In the 301 days that currently make up the year 2014, Baylor’s Deep Ellum flagship has performed 84 heart transplants. And four of those took place during a 24-hour period earlier this month, the most in the transplant unit’s history.
The doctors didn’t plan for such a quick succession and the demand creates a logistical puzzle for Dr. Shelley Hall and her team. First, is the manpower even in town? And then, have they slept?
“We have to orchestrate the procedures in such a way that we have surgeons available to do them,” says Hall, the hospital’s chief of transplant cardiology and mechanical support. “And their physical stamina; you don’t want a surgeon who has been up for two days straight.”
According to the Organ Procurement Transplantation Network, Baylor’s Annette C. and Harold C. Simmons Transplant Institute swaps more hearts than any other program in Texas. Nationally, it is second only to the Los Angeles-based—and internationally renowned—Cedars-Sinai. “It’s a pleasant-hearted competition,” Hall says, unable to resist.
A single transplant team is made up of a transplant cardiologist, a transplant nurse practitioner, at least two transplant surgeons, and an entire team of intensive care nurses and staffers. A Baylor transplant surgeon flies or drives to wherever the donor is and harvests the heart from the patient, who has been declared brain dead. The surgeon cuts the aorta and pulmonary artery in the mid-section to remove the heart and checks whether it is in good condition.
Then it’s time to return to Dallas and the recipient, who will have been bombarded with paperwork and education by a coordinator who is also charged with mobilizing the team.
“It’s a little bit of chaos,” Hall says. “Then there’s a calm while they wait to be taken to the operating room. And meanwhile, we head to the next one and do the same process over again.”
Ideally, the procedure from skin-to-skin—from when the patient is sliced open to when the cut is sutured shut—takes between four and 12 hours.
There are always potential obstacles with patients in need of a new heart. Have they had a chest surgery before? Then there’s likely tricky scar tissue to maneuver. Is there an implanted defibrillator? That’s got to go. All four of these surgeries went well, Hall said. One heart had to be mechanically supported until it could beat on its own, but the patient was fine within 24 hours.
The four who received new hearts on Oct. 9 were three men and one female between the ages of 39 and 66. They have all been discharged. Less than a week after the whirlwind day, Baylor Scott & White Health CEO Joel Allison got to chat with two of the transplant patients while making the rounds.
One man flew in from New Jersey to get his new heart. Allison signed a plush heart for him and advised him to visit the Fort Worth Stockyards before returning east. Another woman came from Amarillo, a city where Allison was once a CEO: “The Good Lord sent us to Amarillo so my son could meet his wife,” he said, getting a round of laughter from the woman and her husband.
Last year, Baylor performed 68 total heart transplants. This year, with two months remaining, it’s already up to 84. In Christmas 2012, Hall says the team transplanted five hearts in a weekend. But they’ve never done four in a day. In North Texas, only Baylor, UT Southwestern Medical Center, and Medical City Dallas have transplant programs.
“We have treated some of the most complex cases and have helped patients who have been turned away by other medical centers,” said Gonzalo Gonzalez-Stawinski, Baylor’s chief of heart transplant and mechanical support. “For these patients, Baylor Dallas has access to a number of services and options for on-site housing.”