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In This Issue:
BWH Touts Historic Quadruple Transplant
The unfortunate loss of one individual and the selfless act of his or her incredibly generous family, made possible the first quadruple transplant involving one donor and four recipients in New England and quite possibly, the world, to take place here at BWH.
“It is the first grand slam organ transplantation with four runs coming across the plate,” said David Sugarbaker, chief of the Division of Thoracic Surgery at BWH, who led the tireless efforts of more than 100 BWH professionals, all of whom sacrificed personal time and pushed other priorities aside to make this event happen.
In just about 24 hours, the potential recipients were located and then reported to BWH, organs were harvested at the donor’s hospital, recipient patients were prepared for surgery, the organs were transported by plane to Boston and then BWH, and one heart, two lungs and one kidney were successfully transplanted into four separate individuals.
“This demonstrates the commitment of the hospital to use its many resources to allow us to perform four transplants at the same time,” said associate chief of Thoracic Surgery and clinical director of lung transplantation Scott Swanson, MD, to a crowd of reporters at Tuesday’s press conference held at the hospital to announce BWH’s most recent milestone.
Dr. Swanson led one of the lung transplants, Raphael Bueno, MD, led the other lung transplant, Lishan Aklog, MD, led the heart transplant, William Goggins, MD, led the kidney transplant and Jeanne Lukanich, MD, led the organ harvest surgery and assisted with one of the lung transplants. They—in tandem with anesthesiologists, nurses, perfusionists, pulmonologists, respiratory therapists, and many others—orchestrated the historic event that provided the gift of life to four very ill patients.
One of those patients is heart recipient John Perry, 56, of Taunton. “I want to thank the donor family who rose above their pain and suffering and reached out to provide something so precious,” said his wife Maureen, who was elated that her husband could once again “dance her around the dance floor and go fishing with his grandkids,” now that he had a new heart.
Aside Mr. Perry’s and the other recipients’ surgeries, BWH ORs accommodated 111 other surgical case on Aug. 18. According to Hugh Flanagan, MD, medical director of the OR, coordinating these four surgeries with such late notice was a challenge, yet rather practiced here at BWH.
In fact, groundbreaking transplantation experience is not out of the ordinary at BWH. In addition to the unprecedented quadruple transplant, other BWH milestones include the first successful human organ transplant—a kidney transplant between identical twins—in 1954; the first heart transplant in New England in 1984; the first lung transplant in Massachusetts in 1990; the first double lung transplant in New England in 1990; and New England’s first triple transplant—two lungs and a heart from one donor transplanted into three different recipients—in 1995.
To successfully meet the challenges of such complicated, simultaneous transplantations “timing was everything” attested those involved in the quadruple transplant. The timing of all activity has to be synchronized in a way that takes great skill and patience.
“The timing needed to be perfect. We couldn’t have the patient ready too early and not have the donor heart on-site and we couldn’t jeopardize the condition of the heart by stalling its transplant by falling behind in prepping the recipient,” said Paul Glova, RN, one of the three OR nurses who participated in the heart transplant. “What all four surgical teams accomplished took great skill and patience,” he added.
“The key is to time the administration of the anesthestetic with the organ harvest surgery—this ensures the recipient patient is under anesthesia for the least amount of time necessary, yet long enough for the surgeons to both remove the old organ and put in the new one,” echoed Steven Lisco, MD, one of the lung transplant anesthesiologists involved, who explained that patients awaiting a lung transplant under any other circumstances are typically not eligible for anesthesia because they are so ill.
Despite the numerous obstacles faced by physicians, nurses and other staff, Lisco said “it was the smoothest lung transplant I’ve been a part of in the five years I’ve been at BWH.”
With a successful quadruple transplant added to the hospital’s history, the focus is now on the patients getting well and observing for any signs of rejection.
Closely monitoring the patient every hour during the first 24 to 72 hours after surgery is vital in determining that the new kidney is functioning properly,” said Ellen Russell, RN, BSN, nurse-in-charge on 15C, the first-shift nurse responsible for post-operative care of the kidney recipient. “Teaching starts immediately. We’ve explained to the patient and his family how vitally important it is follow post-operative orders and we’ve thoroughly gone over the multiple rejection medications he is required to take,” she added.
“It is unfortunate that someone had to die to make all of this possible, but now at least four more people will live to see another day and appreciate how precious our lives really are,” said Glova.