at the Preventive Medicine Research Institute at Sausalito, California, then professor at San Francisco State University. She is married to an American ocean scientist, but frequently returns to Germany – her mother, her brother, two nieces and numerous cousins live here. Her German has meanwhile acquired a slight American twang – and the word “outcome” passes her lips more readily than its German equivalent, “Ergebnis”. But as a key research area, Germany not only offers her family-related advantages: its egalitarian health system is important for her research. In the USA she would have to anticipate significant distortions because the waiting lists for organ transplants contain an above-average proportion of members of the white middle and upper class. In the German system, on the other hand, she sees a representative cross-section of the population.

The Humboldt Research Award, which Weidner received in 2001, opens doors for her work. She had noticed that after the fall of the Soviet Union cases of cardiac illness increased exponentially in the countries of Central and Eastern Europe – especially in men. But didn’t the huge changes in circumstances affect both sexes equally, wondered Weidner? Together with colleagues, she examined living conditions in the post-socialist countries and found that the men’s self-image as strong, independent providers had come under immense pressure, which could cause them to indulge in excessive alcohol consumption and other unhealthy behaviours. Women, on the other hand, were better at dealing with stress – they found it easier to discuss their worries, and therefore felt less alone. And in general they ate more healthily.

The research team: Gerdi Weidner and Heike Spaderna with their Humboldt hosts Thomas Kubiak (left) and Heinz Walter Krohne (right) on either side
The research team: Gerdi
Weidner and Heike Spaderna,
with their Humboldt hosts Thomas
Kubiak (left) and Heinz Walter
Krohne (right) on either side.

Photo: Andreas Reeg

Among those awaiting a transplant, however, it is women who have a worse chance of survival, even though the women on the waiting list are not more ill than the men; but there are indications that they are under greater emotional and social pressure. “If we consider that women generally take care of the family, it may be that they feel the pressure more when they have an illness that incapacitates them,” Gerdi Weidner and her colleague Heike Spaderna write in one survey. Supporting evidence includes the fact that, when asked what the greatest impairments caused by their heart disease were, men named problems in their sex life and constraints on their leisure pursuits, i.e. self-referential factors. “Women, on the other hand, described worries pertaining to their families and their partners.”

As plausible as such interpretations may sound – Weidner always takes care to word them with caution, avoids stereotypes and does not shy away from noting unclear or contradictory aspects.

So why do women with cardiac illnesses have a worse chance of survival than men once they find themselves on the waiting list for a heart transplant – although their chances were far better before the operation was actually in sight?

“We don’t know yet. Currently, we can only make assumptions,” says Weidner.
Maybe it has something to do with the notion of the heart’s significance as the seat of personality, of the soul, of emotions, of which women are especially aware – perhaps this is the reason why they are especially afraid of an impending transplant. “Men are more likely to consider an organ as something they expect to work and which should be repaired or replaced, if necessary.”

Women take a different view: some transplant recipients, for example, report new proclivities that they did not have before the operation – their eating habits change, or they may even develop a foible for shoes that they previously did not have. Many suspect that this is related to the personality of their heart donor.

“We should follow up these reports,” says Weidner. Solving puzzles like this requires good questionnaires and a measure of perseverance, but no expensive medical apparatus. Weidner’s work is, therefore, well regarded by those whose interest is in ensuring that the health system remains affordable, for example statutory health insurance providers. “What we do is far less expensive than surgical intervention. Our results are bad for the medical equipment industry, but good if you want to save money. It’s far more cost-effective to help people who are experiencing psychosocial difficulties than to give them a new heart.” The ultimate goal at least is the same: after all, both sides want to stabilise the people on the waiting list for a new heart and increase their chances of survival – before and after a possible operation. Gerdi Weidner’s work, however, receives less support from high-tech physicians and the pharmaceuticals industry who earn their money with transplants and the expensive medications required by patients, making public research funding all the more important for her work. “I can’t get private third-party funding for this kind of work. No, wait! – a Californian pomegranate farmer once wanted to fund a study to find out whether his beverage was good for the heart,” she says and laughs.

Gerdi Weidner
Gerdi Weidner 
Photo: Andreas Reeg

How can we improve the condition of patients on the waiting list? This is Gerdi Weidner’s big topic.

Further information