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In This Issue:
Philip Blazar, MD, and Christian Sampson, MD, work together during Charla Nash’s face and hand transplant surgery—one of five transplant surgeries that took place at BWH in 24 hours.
When Phil Camp, MD, walked into the Operating Room suite one recent weekend, he looked with amazement at the number of transplant surgeries—two hearts, two lungs, two kidneys, two hands and a face—in progress or set to begin within a few hours.
“It was awesome to look at the board and see so much activity,” said Camp, physician director of Transplant Administration and surgical and program director of Lung Transplant, who was part of three of the surgical teams himself, performing a heart transplant, a single lung transplant and a double-lung transplant that weekend.
In what they sometimes call a “zone” approach, several surgeons paired up to enable more transplants to happen in a shorter amount of time. Camp joined Greg Couper, MD, and a Cardiac Surgery team for the first heart transplant of the day. Then, Camp and Ciaran McNamee, MD, began a single lung transplant with another surgical team. While Couper finished the heart transplant, McNamee began the lung transplant and Camp moved between the two to assist during critical points in the operations.
In the meantime, Thoracic Surgery received a call that a set of donor lungs was available for ex vivo perfusion, a process that the BWH team has been trialing for a year as a way to increase the pool of suitable donor lungs. The reperfusion process rehabilitates lungs unsuitable for transplantation to the point where they can be transplanted.
Michael Jaklitsch, MD, director of the Clinical Laboratory for Thoracic Surgery, worked with perfusionist Trevor Smith to complete the last of the reperfusions required before the hospital can participate in an FDA-approved clinical trial to transplant the rehabilitated lungs into patients in need of a transplant.
“This process has the potential to double the pool of lung donors in New England,” said Camp. “It’s another big step forward for transplant surgery at the Brigham.”
As this process was underway, Couper went on to perform another heart transplant that evening with his team, while Stefan G. Tullius, MD, PhD, chief of Transplant Surgery and Surgical and program director for Kidney and Pancreas Transplantation, performed two kidney transplants. And of course, a 20-hour surgery was underway to give patient Charla Nash a new face and hands (see related story on cover).
“The commitment of the OR teams is incredible,” said Couper. “Regardless of the day or time, our teams are there to enable these transplant recipients to receive these life-saving gifts from the donors. For each recipient, this is an opportunity of a lifetime.”
Smith and fellow perfusionist Bill Riley worked to enable nearly all of the transplants that took place during this time. “I called their work extraordinary; however, all the members of the Perfusion team have been involved in efforts such as these over the years, making the extraordinary seem like just another day at the office,” said Chief Perfusionist Daniel FitzGerald, CCP, LP. “They have quietly gone about the business of bringing their special talents to bear in the care of our patients.”
To complete so many transplants in such a short timeframe requires careful preoperative planning among multidisciplinary teams. Each transplant, in addition to the long hours in the operating room, includes traveling to hospitals throughout New England to procure the donor organs.
“The operating suite personnel, which includes nurses, anesthesiologists OR assistants, surgeons and instrument technicians, did a remarkable job supporting the number of transplants that went on during a 24-hour period,” said Hugh Flanagan, MD, medical director of the PACU, whose role during that busy weekend was to successfully direct and coordinate the delicate and time-sensitive choreography of multiple teams and multiple transplant surgeries.
Pearl Cunningham, MBA, RN, CNOR, Operating Room nursing director, spoke to the contributions of the nursing staff. “Of everyone I called, not one person hesitated,” she said. “These nurses just said yes, ‘when do you want me to come, and how long do you need me.’ I can’t tell you how proud I was of this fantastic group of professionals.”
Sanjay Pathak, MBA, MPH, vice president of Surgical Services and Imaging, agreed. “Our entire surgical team demonstrated heroic efforts to handle these cases in 24 hours,” he said. “And they worked together to do it, sacrificing their time off to put our patients first.”