Heart to Heart

1. Chucky gets lucky

2. On bypass

3. New heart pumping

4. Recovery

5. The long runRiddle of R & L3. Stroke of genius?4. Attitudes are a' changin'


Chuck Reynolds with his wife, Patricia, about 10 days after surgery. Free at last, he's headed home after four months in the hospital, equipped with a new heart.














I'm on a non-stop high

Leaving the hospital
In the days after the operation, Reynolds's liver gradually broke down the lingering chemical soup, and his kidneys temporarily shut down. He suffered a mild blood clot and the pain and soreness of massive surgery. The drains and pacemaker leads were pulled out.

Chuck looks to the distance, Patricia smiles directly at camera.But the new heart continued beating like a champ. Two weeks after the operation, four months after he entered, he left the hospital.

Chuck went home to a new life. Like his wife, he is a registered nurse, but progressive weakness had kept him from working for years. He hopes to return to work.

As the operative pain waned, Chuck confronted his return to health with a rising tide of energy. "I feel like I've been graced," he marveled. "I don't know why."

Later, by email, he told us, "I just gaze about glowing. Kind of a non-stop high." Chucky was, as we've said, lucky. Aside from his heart troubles, his health and youth moved him to the front of the transplant queue.

The matter of the heart
The need for heart donations will rise as more people survive heart attacks, says David Follette, a professor of surgery at the University of California at Davis. He expects medicines to support an increasing number of failing hearts, but says, "The number of end-stage patient is likely to be larger than the number of donor hearts available."

Which raises the question: How do we get more donated organs?

Nationally, about 50 to 60 percent of suitable donors do make the gift of life, says Tony D'Alessandro, executive director of the program responsible for procuring organs at University of Wisconsin Hospital and Clinics, but with so many people waiting, he wants to increase the rate. One tactic is to teach high-school driver's ed classes about the benefits of donation. Another is to let your family know you want to donate, then sign the donation line on your driver's license. That's critical, says D'Alessandro, because after a sudden death, family members are "in a very emotionally charged situation, a tragedy," and they may have difficulty understanding what you wanted.

Dealing with families that have just confronted death places those who procure organs in a ticklish position. They see grief, but can't forget that people like Chuck are at the other end of the pipeline, betting their lives on the generosity of strangers.

Families should be approached slowly and gently, says D'Alessandro. "The nurses or physicians, or chaplains who are helping the family ... must allow them time to grieve, to become aware they have lost their loved one." Organ donation may not be brought up for a day or two, "but if you approach them in a very sensitive manner," success is more likely.

You gotta have heart
Beyond education and simple generosity, some ongoing technical changes are making more organs available. For example, "live donors" may provide kidneys (you have two, but one will keep you healthy), and livers, pieces of which can be transplanted.

A second area of growth comes from donors who were recently considered unsuitable. "We need to get away from the mentality that the ideal donor is a young trauma victim," says D'Alessandro. "Someone who's a little older, even with diabetes or hypertension, or a treated infection, might not have been considered in the past." Aware that people are dying on the waiting list, "we look at how the organ works" rather than the donor's overall medical condition.

This focus on organ health is especially evident in heart transplant. Bruce Rosengard, who directs the heart and lung transplant program at the hospital of the University of Pennsylvania, says among people without infectious disease or other obvious red flags, the variation in the rate of heart usage runs from 25 percent to 70 percent in different locations.

That means doctors must maintain donors in better condition after brain death. Rosengard concludes. He advocates "resuscitating" brain-dead people by, for example, restoring hydration. (Swelling in many traumas causes brain death; doctors use diuretics to reduce swelling, so many donors are extremely dehydrated.)

Graph showing that heart transplant failure rate has dropped from in last 5 years.

For several reasons, surgeons like to harvest organs quickly, but taking time to restore hydration, for example, may make the difference between healthy organs and useless ones. Indeed, before the operation we watched, a quality problem almost disappointed Chuck Reynolds. Surgeon Thomas Starkey found that the donor's blood was highly acidic, which he neutralized before removing the heart. Nonetheless, Starkey said he was 10 minutes from rejecting the heart and returning empty-handed to Madison.

Want a good job? Do it yourself
Another problem arises from a standard method for checking the health of a donor heart -- the echocardiogram. Also called ultrasound, the technique may cause good hearts to be rejected, says Rosengard. With donors under age 40, he says, "All the organs should be good, yet about half the time, the hearts are not used simply because there is an echocardiogram that shows abnormal function."

Echo was originally intended to detect abnormal heart structure, Rosengard argues, not to test pumping ability. A scan showing abnormal heart muscle, he says, may simply be reflecting deadly trauma -- or even treatments used to save the donor's life.

Often, when the echocardiogram shows abnormal pumping, "When it's put in an otherwise healthy person, four or five days later ... the function is normal," Rosengard says. "If you look further, you find there is no data validating" the use of echo for this purpose. Far better, he says, would be to measure heart output with a catheter.

A proposed national standard for treating donors before organs are extracted could make 30 percent to 50 percent more hearts available, Rosengard says. Even without increasing the number of donors, that would allow 1,000 more heart transplants each year. "The term used is 'marginal organs,'" Rosengard says. "I don't think many are marginal, I prefer to think of them as under-resuscitated."

How long will the new heart last?




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