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Toby's Take: Quadruple Transplants

Photo of surgeons performing quadruple transplant in OR

February 21, 2023

You’ve heard of a quadruple bypass. How about quadruple transplants? All in a weekend’s work at The University of Kansas Health System’s Center for Advanced Heart Care. Christmas Weekend.

I wrote a blog post recently on workers who dove into a problem with bursting pipes this past Christmas Day at our Marillac Campus. Now a clinical Christmas miracle:

A team of health system surgeons, anesthetists, nurses and respiratory specialists performed 4 heart transplants in rapid succession from early Christmas Eve until the morning after Christmas.

If the Wise Men brought 3 gifts, this team brought 4. They worked with skill and perseverance (and not an ounce of complaint) for 4 anxious families, basically postponing their holidays until December 26.

Certainly, the ultimate gifts came from 4 unnamed donors and their families who, to this minute, mourn their lost loved ones. The University of Kansas Health System performs many heart transplants. But nobody can remember a run like this.

It takes a team

“I was just happy to be a part of helping all these patients get a new heart,” said Kristiana Rrapaj, a circulatory nurse on the unit all weekend. “I mean, that was amazing for me to be a part of it.”

Her nurse manager, Emily Martin, came in and stayed, too. She troubleshot as doctors prepared to procure the donated hearts before the transplant surgeries. By circumstances only a tiny group will ever know, 4 donated hearts all became available at the same time.

“It's a privilege that most healthcare workers don't get to have. Ever,” Martin said, sitting alongside Rrapaj during an interview last month. “And she got to do it 4 times.”

What’s funny in telling this story about back-to-back-to-back-to-back transplants is also so typical of this place. No one wanted to take credit but kept offering it to everyone else.

Matt Danter, MD, performed all 4 transplants but insisted his partner, fellow cardiovascular and thoracic surgeon Omar Almoghrabi, MD, had the heavier lift. Dr. Almoghrabi removed all 4 donor hearts that, hours later, would beat inside the chests of 2 women and 2 men.

You don't get breaks. You don't get to go to the bathroom ... You can't leave the patient and say, ‘We'll be back in a little bit.’ Everyone was so kind and worked really well together. Emily Martin

Nurse manager

A very large team

Dr. Danter says the recipients have a swirl of emotions as they recover.

“They start to reflect on what actually happened. It can get very emotionally complex. Like there's guilt, and there's this feeling sometimes of unworthiness. (But) I think the most common trait among most recipients is that they're just extremely grateful.”

There’s more credit to spread here:

  • Perfusionists – They operate the heart/lung machine that keeps a patient alive during the transplants.
  • CTI staff – These are members of the cardiothoracic intensive care unit.
  • EVS staff – The minute the first operation concluded, staff started cleaning the operating room for what would be the third transplant, just as they had gotten an OR ready for round 2. And they did it again for the final transplant.

I could go on. Barbara MacArthur, vice president of our cardiac service line, beamed with pride and called the collaboration on those 3 days and 2 holy nights “unparalleled.”

They weren’t operating nonstop, of course, during that span. Sewing in a new heart, for instance, takes about an hour, Martin said. But there are many hours before and after the transplant. And with 4, it might as well have been continuous.

“We just had to rely on each other," Martin said. “You don't get breaks. You don't get to go to the bathroom. You can't leave the patient and say, ‘We'll be back in a little bit.’ Everyone was so kind and worked really well together. It's a really close team, so it was special just to see that.”

Working together for all the right reasons

Focusing on the patient and family helps.

“You know how they're spending their holiday, that patient, and the fact that all they want in the world is a heart. Getting to be a part of that and getting to give them that gift on Christmas...”

Oh yeah. Christmas.

Dr. Danter and his wife, Sherry, have 3 daughters, Maya (12), Kayla (7) and Alyssa (5). Guess who was waiting on Daddy to get home? As these things go, they didn’t have to wait until the next day. He stopped in for a couple of hours between surgeries to open gifts and grab some sleep.

Let’s include them as part of the transplant crew.

“They get it. I'm lucky enough that they are sort of not used to it necessarily, but they're pretty patient with me I think.”

I could write a blog post a week until next Christmas and still not scratch the surface on incredible strides the health system has made in all types of transplantation. Or the hours of dedication it’s taken to make some of this almost routine. It’ll amaze and make your head spin. This includes donations from living patients and those donating as a last, sacrificial act.

“You know, there's an aspect of privacy and that sort of thing,” said Martin. “We don't know the circumstances of the donation, and that's probably better. But I think we definitely have a lot of respect for the gift that someone else had to give in order for this to happen.”

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