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Making a Difference by Saying Yes


He was her husband of 42 years.  His letter was passionate and pleading.  His wife was slowly dying of end stage heart failure and needed a transplant. But there was an issue – they are Jehovah's Witnesses and she would not accept blood transfusions based on her religious beliefs.

While many operations, including surgeries on the heart, can be performed safely without the need for blood transfusions, a heart transplant can be a rather complicated procedure. Recipient patients are usually quite ill, often anemic and the risk of bleeding during and immediately after the surgery is significant. Most transplant centers, therefore, will not perform these surgeries on Jehovah's Witness patients who refuse transfusions – which had been the case for this man and his wife.

 She had been denied life saving therapy at several institutions, and her husband was reaching out on her behalf.  I called him the day I read his letter and his relief and gratitude were palpable. While I did not promise him we could accept her as a transplant candidate, I did offer to see her as a patient.  And it gave them hope.

But things would not be so easy.  She lived several states away and need to overcome issues with her insurance. No matter what, her husband continued to champion her cause and eventually they were granted permission to see us in consultation. They found a local host family and traveled to our hospital in the Bronx. 

Over the next few days the patient met with several members of our transplant team, including a heart failure cardiologist, a psychiatrist, a social worker, a transplant coordinator and me.  After meeting her, our team was faced with an unanticipated and crucial decision.

As there are far fewer organs available than patients in need, we are obliged to make responsible decisions regarding their use. We looked at our results and discovered that blood transfusions were rarely necessary in patients that had not had prior surgery on the heart, so we decided would consider those Jehovah's Witness patients.

That said, it turned that more than thirty years ago this patient had undergone heart surgery to close a small hole, which connected two of her heart chambers.  Had we known this, we would not have agreed to an evaluation. But now we had met her, we had offered her hope and she had traveled several hundred miles for a chance to live.

In the end we developed a plan that gave us confidence to list her for transplantation. She spent many months in our hospital waiting for her lifesaving gift. When at last it came, I was on call and accepted the heart. 

I knew the stakes were high for her and for us. We were performing a complex procedure without a safety net. The operation proved difficult, but her blood count at the end of the operation was near normal despite some initial blood loss. 

The patient recovered well from the surgery and is enjoying her health and her new heart. She and her family have expressed their gratitude to our entire team and for the family that gave her that most precious gift. 

I am especially proud of my team of dedicated practitioners who do not shy away from challenges and who work with the singular purpose of improving the lives of our patients. Especially for this couple, who after 42 years of marriage will now have more time to spend together.

David D'Alessandro is surgical director of Cardiac Transplantation, Department of Cardiovascular & Thoracic Surgery at Montefiore. He also is associate professor of Clinical Cardiovascular & Thoracic Surgery at Albert Einstein College of Medicine of Yeshiva University.

Posted by blogmoderator on 11/01/2013 at 8:50 AM Add Comment