James Wells is an optimist. During the eight months he was awaiting a life-saving heart-kidney transplant, he never gave up hope, even when another medical problem temporarily forced him off the waiting list for organ donation.
“I never used the word ‘if.’ I said, ‘when I get my heart I’m going to be fine,’” remembers Wells, who was suffering from congestive heart failure and related kidney failure. “The thought of not getting a heart and a kidney never crossed my mind.”
A Convincing Case for Transplant
In fact, heart-kidney transplants are rare occurrences. Only about 35 such procedures take place in the United States each year, and the dual transplant had never been performed at Rush University Medical Center before Wells received his new heart and kidney in January 2010. In addition to dual transplants being rare, Wells is 69, and some transplant centers are reluctant to offer transplants to older adults, due to concerns about lower survival rates and the view that available organs would be better used in younger patients.
“There are many places who would not have considered him for heart transplant just because of his age alone,” observes his cardiologist, Barbara Pisani, DO, medical co-director of heart failure, heart transplant and mechanical circulatory support at Rush.
Nonetheless, Pisani decided Wells deserved a chance. “He was very motivated, cooperative and determined, and he had a very strong family support system,” she says. Furthermore, Wells didn’t have any other disqualifying medical conditions, such as a past history of smoking or drug use.
Pisani’s advocacy persuaded her kidney transplant colleagues at Rush. “One of Mr Wells’ greatest risk factors for a kidney transplant was his poor cardiac function. Because he was receiving a heart transplant concurrently, his cardiac function would be dramatically improved, which also improved his chances for doing well with a kidney transplant,” says Edward Hollinger, MD, PhD, transplant surgeon. “At the same time, we felt a functioning kidney would improve his chances of a good outcome from the heart transplant, and make the management of his fluids much more straightforward.”
The heart and kidney transplant teams held a joint conference to determine how to manage Wells’ care while he was on the waiting list for donor organs; how they’d coordinate obtaining the organs when they became available; and which immunosuppressive medications they would use to prevent Wells’ immune system from rejecting his donor organs after the transplant.
Fighting for a Chance
Wells’ health struggles began in 2008, when he developed congestive heart failure, a condition in which the heart can no longer pump enough blood to the rest of the body. Congestive heart failure can be caused by a number of factors, such as narrowing of the arteries that supply blood to the heart, congenital heart disease, heart valve disease and weakening of the heart muscle itself. Although the exact cause of Wells’ illness never has been determined, he had a form of congestive heart failure called dilated cardiomyopathy, which causes the heart to become weakened and enlarged—his heart eventually swelled to the size of a basketball.
Wells was treated at another hospital with medications and an implant to help his heart pump. His heart continued to deteriorate, though, which deprived his kidneys of oxygen and nutrients, causing them to shut down.
He ultimately came to Rush in search of other options. “Dr. Pisani said that transplant was a possibility,” he remembers. “I decided that if I passed the physical, I was going to try it.”
He began dialysis — the process of intravenously routing the blood through a machine that cleans it when the kidneys no longer can do it themselves — and underwent an extensive series of tests that showed that he was eligible to receive the transplants.
Hollinger and the cardiovascular surgery team planned on using a kidney and heart from the same organ donor to reduce the chances that Wells’ immune system would reject the organs, which is standard procedure. So Wells went on the nationwide waiting list for donor organs.
But Wells suffered a setback when he had to undergo surgery to remove his gall bladder in June 2009, followed shortly afterwards by a second procedure to remove a gallstone from a bile duct. Steven Bines, MD, a general surgeon at Rush, performed the surgery. Wells came through them fine, but he had to be placed on hold for transplant while he recovered.
Such delays can mean the difference between life and death, according to Hollinger. “Patients who get on the waiting list have a steep curve and are at risk for developing complications that would preclude them getting a transplant,” he says. “You really have to be on top of things and stay out of trouble. Mr. Wells took good care of himself.”
In addition to his dialysis treatment while he was awaiting his transplants, Wells received heart medication through a catheter inserted in his chest and had to change the bag containing the medication every other day. Wells credits family members for looking after him and helping him manage his treatments.
The Long Road Back
This January, a donor matching Wells’ blood and tissue type became available. After the heart transplant surgery, Wells spent a few hours being monitored in the surgical intensive care unit to guard against bleeding and other complications. Then, shortly after midnight, he was wheeled back in to an operating room, and Hollinger transplanted his new kidney.
After spending some time in Rush’s surgical intensive care and cardiac intensive care units, Wells was transferred to Rush’s Johnston R. Bowman (JRB) Health Center, which provides posthospital inpatient recovery and rehabilitation services. Wells’ illness and convalescence had left him severely weakened, and rehabilitation therapists in JRB helped him regain the ability to walk and perform basic tasks like dressing himself again.
“They were really, really good,” he says. “It’s a tough mental challenge to push muscles that hadn’t been used in months, and they inspired me and got me rolling.”
Pisani says that Wells has opened the door for other patients to receive heart-kidney transplants at Rush. She notes that until now, many patients with kidney failure were rejected for transplant if they had heart failure, and vice versa.
As for Wells, things definitely are looking up. He comes to Rush for regular tests and follow-up exams, plus physical therapy twice a week, and hopes to be fully recovered by the end of the year so he can take a trip around the world.
“I’m a goal-oriented person,” he says. “So are the doctors at Rush. It’s an impossible task, what they did. It was just amazing.”
More Information at Your Fingertips:
- To learn more about organ donation and nationwide efforts to address the growing demand for donor organs, check out this Q&A with Rush heart transplant surgeon Robert Higgins, MD, on the Rush News Blog.
- Looking for a doctor? Call toll free: 888 352-RUSH (888 352-7874)
- Stay in touch with Rush with Rush Blogs, Facebook, Twitter, YouTube and more.
Please note: All physicians featured in Discover Rush Online are on the medical faculty of Rush University Medical Center. Some of the physicians featured are in private practice and, as independent practitioners, are not agents or employees of Rush University Medical Center.
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