Patients from across the Northeast come to Rochester for heart transplant, the only comprehensive center in Upstate New York
By Donna Jackel
On Dec. 3, 1967, the world watched in wonder as physician Christiaan Barnard performed the first human-to-human heart transplant at the University of Capetown in South Africa. His patient, Louis Washkansky, lived 18 days post surgery.
In 2022, 4,169 heart transplants were performed in the United States, according to the United Network for Organ Sharing.
The University of Rochester Medical Center has the only comprehensive heart failure and transplant care department in Upstate New York. Since the program began in 2001, surgeons have performed 315 heart transplants.
Last year, it completed a record 22 heart transplants.
Most of the patients are from Rochester, Buffalo, Syracuse and the Adirondacks. But people have also come from northern Pennsylvania, Albany and Burlington, Vermont. Heart recipients have included grandparents, teachers, firefighters and students.
The considerably sized heart transplant team includes surgeons, cardiologists, infectious disease specialists, nurses, pharmacists, mental health professionals, social workers and dietitians.
“It’s a really integrative approach with a lot of people involved,” said physician Leway Chen, director of the heart failure and transplantation unit, who has been there since its inception.
Heart failure is the most common condition requiring a heart transplant, said Chen. There is also ventricular fibrillation, a life-threatening heart rhythm that results in a rapid, inadequate heartbeat. Some patients have heart muscle problems, he added.
Who qualifies for a heart transplant?
“Doctors regularly attend meetings where they present patients and discuss who should be put on the waiting list,” said Chen.
Each patient is evaluated as to whether she or he is a good candidate for a heart transplant. Then, the patient undergoes a series of tests to determine whether their body will accept an organ.
Sometimes a patient with a high body mass index is able to lose enough weight to qualify for the wait list, according to Katherine Wood, one of the three transplant surgeons on the team. “This can be difficult as heart failure patients tend to be tired, retain water and find it very hard to move and be active.”
Other decisions may be driven by patient preference. For example, one potential recipient didn’t want to give up cigarettes.
“We want to meet patients where they are,” said Wood. “Not everyone is able to have a transplant.”
When a donor heart becomes available, the transplant surgeons must move fast. “It’s a very coordinated surgery,” said Wood. While one surgeon jumps on a plane to procure the donor heart, another is preparing the recipient for surgery. It takes between six to 12 hours to perform a transplant.
“You don’t take out the bad heart until you know the good heart has landed; then you quickly proceed with the operation,” said Wood.
In the U.S., only 5.3% of heart transplant surgeons are women.
Immediately after the operation, the surgeons care for the patient. Then, Chen or one of the other acute care cardiologists resumes the patient’s care.
“It’s very intense at the beginning — so much happens the first six month post-transplant — checking for infections, rejections,” said Chen. “After the first year to two years, we wean down medicines and the patients come back twice a year.”
Interpreting the survival data is complex because patients’ overall health varies greatly, said Leslie White, a URMC spokesperson. Overall, the one-year survival rate nationally is 85%; 50% of patients survive 10 years and 15% live 20 years after transplantation. Strong Memorial Hospital’s one-year survival rate is 95.5%, said White.
Since there are thousands of patients with heart failure, Chen uses diet, exercise, medication and physical therapy to manage their conditions. One option is a ventricular assist device, a mechanical heart pump, used to treat heart failure. Originally used to keep patients alive while they awaited a new heart, VADs are now also used long-term for those ineligible for transplant, or who choose not to wait for one.
Strong Memorial has thus far implanted more than 900 pumps.
URMC also offers a telemedicine program called TeleVAD, which provides follow-up care for patients who live far from Rochester. A cardiac critical care transport team, composed of cardiac critical care nurses, respiratory therapists, perfusionists and physicians, rushes patients in outlying areas to the medical center.
No matter how state-of-the-art a heart transplant facility is, the team and patients still rely on human donors. “There is a tremendous amount of research going on, but we haven’t reached a point where we’ve been able to create an alternative to another human heart,” said Wood.
She encourages everyone to register as an organ donor.
“It’s an opportunity to give someone a second chance at life and it’s a way for the person who gave their heart to live on,” she said.
In the U.S., there are more than 104,000 people waiting for a heart transplant, including about 8,100 in New York state.
According to the Finger Lakes Donor Recovery Network, the organ procurement organization affiliated with URMC, about 45% of eligible New York state residents are registered organ donors. In the Finger Lakes region, 61% enrolled in the registry, slightly below the national rate of 65%. That leaves many very sick patients waiting longer for a heart.
Anyone aged 16 and older can enroll in the New York State Donate Life Registry by:
• Enrolling online at www.passlifeon.org/;
• At the Department of Motor Vehicles;
• When applying for health care benefits through the New York Health Exchange;
• When registering to vote.