Newswise — No heart transplant procedure is considered routine but Mike Iwuchukwu's was unusual enough that his doctors are writing an article " maybe several " for medical journals.
In a March 13, 2007 operation at Cedars-Sinai Medical Center, Iwuchukwu became possibly the first patient ever to receive a heart that had been transplanted before. If such a procedure has been performed, there appears to be no record in the medical literature, according to the cardiothoracic surgeons and cardiologists involved in Iwuchukwu's case.
The reuse of any solid organ for transplantation is extremely rare and has been successfully accomplished only in the past few years. Members of Cedars-Sinai's heart transplant program said it is unusual to accept a previously transplanted heart, for several reasons, and the decision was made only after carefully considering all the information about the donor and recipient.
In this case, the first recipient experienced non-heart-related complications during the transplant operation. Declared brain dead, the recipient became a potential donor and, with the family's consent, the heart was offered for donation six days after the operation. OneLegacy, the transplant donor network serving seven Southern California counties, notified Cedars-Sinai's transplant specialists of the heart's availability.
Few previously transplanted hearts become available to a second patient because most recipients go on to lead a relatively long life. If a once-transplanted heart is offered, several issues require careful deliberation, according to the transplant specialists. The heart already has been exposed to the tissue and antibodies of two people, which increases rejection risk and requires extra vigilance on the part of cardiologists and specialists in immunology. Also, because the heart's vessels already have been grafted once, a second procedure is more complex and potentially time-intensive for surgeons. In addition, the heart muscle itself may be stressed from lack of oxygen and the inherent trauma of two operations.
Iwuchukwu's care and the decision to accept the organ were directed by cardiothoracic surgeon Sinan A. Simsir, M.D., surgical director of the Heart Transplant Program; cardiologist Lawrence S.C. Czer, M.D., medical director of the program; and transplant cardiologist Ernst R. Schwarz, M.D., Ph.D. Cardiothoracic surgeon Gregory P. Fontana, M.D., traveled to the site of the initial transplant to evaluate and procure the organ.
Iwuchukwu, 45, of Porter Ranch, Calif., had a very rare heart condition called noncompaction syndrome, which gives the heart a sponge-like appearance. The disorder led eventually to the malfunction of his heart and the need for a transplant. Iwuchukwu is a very large man, and because a donor heart needs to be somewhat similar in size to the recipient's heart, Iwuchukwu's physicians were concerned that a suitable heart would not become available in time to save his life.
For patients like Iwuchukwu, and in view of the current shortage of available donor organs, the reuse of healthy, viable organs is a possibility that is just now being realized, according to the doctors. Iwuchukwu said he feels strong and healthy with the new heart and was not concerned when he learned that it had been transplanted before. He currently returns to Cedars-Sinai every week for testing, and there is no sign of rejection or any other complication.
His name was first placed on the transplant waiting list in 2002. He went off the list for several years as his symptoms were managed through medication and the implantation of an internal cardioverter-defibrillator (ICD) to synchronize his heartbeat. But in February 2006, his condition deteriorated and his name was put on the list again. More than a year later, at about 4 p.m. on March 13, a transplant coordinator called to say the hospital had a heart for him.
"You're kind of speechless," Iwuchukwu said. "You have been expecting it but when that call comes in, it's a totally different feeling." Within a few hours, Simsir led a surgical team in the four-hour operation that gave Iwuchukwu his new heart.
Iwuchukwu, a civil engineer, said "miracle" is the only word that comes close to describing how it feels to receive a much-needed organ. "It's like a gift. It's a second chance. It's like you're a new person again."
Californians can register with the Donate Life California Organ & Tissue Donor Registry at www.donatelifecalifornia.org or by checking "Yes" to be an organ and tissue donor when renewing their California driver's license.
The first in Southern California and one of only 10 hospitals in the state whose nurses have been honored with the prestigious Magnet designation, Cedars-Sinai Medical Center is one of the largest nonprofit academic medical centers in the Western United States. For 19 consecutive years, it has been named Los Angeles' most preferred hospital for all health needs in an independent survey of area residents. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities as well as breakthroughs in biomedical research and superlative medical education. It ranks among the top 10 non-university hospitals in the nation for its research activities and is fully accredited by the Association for the Accreditation of Human Research Protection Programs, Inc. (AAHRPP). Additional information is available at http://www.cedars-sinai.edu.
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