A new heart
Transplant patients face a difficult journey
Watching Mark Bell straddle his shiny black Harley, you would never know he received a new heart in February.
Bell, 53, first suffered two heart attacks in 2008. A truck driver who grew up in Hartford City, oldest of three boys and now with children of his own, it was shortly after his youngest son was diagnosed with brain cancer that Bell had his first heart attack.
His health began to spiral downward. He had a defibrillator implanted in his chest to jolt his heart back into a natural rhythm whenever it strayed. He lost his truck drivers license because of it and went on unemployment.
After he received the defibrillator it began to go off with increasing frequency, and at first he kept it secret. But on Thanksgiving 2012, his family noticed he was quiet and withdrawn. His mother, Joyce Bell, recalled when she asked him what was wrong he said he thought he was coming down with the flu. On the Sunday after Thanksgiving he called her and told her he was at Lutheran Hospital.
“Once they got him in there and started checking him out, all the stuff about his defibrillator going off came out,” Joyce Bell said.
Two weeks after his admittance and many tests later, he was told his heart would last two years. He was put on the heart transplant list. It was his last option. His daughter, Dianne Bell, said he had never talked about a transplant until he went to Lutheran. Once he was on a list they told him it could be anywhere from a day to six months before he would get a heart.
He didn’t have long to wait; the call came Feb. 15.
Lutheran Hospital has been performing heart transplants since 1985. Since that time they have performed more then 260 heart transplants. Patients are told it will add 10 years to their life, but some recipients live much longer. They have followed 115 transplant patients at Lutheran for more than 15 years. The longest-living recipient at Lutheran was 51 in 1989 and is still alive, 24 years later.
Doctors have a four-hour window from the time a heart leaves a donor to the time it must be restarted in the recipient. Miss the window, and the organ tissue begins to break down.
Bell would learn later his heart came from a 45-year-old man in Georgia.
In the early morning hours of February 16, Bell was prepped for surgery and given a chance to say goodbye to his family. Sitting up in the bed that would ferry him to surgery, Bell looked stunned but managed a thumbs-up to his family and girlfriend. They trailed after him as he negotiated the maze of hallways down to the operating room level; he gave a last wave as he passed through the double doors to the surgical unit hallway.
A whole team of people is involved to make a transplant possible. The group is comprised of doctors, surgical nurses and medical technicians. Part of the team travels to the donor to collect the organ. Once in Fort Wayne, the heart is passed on to the patient’s surgical team. While the heart is out of the body, a heart-lung machine keeps the patient alive and an infusionist keeps the right mix of blood and gases going to the body.
Two surgeons work together on the patient. Once the new heart is in the chest, it takes one to move things out of the way and another to reconnect the new organ. Dr. Joseph Ladowski, medical director of transplantation at Lutheran Hospital, was the lead surgeon on the case. Ladowski, a former runner turned tri-athlete, is a veteran of many transplants. He became known in the ’80s in Pittsburgh for his work on heart-lung transplants at the University Health Center of Pittsburgh.
He decided to become a heart transplant doctor in 1967 at age 12. He received his undergraduate degree at the University of Chicago, a medical degree from the university’s Pritzker School of Medicine in 1980, and his residencies were at the Hospitals of the University Health Center of Pittsburgh, where his training focused on heart and heart-lung transplantations.
“I didn’t tell anybody I wanted to be a heart transplant doctor until I got into medical school,” Ladowski said.
Since then he has done hundreds of heart transplants. Back in the ’60s, Ladowski said, there was a lot of enthusiasm about heart transplants. In 1969 there were 124 surgeries done, but by the end of that year only 20 percent of the recipients were alive. Although the surgical process was a success, the immunosuppressant drugs were killing the patients.
The drugs were too strong; a cold sore or common cold could kill a patient. In 1979 and 1980, Dr. Thomas E. Starzl at the University Health Center of Pittsburgh used a newly discovered immunosuppressant drug, cyclosporine. The new drug could selectively reduce a small part of the immune system. It created a surge in heart transplants. There are currently 146 sites for heart transplants in the United States; last year 2,200 were performed in the United States. Nine of these were at Lutheran.
To be approved for a heart transplant, a patient must be healthy enough to receive it. People whose bodies are failing in other areas are generally not put on the list. Liver failure or bad lungs or kidneys would all keep someone off the list. Patients who have had cancer and been cancer-free for a year are considered on a case-by-case basis.
For Bell the hour had come, and there was no turning back. Fully draped with only a small part of his chest exposed, he waited on the table for the organ to arrive.
As soon as the cooler bearing Bell’s new heart passed through the OR door at 3:37 a.m. the surgical team began cutting out the old heart to make room for the new. Meanwhile a doctor worked at gently warming up the new heart and trimming off excess fat, shaping the vascular vessels for easier reconnection. When the old heart was removed, it was easy to see it was enlarged; the muscle had little elasticity. The donor heart was much smaller with less fatty tissue surrounding it.
As the minutes flew off the clock, Bell’s team worked to give him his new heart.
When a heart is reattached, the surgeon starts at the back and moves forward, connecting first the left atrium, the right atrium, the inferior vena cava, the superior vena cava then the pulmonary artery followed by the aorta. As he works, the other surgeon moves things out of the way.
Just as the team was coming up on the four-hour deadline, the heart-lung machine was backed off and blood began to pump through the organ. The moment the blood flowed through the heart, it began to beat. The beat was unsteady and then stopped. The heart-lung machine was restarted as the doctors looked for the solution to the problem. Bell said he was later told anesthesia turned out to be the culprit. It took about four minutes to restart the heart and get a steady heart beat line on the monitor. After that it was a matter of making sure there were no leaks before closing Bell up and making sure he was stable before moving him to intensive care.
Although it sounds like the end of a successful transplant, it is just the beginning. Bell will be a patient for life. Once released from the hospital he would return weekly for heart biopsies for the first several months. The biopsies make sure the body is not rejecting the new organ. Five months out, Bell was able to go bimonthly.
He is on a strict medication regimen; he takes 19 different pills, a total of 35 a day. Some suppress his immune system; some keep his blood from clotting. Others he took before the transplant. Over time, as his body integrates his new heart, his immunosuppressant drugs may be dialed back, but they will never go away.
For the first few months after surgery, Bell bounced in and out of the hospital. First he had an infection in his incision, then a clot in one of his legs, and then his kidneys failed for several weeks. For his live-in girlfriend of three years, it was too much. Bell is now living back in Blackford County with his parents, Joyce and Fred Bell, until he can return to his work as a truck driver.
Despite the trips to the hospital and the breakup of his relationship, he remains optimistic about his future. He’s adjusting to a new normal and is grateful for the second chance at life. He can now watch his granddaughter, Braelyn Bell, 4, grow up. He is currently undergoing cardiac rehabilitation at Marion General Hospital to teach his body and new heart to work together. Bell is finally back on his motorcycle and planned to travel to the Harley rally in Sturgis, S.D., this fall.
“It’s the best I have felt on my motorcycle in two years. I don’t have to worry about the defibrillator going off,” Bell said.
Bell said a couple of weeks ago he was out riding his bike with some friends when they got caught in a storm. As he and his friends waited out the storm under an overpass, Bell found himself watching the rain with a whole new appreciation, because he can.
“It gives me a different outlook on life, knowing someone died to give me this gift,” Bell said.
First appeared in 2013 Fort Wayne Monthly’s Health.