Oriented to Thoracic Transplant
Recipients -- August 1997
PATIENTS THRIVING WITH NEW OLD HEARTS
- By Popsy Sadock - Tribune-Review
- Like a dependable watch, the heart in Bill Galko's chest just
keeps on ticking. It's not his original heart; that one gave up on
him ages ago. His new heart came from a 43 year-old man who died of
an aneurysm. Had it not been for a new program that allows doctors
to use older, sometimes imperfect donor hearts for older, less
perfect candidates, neither the heart nor its current user might be
- The Export resident was among those accepted for the Expanded
Heart Program at the University of Pittsburgh Medical Center in
Oakland. Patterned after a program started several years ago in Los
Angeles, UPMC's program takes hearts from older donors that might be
rejected by other programs and transplants them into patients 65 and
older. The cutoff date for heart transplant recipients is generally
- The demand exceeds the supply in the search for new hearts for
any age group. "The extended donor program is a way to expand
the donor pool, which we need so badly," said Dr. Si Pham,
director of the UPMC program, which is less than a year old. "Five
patients have had the transplant (in Pittsburgh) and are doing
- "Traditionally, donors of 45 (and older) who have a
mediocre medical history, transplant programs turn them down,"
Pham explained. "These hearts may reasonably have a good
function. The only reason they are turned down is because not all
hospitals in small cities have the capabilities of sophisticated
testing. Older hearts may have certain risks."
- If there is a problem with a heart, such as angioplasty, the
cardiac surgeons try to correct it. Hence, these donor hearts are
sometimes called "retreads" by the patients. "The
hearts for transplant, if it had a flaw, they used to throw it
away," said Galko. "They give you a catheterization after
the transplant now and if there's a problem, they fix it."
- Although the hearts still function well, they would be rejected
for a younger person with a longer life expectancy, Pham said. "It's
a difficult decision, from a philosophical point of view. Ethics
enter into it," he said. "At least the donor pool is
expanding. We want the public to be aware of the program. We do
improve quality of life."
- Galko, 67, was put on the "alternate donor list" at
UPMC Oct. 17, and received a new heart Feb. 27. His problems started
in October 1987, when he had a slight heart attack. After a massive
heart attack the next New Year's Day, he had open heart surgery at
West Penn Hospital in Bloomfield in March 1988.
- Galko began to cut back on his active lifestyle, retiring and
selling the roof truss business he owned in Murrysville. Then he
began to have problems with angina and was in the hospital nine
times from July to October 1996. "More surgery wasn't an
option: my heart was too weak," he said. "Dr. Bartley
Griffith (UPMC's chief of transplant surgery) told me the only
alternative was a heart transplant."
- But Galko was 67. "I had heard about an expanded donor pool
program for older patients that began in Los Angeles, and were also
done in Cleveland, Chicago and Pittsburgh with good results,"
Galko said. He was judged to be a good candidate for the program, he
said, because he worked out regularly and was in good physical
- The alternate donor list for designated recipients older than 65
allows for evaluation and potential use of donor hearts deemed
unsuitable for younger patients. All Status 1 (most medically
urgent) patients of any age have access to the alternate list as
well; the older recipients are maintained as Status 2 (medically
urgent) to avoid usurping potential donors from younger patients.
- The 65-and-over group must undergo even greater scrutiny by a
transplant evaluation team and have no major noncardiac related
- Disqualification factors include organ damage from diabetes,
liver dysfunction or a history of smoking.
- While waiting for his new heart. Galko continued to work out,
trying to maintain what physical strength he had left. "Everything
was well except my heart," he said.
- Galko said the six-month wait for a heart was "scary and
tedious." "You anticipated every phone call," he
said. "Finally ... the call came that they had a heart. The
first feeling was like a lightning jolt that it was finally here."
- The first heart, though, wasn't the right blood type, so Galko
began the wait for a second heart. The call came at 11 p.m. Jan. 11,
and he was at Presbyterian University Hospital in Oakland, a UPMC
facility, in an hour. "I was all ready, tubes, catheter and on
a gurney ready to go into the operating room ... again, the heart
was no good and they sent me back home. I was disheartened, to say
- But on Feb. 27, a third, healthy heart was found, donated by the
family of a 43 year-old man who died from an aneurysm. "The
heart fit perfectly, like a glove on a hand," Galko said.
- He was home within a week, and was mowing the lawn three weeks
later. He still works out three times a week, and his only physical
restriction is no heavy lifting.
- Aside from an irregular heartbeat, which was treated
successfully, and diabetes caused by anti-rejection medication, for
which he takes insulin, he has had no problems. "My wife,
Doris, she had to learn how to cook for me. She watches me like a
hawk. I lost 25 pounds, gained 15 back. Now I have a good appetite,
like always," he said.
- Donald Miller, 66, of Stanton Heights, described the process
leading up to his "retread" heart transplant as "an
emotional roller coaster."
- "It's a real gift to have someone give you your life back,"
he said. Three months after receiving his heart, Miller was turkey
hunting. As a police detective for the city of Pittsburgh for 38
years, Miller, who is 6 feet tall and 210 pounds, thought he was in
good physical shape - until he had a heart attack in '91. His health
subsequently deteriorated and he was in and out of Shadyside
Hospital often. "I went to my barber one day and he said I
didn't look too good. I was panting," he said. "That night
I was back in Shadyside again in bad condition. There wasn't much
heart function left. I couldn't catch my breath."
- Miller recalls being evaluated by Griffith. "He said my
options were zero -there was no choice. He gave me the pros and cons
of the Expanded Heart Program, said they might use an older heart
and I was an older recipient," he said. "Some people told
me they wouldn't do it ... they wouldn't go for a transplant. I
wasn't like that. I was glad I had a chance to live. I could have
been looking' at the grass from the bottom up by now."
- Miller was put on Status I and waited for six months in
Shadyside Hospital for a heart. Some people don't survive the wait.
On Dec. 9, in Presbyterian Hospital, Miller received the heart of a
50-year-old man killed in an automobile accident in West Virginia.
"It fit perfectly. No pain afterward. Sedated to the max,"
he said. "After 14 days, I came home for Christmas with a new
heart on my 66th birthday. Talk about being born again."
- One setback: Miller contracted cytomegalovirus, a viral heart
infection he terms "bad stuff." On intravenous medication
for 21 days, he temporarily lost his appetite and his weight dropped
by 80 pounds. "But the doctors handle everything with ease,"
he said. "It's like,' Oh, you have a little problem, eh? We'll
sew the buttons back on. Don't worry.'"
- Miller said he has no physical restrictions. And he's gotten
lots of support from his wife, Audrey, plus his three children and
five grandchildren, whose classmates in Catholic school prayed for
him twice a day. "Their prayers were answered," Miller
said. "And I was glad about that.
- "Every day's a gift. I feel I'm age 50 on one side and 66
on the other. Some days I have a twinge or two, but so what'? It
goes away. Life is good."
- Joe Myers, 63, of Des Moines, Iowa, waited for his heart at
Presbyterian Hospital from November to June. His wife, Sandy, stayed
at the Holiday Inn University Center in Oakland the entire time,
learning what it would take to get her husband back in shape. "We
made it," she said uncomplainingly. "and that's what
counts." He added with a smile, "But I'm about hospitaled
- Myers had a heart valve replaced by world-renowned heart surgeon
Dr. Michael E. DeBakey in Houston, Texas, Nov. 11. 1973. Twenty-four
years later, he suffered from congestive heart failure and
cardiomyopathy, an infection of the heart's lining, plus an aortic
aneurysm. His cardiologist in Des Moines told him a new heart was
his only chance to live. Myers was older than most patients
considered for a transplant, but not yet 65. If he waited for a
younger heart. he probably wouldn't make it.
- He learned about the Expanded Heart Program, which could mean a
shorter wait. and opted to come to Pittsburgh in November. Six
months later, in April, his aneurysm was removed and he received the
heart of a 47-year-old man who died in a car accident.
- He, too, recovered from cytomega1ovirus. He was released from
the hospital April 27, and returned to Des Moines June 17. "I'm
tired, but I'm game to get into therapy," he said. "I
never worked out at a gym before, but I'll do whatever it takes. Can
you believe what they can do to give you a new life?" Myers is
enjoying his back porch in Des Moines, visiting with friends and
family. In a phone conversation earlier this month, Sandy Myers
said, "Joe's out for a walk. That's something he couldn't do
three weeks ago. It's a new life."
NOW HERE'S WHAT TRANSPLANTATION IS ALL ABOUT!
- A month or so ago, UpBeat asked for suggestions on how to
celebrate the 10th anniversary of one's successful transplantation.
There weren't many replies, but here's the one that tells it like it
really is, and no party is required!
- Next year I will celebrate my 10th Anniversary of my heart/lung
transplant by receiving my Masters of Fine Arts degree in Performing
- I have accomplished many things in my life after my operation
and found that I can do anything that I want to. I have survived so
long because I have a positive attitude, wonderful friends and
family, take my medication properly and have a lot of fun with
everything I do. Yes, there have been numerous times being in the
hospital with rejection or having my lung collapse, but those
incidents have not stopped me from pursuing my goals.
- I am now 25 years old, my heart and lungs are 9, and we are
extremely happy together. I cannot wait until that MFA is in my
hands and to prove to myself that once again - Nothing is
- Allison McCartney Sparta, NJ
- My anniversary is March 30, 1998.
HELP OF ALL TRANSPLANT RECIPIENTS REQUESTED
- American Organ Transplant Association's Executive Director,
Ellen Gordon Woodall, and her Executive Assistant, Barbara
Haughton, spent several days on Capitol Hill, in Washington,
D.C.,, to discuss H.R. 1061, a bill being presented in the House of
Representatives. This bill extends Medicare coverage of lifesaving
immunosuppressant medications for the life of the organ transplant
recipient, from the current three-year limit. These medications must
be taken to control rejection of the implanted organ. Without these
extremely expensive medications, transplant recipients will most
likely die, or in the case of kidney transplants, will lose the new
kidney and be put back on expensive dialysis. The benefit of this
legislation are much more than life-saving. If this bill is passed,
it will be of great savings to Medicare.
- Several congressmen personally told Ellen and Barbara that H.R.
1061 can pass if constituents and their families and
friends from around the county would write or fax their
congressional offices. It was made quite clear that a letter writing
campaign would be successful for the passage of this bill.
- For more information regarding H.R. 1061 or other organ
transplant issues, please contact American Organ Transplant
Association, 3335 Cartwright Road, Missouri City, TX 77459. Phone:
(281} 261-2982. Fax: (281 } 499-2315.
LETTER TO THE EXECUTIVE DIRECTOR - AOTA Items, June 1997
- Dear Ms. Woodall:
- Knowing of your interest in organ transplant issues, I am
pleased to inform you that I have agreed to co-sponsor legislation
to expand Medicare coverage for post transplant immunosuppressive
- This legislation (H.R. 1061) will help ensure that thousands of
Medicare patients who have transplants have access to the drugs that
help their immune systems accept their new organs. Under current
law, Medicare provides coverage for three years following the
transplant. However, transplant patients often must take these drugs
for the rest of their lives. By repealing the time limit on Medicare
coverage for immunosupressive drugs, H.R. 1061 will make an
important contribution towards the successful recovery of Medicare
patients who undergo transplants.
- I hope this information is useful to you. If I may be of further
assistance on this or any other matter, please do not hesitate to
- With kindest personal regards. '
- Kenneth E. Bentsen Jr., Member of Congress
- Executive Director's Note:
- Everyone reading this should obligate themselves to contact
their own congressmen and insist they vote favorably for this bill
H.R. 1061. It's a matter of our lives and deaths. Ask them also to
include coverage for immunosuppressant medication for recipients who
are on Medicare, but whose transplant was not covered by Medicare at
- Seems to me it wasn't long ago that Novartis ne. Sandoz was
proclaiming that there was no way Sandimmune would be removed from
the market. Well, not quite, from the tone of the following letter,
it will be removed when Novartis ceases to reap the dollars it
desires from the product. The letter is addressed to Ellen Woodall,
Executive Director of American Organ Transplant Association of
Missouri City, Texas.
- Dear Ms. Woodall:
- Regarding a statement for your newsletter about the market
availability of Sandimmune, I provide the following information for
you to include:
- Sandoz wishes to reassure the transplant community that it has
no plans at the present time to withdraw Sandimmune from the
marketplace. Should a decision be made to withdraw Sandimmune it
would be done through close collaboration with the transplant
community. Only the use of Neoral and Sandimmune, as well as
- demand will determine, if, how, when, and under what
circumstances Sandimmune should be withdrawn. Although we strongly
believe Neoral is a better product than Sandimmune, Sandoz
recognizes its responsibilities to the patients and physicians who
depend on its products and will not make a decision to withdraw
Sandimmune unless the market dictates. Sincerely,
- Joanne Machalaba,
- Director Sandoz transplant, a division of Novartis
- Golly gosh, after all the nice words, "collaboration,
responsibilities, reassure" it comes down to "the market
dictates." Really there's no argument with such a policy, but
just tell it like it really is! Our policy places prices and total
dollars before patients every time!
- Just not quite sure what happened, but TRIO has quickly moved
their annual conference from Chicago to Washington, DC. at the
Hilton. Seems to me it' s been there a couple
- of times previous. I know of one chapter that was actively
involved in chartering a bus to Chicago, and darned if yours truly
hadn't completely planned out his train trip. As of August 1, no
program of events has been posted.
- Speaking of TRIO, wouldn't it be apropos if at their annual
conferences they held organ specific "10 years and Up Club"
lunches, or whatever. And what about the potential of organ specific
pins announcing the fact that the wearer has had a successful organ
transplant for more than 10 years? Might just help both the wearer's
morale and organ donation.
HEART TRANSPLANT OBSTACLES OVERCOME IN JAPAN
- By Yuri Kageyama - AP Writer
- TOKYO (AP 6/14/97) -- Performing his country's first heart
transplant made him an instant hero. Then it made him a murder
- Nearly 30 years later, Dr. Juro Wada still is cited by Japanese
looking for examples of why doctors -- and the establishment in
general -- should not be trusted.
- His first heart transplant also was Japan's last. And it comes
up often in the public debate over whether to rewrite a strict
definition of death that results in Japan being the only industrial
nation where doctors are unable to obtain viable hearts, livers and
lungs for transplant.
- When he carried out his Aug. 8, 1968, operation, Wada drew
headlines and adulatory comparisons to TV's heroic Dr. Ben Casey.
But reactions quickly soured when the patient died 83 days later. A
group of herbal doctors demanded a criminal investigation.
- While Wada was never charged, the prosecutors' investigation
discovered he had kept no records of the heart donor's brain waves,
which would have proved the patient was clinically dead when the
organ was removed.
- A witness said the donor was still breathing on his own at the
time the heart was removed. Another doctor said the 18 year-old
recipient hadn't really needed a transplant.
- After the operation, a section appeared to be missing from the
recipient's old heart, and one valve was suspected of being from a
totally different heart. That raised suspicions Wada might have
tampered with the heart to exaggerate the recipient's ailment.
- Wada, now 75, still works as a doctor and denies he did anything
wrong. He rarely speaks to the press, but in an interview with The
Associated Press he said his only regret was that no other doctor
followed his example.
- "He was a lovely young man," Wada said of the heart
recipient. "He was so happy. The outcome was short, but he had
a rich, wonderful life."
- Under current Japanese law, death is defined as the moment at
which the heart stops beating. At that point, kidneys and corneas
are still usable in transplants, but the heart, lungs and liver
deteriorate too much.
- By contrast, the United States and other countries where
transplants are routine define death as the absence of brain
activity, which often occurs before the heart stops beating.
Machines can keep a body's blood pumping after brain death, thus
keeping organs in good condition for transplant.
- Legislation to recognize brain death and open the way for
transplants failed last year in the Diet, Japan's parliament. This
April, the lower house passed a bill that would allow the brain
death standard to be used for transplant donors -- provided donors
had left written consent for their organs to be used in transplants.
But the bill stalled in the upper house.
- Now, legislative leaders have worked out a version that would
allow family members to overrule a doctor's diagnosis of brain
death. The upper house is scheduled to vote on the bill Monday, and
if it passes, the lower house would be expected to adopt it before
the legislative session ends Wednesday.
- But changing the law might not change the transplant situation.
Opinion polls say Japan is deeply divided on transplants.
- Japanese cultural beliefs about death is one obstacle. Some
people think cutting open a corpse or taking away organs hurts a
person after death.
- But the most pervasive obstacle is a deep-rooted suspicion of
the medical establishment.
- Traditionally powerless before politicians, bureaucrats, bosses
at work and other authority figures, Japanese are nervous about
being kept in the dark about dangerous decisions, even if most feel
they don't have the right to question their doctors. That fear is
especially pronounced when the decisions involve death.
- "I think transplants are sometimes a way for surgeons to
show off," said a housewife, Eiko Mizuno.
- The medical establishment' s reputation was further damaged
recently by a scandal involving government health officials and
doctors who knowingly used blood products tainted with the AIDS
virus, causing the deaths of some 400 hemophiliacs. A prominent
doctor, is being tried on criminal negligence charges in that case.
- In a recent editorial, the national newspaper Asahi said organ
transplants will never be accepted in Japan unless hospitals start
practicing "medicine that patients can trust."
- Doctors and patients must be on an equal footing, and the
informed consent of patients as well as a more open, fair system of
treatment must be guaranteed, it said.
- Such concepts are alien to many in Japan.
- Many doctors refuse to even tell patients when they have cancer
or other serious illnesses. Malpractice lawsuits are rare.
- Surgeons routinely accept cash gifts from patients, in addition
to regular billing. and are believed to award better treatment to
those who give the bigger gifts.
- "In Japan, doctors are still viewed as way above their
patients," said Katsunori Honda, a Tokyo University Hospital
ORGAN BILL PASSES JAPAN PARLIAMENT
- By Yuri Kageyama - AP Writer
- Tokyo (AP 6/17/97) -- After years of emotional debate on whether
doctors can be entrusted with defining death, Japan's parliament
passed a law today to allow heart and other organ transplants in a
country where they are virtually banned.
- The law, which will take effect in three months, will pave the
way for the nation's first heart transplant in nearly 30 years.
Japan's only heart transplant, in 1968, resulted in two criminal
investigations against the chief surgeon and left the nation one of
the few without such operations.
- "This is a big step forward for transplants," Health
Minister Junichiro Koizumi said in an interview after the voting.
- Many remain wary of letting doctors define the moment of death
-- which is required when key organs are donated -and that stalled
the bill, proposed three years ago.
- Cultural beliefs against cutting open corpses, for fear that may
hurt the person after death, also have discouraged transplants.
- Up to now, hundreds of patients needing heart, lung and other
organ transplants have had no choice but to go abroad for the
lifesaving operations. Only a handful of patients have been able to
afford the trip.
- I've been struggling for so many years to get this bill passed,
I feel so relieved now." Hiroshi Takamori, a 34-year-old
patient awaiting a heart-lung transplant, said in a telephone
interview from the central city or' Nagoya.
- The main sticking point in the dispute has been Japan's strict
definition of death.
- Under Japanese law, death comes at the moment when the heart
stops beating. At that point, corneas and kidneys can still be used
for transplants, but the heart, lung, liver and other organs
deteriorate so much they can't be used.
- The United States and other nations where organ transplants are
routine recognize brain death, in which the brain ceases activity
but the heart and other organs can be kept working with machines.
- Transplants are not illegal in Japan but those from brain-dead
donors are almost never performed.
- "Japanese thinking has finally come closer to international
standards," said Taro Nakayama, a doctor and lawmaker who
proposed the initial bill.
- Given the deeply divided public opinion on transplants,
Nakayama's bill, which recognized brain death across the board, had
to undergo major revisions to win today's 181-62 approval in the
upper house and the 323-144 lower house vote.
- Under the revised law, brain death will be recognized only for
transplants. That means brain-dead people who don' t agree to
transplants would still be considered alive and continue to receive
- The law also specifies that transplants be allowed only from
donors who have left written consent. Family members will also be
able to overrule a doctor's diagnosis of brain death.
- Outside the parliament building, about 25 demonstrators, some in
wheelchairs, chanted protests against the law.
- "We are afraid the law will lead to some people's lives
being valued over others," said Norio Koga, a 37-year-old blind
acupuncturist and protester.
- Surgeons across Japan have been setting up organ networks,
readying medical facilities for transplants and passing out
- The nationwide medical association of surgeons has said a
transplant from a braindead donor will be carried out before the
year is over.
- "The law is the first step toward the birth of a new kind
of medicine that requires the participation of the entire society,
not just doctors and patients," said Kikuo Nomoto, a doctor and
transplant advocate. "It' s epoch-making for Japanese
GERMAN PARLIAMENT EASES RULES ON ORGAN TRANSPLANTS
- Bonn, (Reuters 6/25/97) - Germany's parliament passed a bill on
Wednesday that aims to resolve a shortage of organs available for
transplant operations by relaxing rules on when physicians may
remove body organs from clinically dead patients.
- By a vote of 449 to 151, the parliament passed the controversial
measure that permits relatives of clinically dead people to sign
over the body organs even if the patients had not previously agreed
in writing to the donations.
- The measure passed after a five-hour debate in the Bundestag and
a two-year-long discussion that caused divisions in all the
political parties in parliament. There was cross-party voting both
in favor and against the bill.
- Strongly backed by health minister Horst Seehofer, who has
complained of a shortage of donors, the measure was supported by the
parliament leader of Chancellor Helmut Kohl's Christian Democrats,
Wolfgang Schaeuble, as well as the opposition Social Democrats'
parliamentary leader, Rudolf Scharping.
- Opponents of the measure urged that the present system be
maintained whereby organs could only be harvested from people who
had specifically stated their willingness in advance.
HEART TRANSPLANTED INTO II-YEAR-OLD IN INDIA
- Madras, India (Reuters 6/16/97) - An 11 year-old boy has
undergone a successful heart transplant, becoming India's youngest
recipient of a donor heart, hospital officials said Monday.
- The Madras Medical Mission said the surgery late Sunday was also
significant because the donor' s heart was removed from an accident
victim at a distant hospital.
- The heart was removed from the accident victim at Apollo
Hospitals in Madras, placed in ice and taken 7.5 miles to the Madras
Medical Mission's Institute of Cardio Vascular Diseases.
- "The donor heart thus was deprived of blood circulation for
nearly three hours and 10 minutes," the mission said in a
statement, adding that the patient was recovering with no
- It was the fifth heart transplant at the institute, and all
previous recipients were leading normal lives, the statement said.
BREAKTHROUGH IN CHILD HEART SURGERY
- London, (Reuters 7/25/97) - A cardiac surgeon has pioneered a
revolutionary procedure for child heart surgery, the Scottishbased
HCI International Medical Center reported on Friday.
- Dr. Tony Corno, director of the Center's pediatric cardiac
program, has discovered children can endure heart surgery without
having their body temperature lowered. Traditionally, heart surgery
on the young involves chilling sick and fragile children before
operating, a technique known as hypothermia surgery. The problem is
that a quarter of children undergoing such surgery suffer serious
- Corno's method, which he calls normothermia, had astonished
doctors around the world, HCI, which is located near Glasgow, said.
He has performed the technique, operating on children without
lowering their body temperatures or slowing metabolism and blood
flow, in 60 cases since last year.
- "The benefits of the normothermic technique speak for
themselves," Corno said. "Although it means we have to
work much faster, we are able to avoid the complications which can
arise from deliberately chilling and re-heating the child."
- Corno, 47, said most of his patients leave the HCI intensive
care unit after 24 hours and return home after five to seven days.
Under traditional methods, 11 days is more normal.
- In addition, fewer children require inotropic drugs to maintain
the heart's ability to pump blood after surgery, while complications
such as respiratory disorders and blood, liver and kidney
difficulties are significantly reduced. All that adds up to a
significant reduction in hospitalization costs.
FDA ADVISERS REJECT LASER ANGINA THERAPY
- The Washington Post
- AP (7/29/97) Government advisers yesterday rejected a
revolutionary approach to treating heart angina: a laser treatment
that promised to relieve chronic patients' crippling pain by zapping
up to 40 tiny holes into the heart.
- Some patients clearly showed relief from pain, advisers to the
Food and Drug Administration said. But the company seeking approval
for the treatment, PLC Medical Systems, had serious deficiencies in
its study of the laser, which could even pose a risk to already-sick
patients, the scientists said.
- "I have a close relative who needs this procedure. There's
nothing I'd rather do than approve it," said Robert Califf of
Duke University. But be called the data supporting the laser
inadequate and troubling, and on a 9 to 2 vote, most of his fellow
panel members agreed. At issue was a controversial but long-awaited
procedure called transmyocardial revascularization (TMR). By
blasting one millimeter holes into the left side of the heart, the
procedure theoretically increases blood flow to portions of the
muscle that have been severely damaged by advanced heart disease.
- In the two-hour operation, doctors slice a four-inch cut between
the ribs to insert the laser, and then blast directly into the
heart. The outer layers of the heart heal almost immediately but the
beating heart forces the laser-made channels to stay open in the
interior. The theory is these channels diffuse oxygenated blood into
the oxygen-starved tissue and relieve the crippling chest pain known
- About 150,000 Americans have endstage coronary artery disease,
which is almost always accompanied by angina.
- The laser is intended for those who are not helped by standard
medication, including nitroglycerin and other drugs, and who have
already exhausted all surgical options such as bypass. Many patients
with milder angina receive relief from medicines.
- A study of 198 patients found those who received TMR had fewer
angina attacks than control patients who took standard medication.
For patients followed at least six months after the operation, 65
percent of the TMR recipients had significant angina improvement
while drugs helped just 10 percent of the control patients.
- Then doctors measured blood flow through the heart. Among TMR
patients, 60 percent of those whose angina improved significantly
also showed a significant increase in blood diffusion.
- But complicating that measurement are suggestions that the holes
in the heart do reclose several months after surgery. Several animal
studies and a handful of human autopsies have shown holes almost
completely reclosed, prompting critics to question if the therapy
had done any good or if the mere thought of a helpful surgery had
made patients feel better, a phenomenon called the placebo effect.
- The FDA is not bound by advisory committee decisions but often
follows them. Ed Note: Until something better might become
available, this procedure appeared, on the surface at least, to be a
viable "last ditch" opportunity for transplant recipients
suffering from TCAD.
THE ULTIMATE CHARITY
- By DR. TED LISTOKIN
- New York University School of Medicine For AP Special Features
- Today, eight Americans will die because they did not receive an
- Potentially, there are plenty of organs available. The problem
is that the majority of Americans do not tell family members that
they would like to donate organs if they die suddenly. Since an
organ donor card is not legally binding, the family must give
physicians permission to procure organs.
- For example, a young man we'll call John was killed in a tragic
car accident. Because he had told his wife and parents that he
wanted to donate organs, his family gave permission to harvest them.
John's final act was that of saving the lives of several people. A
teen-age boy with a rare heart disease received John's heart and the
gift of life. A man who had been born blind saw his children for the
first time with John's corneas. A young woman with diabetes was able
to come off dialysis because of the transplant of one of John's
kidneys. A little girl who was crippled in a car accident was able
to walk again after one of John's tendons was transplanted into her
- John was only able to help these people because he had made it
clear to his family that he wished to donate organs. His organs were
harvested only after John was declared legally braindead, despite
valiant efforts to save him. Donating organs did not disfigure
John's body, nor did it cost any money to his family Although losing
John was heart-wrenching, his family was comforted to know they were
carrying out his last wish by donating his organs.
- If you want to donate your organs, two things must be done.
First, fill out an organ donor card and carry it in your wallet.
Although it is not a legally binding document, it helps. You can get
a card by calling the New York Organ Donor Network at (800)
443-8469. On the card, you may check off a box to give any needed
organs or tissues, or you may choose to give only certain organs or
- The second and most important step is telling your family about
your decision. Talking about the issue now could make it easier for
them to carry out your wish during a painful time.
- Right now, 45,000 Americans need transplants, but only 4,500
people donate organs every year. Some policy-makers have proposed a
"mandated choice" program in which a person would indicate
whether or not they wanted to donate organs after his or her death.
- Potential donors would record their choice on a form such as a
driver s license or federal tax return. 'this would take the stud
difficulty of decision making out of the family's hands. However,
there is no such mandate yet
- For now, telling your family about your decision to donate or
not to donate is the best way to ensure that your wishes are
- Disclaimer: The material in this document has
been collected by Don Marshall and friends. If any of the views and
opinions expressed here are taken the wrong way, we can be nothing m
ore than sorry. New ideas and materials are welcome all the time.
As a policy, UpBeat is sent upon request to heart and heart/lung
transplant recipients and other interested parties. Donations of $15
per year, or more, from Tx recipients, if not a burden, are vital.
From all others t he donation is specifically requested. The date
shown after the name on the address label indicates the last time a
donation was received. Please make checks payable to Don
Marshall, as we cannot afford to become nonprofit. Send
materials, letters, or checks to:
Mathews, VA 23109-0482