Seven-year-old Kari Reynolds will have visitors today. Not just her mother, Pam, but two other women who will stop by her room and try to coax a smile or a wave from the frail little heart transplant patient.
The women, Cheryl Westlake, 28, and Jackie Wilmarth, 37, are UCLA's heart transplant coordinators, a relatively new breed of medical personnel.
Seeing patients like Kari, they will tell you, "is how we get our rewards."
The little girl, who at birth was given 24 hours to two weeks to live, had three heart operations before she received a donor heart at UCLA Medical Center on Nov. 18. Now she plans to be home to celebrate her eighth birthday on Dec. 18.
Coordinating Complex Steps
As heart transplant coordinators, Westlake and Wilmarth are responsible for coordinating the complex scientific and logistical steps that must be taken before a recipient, often hanging on to life by a thread, can be matched with an appropriate donor--who may be in another state.
They work against the exigencies of time, distance and the disappointment of finding that a match between potential donor and recipient is almost, but not quite, good enough. They wear beepers and are on call most of the time, even on weekends. They often work 20-hour days, on a precise schedule. A heart available for transplant can only last four hours without blood and oxygen.
The fact that their jobs even exist shows how commonplace heart transplants have become in the 20 years since Dr. Christiaan Barnard gave the world its first, implanting the heart of a 25-year-old accident victim into a 55-year-old man in Cape Town, South Africa, on Dec. 3, 1967. The patient lived only 18 days, but the then-experimental procedure revolutionized heart surgery for patients with end-stage heart disease.
Now, officials at most established heart transplant centers report a survival rate of 80% to 100% one year after transplantation; 65% of recipients will be alive at the five-year mark. The longest heart transplant survivor in the U.S. is a Stanford University School of Medicine heart recipient who has lived 18 years since his transplant and is leading a normal functional life at age 58.
'Pretty Routine Now'
"I think we've made some quantum leaps since that initial surgery 20 years ago," said Dr. Leonard Bailey, 44, the pioneering pediatric heart surgeon at Loma Linda University.
"It's pretty routine now," Bailey said of heart transplants. "And it is excellent therapy in the long term."
"There has been an acceptance in the last few years (of heart transplants) as a standard form of therapy by the medical profession and by third-party payers (insurance companies)," said Dr. John Baldwin, director of Stanford's heart-lung transplant program. "It's a proven form of therapy not being thought of as experimental anymore."
Yet, as the number of heart transplants increases each year--it is estimated that more than 1,000 will be performed in 1987, and the projected need is for 15,000 annually--the number of donors is not increasing by the necessary percentages. Stanford researchers predict a donor supply of about one-tenth of the yearly need.
Stress of Excess Need
For people such as Westlake and Wilmarth--who work daily with heart transplant recipients before and after their transplants--the gap between supply and demand is an ever-present source of stress.
"They will call you at home, just because they're getting so frustrated," Westlake said of prospective heart recipients. "You can imagine if your life is depending on a transplant and weeks and months keep going by. You get loony-toony. You get stressed."
Sometimes the two, both cardiopulmonary nurses with master's degrees, have to stay awake and functioning at the hospital for three straight days, if they have three back-to-back heart transplant surgeries as Westlake did in January.
Then Westlake was working alone, on call seven days a week. Wilmarth was hired two months ago, so each woman now gets some time off.
When Westlake and Wilmarth hear from an Organ Procurement Agency that a heart is going to be available, their schedule goes something like this:
They check numerous records--blood type, height, weight comparisons--of donor and possible recipient and call the surgeons. If the surgeons approve the match, the coordinators work with the donor's medical staff, and UCLA's. They schedule operating rooms, alert the nursing staff, the laboratory, the blood bank and psychiatrists who will assess the patient's mental state, and notify the proposed recipients to come to the hospital. UCLA's potential heart recipients who are well enough to remain at home before transplant surgery are equipped with beepers.
Several Transplant Teams