Emory’s road to
1000 HEART TRANSPLANTS

THE BEGINNING

The first heart transplant procedure took place more than a half a century ago. On December 3, 1967, 53-year-old Louis Washkansky received the first successful human heart transplant in Cape Town, South Africa. Because little was then known about how to suppress the immune system to prevent rejection, the surgery was a huge gamble and Washkansky survived only 18 days. By the l970s, the rejection problem proved daunting—too many patients were dying—and heart transplants were mostly stopped.

In the early 1980s the drug cyclosporin, which lowers the odds of organ rejection and boosts survival rates, again made heart transplantation a potentially viable option for people with severe heart failure, sparking renewed interest and hope for the procedure in medical centers, including Emory University Hospital. 

Douglas Murphy was a young Emory cardiothoracic surgeon in 1984 when he found himself at a meeting of senior surgeons discussing the launching of a heart transplant program at Emory University Hospital. Called away briefly to answer a page, Murphy returned to find he’d been chosen to be Emory’s new and, at the time, only heart transplant surgeon.

Murphy made arrangements to visit and observe surgeons with whom he’d trained who were then performing heart transplants at Stanford University Hospital. “I went with them on the run to pick up a donor heart, watched the surgeons sew it in, and then came back to Emory and started organizing,” he recalls.

In 1985, a young man from South Carolina was in the hospital with severe heart failure. The newly launched Emory Heart Transplant team was notified of a donor heart in south Fulton County, Georgia. They rapidly retrieved the heart, and the transplant went well. And although the young man eventually suffered rejection of the heart, he received a second successful transplant at Emory. Other heart transplants followed, most with good outcomes. 

Murphy is now medical director of surgical robotics at Emory Saint Joseph’s Hospital, but occasionally he still hears from former heart transplant patients, including his third, Harry Wuest, who is one of the longest living heart transplant patients in the world (see sidebar).

TODAY'S HEART TRANPLANT TEAM

In recent years, the national one-year survival rate for heart transplant patients has climbed to 90 percent, according to Emory Clinical Chief of Cardiology Andrew Smith, a specialist in heart failure and transplantation cardiology. “At Emory, that survival rate is 94 percent. For each year after the first year, there is over a 96 percent chance of ongoing survival. So, the outcomes are very promising,” he says.

J. David Vega, current director of Emory University Hospital’s Heart Transplant Program, has performed more than half of Emory’s heart transplants. He credits collaboration for the remarkable success of Emory’s program. “We work as a team. Everyone’s input is valuable, and the patient and their family come first. We keep that focus,” he says. 

Emory’s heart transplant surgeons, who along with Murphy, Vega, and Daneshmand include Tamer Attia and Jeffery S. Miller, work with transplant cardiologists both before and after the procedure to optimize patient care. 

The team includes a host of other medical specialists, including transplant infectious disease specialists, arrhythmia experts, transplant coordinator nurses, nutritionists, physical therapists, imaging experts, and others, all working to bring collaborative and individualized care to patients before, during, and after their transplants.

COMBINED EXPERTISE

A patient’s diagnosis of heart failure does not mean someone is necessarily headed for a transplant, says Divya Gupta, medical director for Emory’s Advanced Heart Failure and Transplant program. Medication, diet, and lifestyle changes can often help prevent progression of the disease. 

“Approximately five percent of heart failure patients develop end-stage heart failure, and that can happen at any point within their disease trajectory,” says Gupta. “We don’t have a great way of predicting who is going to progress and how quickly they are going to progress. However, with adherence to current guideline-based recommended medications, there is a greater chance of feeling better and living longer with this disease.” 

When a heart failure patient at Emory is a potential transplant candidate, Gupta and her colleagues do an assessment to make sure the person is able to survive a transplant. They also ensure the patient has no other health problems that would likely worsen with the transplant. 

Heart failure patients waiting for transplants are supported with medication and, if needed, temporary mechanical devices to help their heart. Throughout the entire process, from evaluation through post-transplant follow-up, heart transplant coordinators—nurses with extensive specialized training in the field—are key. 

They manage the wait list for heart transplants, follow transplant patients in the period immediately following their surgery, and coordinate care after patient discharge and throughout the patients’ lives.

Virtually all patients who reach advanced cardiac failure will have arrhythmias, sometimes dangerous irregular heart rhythms. Doctors on the transplant team, like Anand Shah, an electrophysiologist, or heart rhythm specialist, treat these patients to help optimize their cardiac function and help keep them healthier as they await transplant.

“We coordinate our approach with other members of the transplant team to understand where the patient is on their heart journey and what therapies might be most appropriate and what therapies the patient can tolerate,” he says.

A LIFEGIVING MEASURE

Rachel Moore’s heart transplant took place in January 2009. “Never in a million years can I say enough thanks to the donor family for that precious gift,” she says. Her story also illustrates the complex, team-based process involved in transplant surgery. 

Moore was a 42-year-old cardiac nurse in Chicago in the mid-2000s  when she noticed simply walking a short distance made her short of breath. She was diagnosed with cardiomyopathy, and tests showed her heart was weakening. Her doctors implanted a defibrillator to protect her from a potentially deadly irregular heart rhythm and prescribed medication, gentle exercise, and a special diet, but nothing improved her condition. 

When a problem with a heart valve was discovered, doctors placed Moore on an LVAD to strengthen her heart for valve surgery to no avail. With her options diminishing, her doctor referred her to Emory and David Vega.

It wasn’t until January 2009, more than two years after being placed on the transplant list, that a donor heart became available. 

“The heart transplant changed my philosophy of life. I was given a second chance to live and that’s what I want to do—really live,” Moore says. “I tell people to not be so busy that you don’t look at the sky today, hug your family. When you wake up today, enjoy your life.”