Transplant Is Patient’s First, Heart’s Second
Pearl Ferrandino was hardly surprised last Sunday when a transplant physician at UCLA Medical Center reported that her 42-year-old husband, John, had successfully received a used heart.
Of course the heart was used, she thought. It had just been taken from a deceased donor and sewn in her longshoreman husband’s chest.
But that isn’t what the surgeon meant. This heart had not one but two previous owners: the woman who was born with it, and a man who had received it in an earlier transplant but had died suddenly after a brain hemorrhage.
“One heart--it’s fantastic,” said Pearl Ferrandino. “It’s amazing. I had never heard of that happening before.”
Medical experts said they know of only one other case in which a heart has been transplanted twice. In 1991, doctors in Switzerland removed the heart of a 47-year-old transplant recipient after he died of a stroke and stitched it into a 58-year-old man. The surgery was described in the Feb. 4 issue of the New England Journal of Medicine.
While doctors do not expect such recycling to become widespread, they say it underscores the scarcity of transplant organs. As the success of transplants has increased, so has the demand for them, rapidly outstripping the supply of donor organs. Last year, 2,567 people died in the United States as they awaited transplants.
That has forced doctors to become inventive. Said Dr. Davis Drinkwater, the surgeon who performed Ferrandino’s transplant: “We’re looking at every option available, and this is one of them.”
Doctors say they decided to supply Ferrandino with a heart that had already been transplanted because his heart was weakening rapidly and no other suitable replacement was available.
In fact, the San Pedro man was near death last week as he waited for an organ. He was stricken with weakening of the heart, known as dilated cardiomyopathy, and was admitted to UCLA Medical Center on June 16.
As he waited, another man was preparing to leave the same hospital after a successful heart transplant. Just as the man was being discharged, he suffered bleeding in the brain and died 11 days after his transplant.
What ensued is a stark reminder that, through transplant technology, tragedy for one family can be salvation for another.
With the permission of the deceased man’s family, doctors decided to give his transplanted heart to Ferrandino. The surgery was suggested by UCLA transplant cardiologist Dr. Jon Kobashigawa, who was treating both men.
“That heart saved two people, in a way,” said Kobashigawa. It gave the first man an extra 11 days of life, and doctors hope it will allow Ferrandino to pursue a virtually normal existence.
“I think it is very rare, and I think it is a very reasonable thing to do. But it’s going to happen so rarely that . . . it’s not going to affect our huge donor shortage,” said Dr. Dale Renlund, a University of Utah cardiac transplant physician who chairs the thoracic organ committee for the United Network for Organ Sharing.
Organ reuse will probably remain rare, doctors say, because it requires a unique chain of circumstances, including a strong donor heart and an initial recipient who dies of causes unrelated to cardiac problems or organ rejection.
“Not many (transplant) patients die. When they do die, there are usually reasons that you don’t want to use the heart again,” said Dr. Michael R. Bristow at the University of Colorado in Denver, a member of the American Heart Assn. committee on cardiac transplantation.
But the right factors fell in line at UCLA this month, prompting a drama described by doctors and hospital officials.
It featured three main players: John Ferrandino, the transplant patient who died before him and the first heart donor--a woman who was only 20 when she died as a result of a car accident in early June, Kobashigawa said.
Doctors will not disclose the woman’s identity, citing donor confidentiality. But Kobashigawa said that after her death, her family allowed her organs to be donated. Her heart, liver and kidneys went to three separate people.
Among them was a Southern California man in his 40s who was suffering from the same problem as Ferrandino: a heart that was growing too weak to pump blood. The man, whom doctors also decline to identify, had been forced to wait three months for a new heart at UCLA Medical Center. Finally, after the young woman’s death, he received her heart June 8.
The man recovered rapidly, doctors said.
“He was able to walk up and down the halls, speaking freely. His energy level was increasing day by day. We were ready to send him home,” said Kobashigawa.
Medical workers had grown to know the man well during his time in the hospital, and Kobashigawa said that he was well liked.
As the man prepared to leave the medical center, he had a brain hemorrhage and underwent surgery. The staff battled for two days to save him.
“We tried everything to keep him alive,” Kobashigawa recalled. But the bleeding brought on brain swelling, and the man was declared brain dead last Saturday.
Knowing of Ferrandino’s need for a heart, medical workers asked the deceased man’s family if his heart could be transplanted again. His wife and other family members agreed, Kobashigawa said.
“As she put it, the patient would want to have it that way,” Kobashigawa said.
So another heart transplant surgery began, the 400th to be done at UCLA Medical Center, which performed 75 transplants last year and has one of the largest programs in the nation. The four-hour procedure was very similar to a transplant with a heart from the original donor, said Drinkwater, the surgeon.
“Every surgeon doing transplants should be able to do it,” he said.
On Friday, five days after the surgery, Ferrandino was recuperating, with his wife at his bedside in the UCLA intensive-care unit, where doctors say he will probably remain several more days.
