Patient Awaiting donor heart SOL

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I have two links...

 

One with this story and another local story that a transplant surgeon wrote that describes a transplant surgery that I found interesting.

 

link

 

Organ transplant patient could be in danger as a result of Lake Michigan crash

A transplant patient awaiting an organ being delivered on a plane that crashed in Lake Michigan could become the seventh fatality of the accident if another organ can't be found quickly.

 

Associated Press

 

Last update: June 06, 2007 – 7:17 AM

 

ANN ARBOR, Mich. - A transplant patient awaiting an organ being delivered on a plane that crashed in Lake Michigan could become the seventh fatality of the accident if another organ can't be found quickly.

The patient was put back on the waiting list for another organ Tuesday and was reported to be "very critically ill,'' a day after six members of an organ transplant team died trying to save his life.

 

Hospital officials and organ-donation authorities would not identify the transplant patient other than to say he was a man, and would not say what type of organ he was awaiting, citing medical privacy rules.

 

But one of the doctors killed was a cardiac surgeon, suggesting the patient was about to get a new heart or lungs.

 

"It was a very sad moment in the operating room'' when word came that the plane had gone down on its way from Milwaukee, said Dr. Jeffrey Punch, chief of transplant surgery at the University of Michigan Health System hospital in Ann Arbor.

 

The Cessna 550 Citation crashed about 5 p.m., shortly after takeoff. National Transportation Safety Board investigator John Brannen said the pilot had signaled an emergency and was making a left turn and heading back to the Milwaukee airport when the plane went down in 57-degree water.

 

The crash was under investigation.

 

Killed were both pilots, two University of Michigan surgeons, and two technicians whose job was to prepare the organ for transplant.

 

Hospital officials would not disclose how far along the surgery was, but said that typically they do not remove a transplant recipient's old organ until they have a replacement ready.

 

As of Tuesday afternoon, the donor organ, which was packed in ice in a cooler, had not been found. Hearts can last outside the body for only four to six hours and lungs eight hours, said Dr. Tony D'Alessandro, executive director of the University of Wisconsin Hospital and Clinic Organ Procurement Organization.

 

On the morning of the crash, the Ann Arbor hospital's Survival Flight Team received word that an organ was available at an unidentified hospital in the Milwaukee area. It immediately arranged to bring it back to Ann Arbor, officials said.

 

The team included two veterans, cardiac surgeon Dr. Martinus "Martin'' Spoor and transplant donation specialist Richard Chenault II, who had flown dozens of such missions. Also on the team were Dr. David Ashburn, a 35-year-old physician-in-training in pediatric cardiothoracic surgery, and another transplant donation specialist, Richard LaPensee.

 

The team flew to Milwaukee, and the two surgeons removed the donor's organ, which was then packaged for transport. The team contacted the Ann Arbor hospital and gave the go-ahead for the surgery to begin on the transplant patient at 2:45 p.m., Punch said.

 

The plane took off as light rain fell with winds at 12 mph, gusting to 22 mph. At the controls were Dennis Hoyes and Bill Serra, two pilots who worked for Marlin Air Inc., the university's jet-service contractor.

 

The plane hit the water at about 190 mph, authorities said. By midday Tuesday, only small parts of the aircraft - including pilot seats and small pieces of the cockpit - had been found.

 

A recent NTSB study found that accidents involving emergency medical services flights - those carrying patients or organs for transplant - have been increasing. Between January 2002 and January 2005 there were 55 such accidents and 54 deaths.

 

 

link

 

To transplant a human heart

By Richard "Rocky" Daly

“It all starts with a phone call. And the call often comes at night.

 

The neurologists caring for a potential organ donor perform a detailed examination and a number of tests before declaring brain death, and two separate exams are required. Coordinators then speak with the family about organ donation. If the patient had not completed consent during life, the family has to give consent for donation. A number of tests are performed to determine whether the patient’s organs are suitable for donation. The heart is still beating and the donor is on a ventilator during this time. The whole process can take the course of a day so the calls come at night.

 

I have a pager, a cell phone, a Blackberry, my own personal cell phone ... you can’t believe the electronics I carry. They should always be able to get in touch with me.

 

The donors are mostly victims of trauma or spontaneous strokes. Most of the blunt trauma is caused by automobile accidents, motorcycle accidents, or falls. Every organ donor, and their family, have suffered a terrible tragedy, because these are otherwise healthy people who have healthy organs that can be used for transplantation. If you think too much about the circumstances of the donor, you’d become emotionally distraught so often that it would be hard to function. So we try not to think too much about that ...

 

Rather, we focus on the priceless gift that the donor and family are giving to others.

 

We have a list of patients waiting for heart transplantation. The waiting time is variable—some people are on the waiting list for years, some for just a few days. It is very common to wait for many months for a heart transplant, and many wait in the hospital or wait in Rochester, Minnesota, far from their home. Our team gets to know these people very well and develops a relationship with them.

 

When we receive the call notifying us that a heart is available, it is offered for a specific recipient, and if we can’t use it for that person it goes to the next person on the waiting list.

 

Usually, the donor is in another hospital, often in another state. We organize a procurement team to go to the other hospital to evaluate and procure the heart. If the donor is nearby, our team may drive to the hospital. For longer distances they fly by fixed wing aircraft. When

returning with the heart, it is important to travel as fast as possible. Every minute counts when the heart is out of the body—after four hours the risk that the heart won’ t be able to support the recipient rises exponentially with time.

 

At the donor hospital, efforts are being made to place other organs as well. Other centers may use the lungs, liver, kidneys, or other tissues from the donor. Several procurement teams may need to be brought to the hospital. A coordinator at the donor hospital organizes the travel of all the teams so they arrive at about the same time.

 

When the procurement teams are available, the donor is moved to an operating room. Procurement is a surgical procedure with anesthesia and with the usual sterile prepping and draping and antibiotics. So it’s a very sophisticated process.

 

We flush all the organs and prepare them for transportation simultaneously. We give the heart a special fluid that stops it and relaxes it. We put it in a sterile bag in saline and put it on ice in a cooler. Keeping the heart cold helps to protect it while it is out of the body.

 

While the procurement team is returning to our hospital, a different team begins the surgery for the transplant. Our coordinator is instrumental to organizing this process. The recipient is called in and prepared for surgery. We bring them to one of the 12 cardiac surgery operating rooms at St. Marys Hospital.

 

The procurement team calls us when they are leaving the other hospital, we know what the flight time is, and we can anticipate the time they will arrive. We time the operation in the recipient so we are ready for the new heart when it arrives.

 

Heart transplantation begins like other heart operations. We make an incision over the breastbone. We cut the breastbone and then we separate the chest so we can see the heart. A bypass machine supports the patient while their heart is not beating.

 

We reach behind the diseased heart and cut it out with a scalpel and scissors. We remove all of the diseased heart except for what we need to sew in the new heart.

 

After arrival in the operating room at St. Marys, the donor heart is removed from the sterile packaging and prepared for implanting it in the recipient. During this preparation process, we keep the new heart in a pan with ice, then we lift it out of the pan and place it in the recipient’s chest.

 

I have been asked what it feels like to hold a heart. It is a sense of privilege, and appreciation for the gift it represents.

 

Sewing in the heart takes about one hour. We sew the right atrium, the left atrium, the aorta and the pulmonary artery of the donor to the recipient. Each of those takes one long suture, about 36 inches in length.

It takes several years to acquire the skills needed to perform heart surgery. Formal residency programs last eight years after medical school, and I spent an additional year training in transplantation. The technical skills are just one facet of performing surgery, but they are important. Time is critical in heart surgery, so the operation must be accomplished in an efficient manner. It takes an entire team to perform an operation, so we’re never working as a single person. There might be ten people in the operating room for a transplant. The surgeon is just one part of this amazing team.

 

During the heart transplant procedure, I am usually not aware of background music in the O.R. because I am focused on accomplishing the operation efficiently and accurately. In transplantation, we’ve already used considerable time transporting the organ, and the heart will only tolerate a limited time before we re-establish blood flow to it. Of course, it’s a catastrophe if the heart doesn’t work.

 

When we have completed all of the surgical connections, we remove a clamp from the aorta—we’d clamped the aorta when we removed the old heart—and that lets blood come into the coronary arteries of the new heart. The blood flushes out the preservation solution and the heart will start to beat. If you give it blood, the heart muscle knows to beat. The heart wants to beat.

 

Sometimes the muscle fibers are not beating synchronously with each other and we correct this with an electrical shock. We use small paddles to administer a very small voltage right on the heart.

 

The heart is allowed to beat and recover for awhile before trying to wean the patient from the heart-lung bypass machine. This helps it to recover from the insult of not having been in the body. The heart gradually gets stronger, and we can directly watch this process. When the donor heart is contracting well, the patient can be removed from the heart-lung machine, and that’s a moment that is exciting and dramatic. For the surgeon, there is also a small sense of relief that the new heart is working well and supporting our recipient.

 

One of my mentors said ‘You never get tired of seeing the heart beat.’ One of the exciting things about heart surgery is working on an organ that is actually moving, and you can watch it performing its function. It’s harder to appreciate this in other organs. The liver, for example, is a terribly complex, brilliant organ with all the biochemical processes it performs, but you can’t see them so it’s not as exciting, at least to me, as seeing the heart.

 

The heart pumps the blood for us. It’s gratifying, isn’t it, to see it actually doing that?”

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Everyone should consider being a donor and giving "the priceless gift that the donor and family are giving to others."

[Big John]

Offset of this thread

 

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I just saw it in the news this morning.

 

Great to see it already posted.