Thoracic Transplant Recipients -- November 1997
ORGAN TRANSPLANTS AND
by Scott Huelskamp
- On board, packed in dry ice, safely contained in an insulated
container, and watched over closely by a helicopter crew flying
almost I, 000 feet above the ground, is a vital piece of cargo. For
one of the nearly 53,000 people in the United States who need an
organ transplant, this could be their time to cheat death. It is
another step in the intricate, complicated procedure of transferring
an organ from one body to another- a process that must be planned
and orchestrated right down to every last-minute detail.
- Transplantation is one of the most complex medical endeavors,
yet it has become a common lifesaving solution for patients
experiencing end-stage organ failure. If a heart, lung, kidney or
liver transplant is going to be successful, everyone must go
according to plan. For the teams of surgeons and nurses on the
giving and receiving ends at 281 transplant centers in the United
States, the transfer must be smooth, without hesitation, without
- The urgency of the situation is clear. One-third of the people
on the United Network for Organ Sharing (UNOS), the national waiting
list, will die before they get their lifesaving transplant.
- But if they're lucky enough to get an organ, they have a good
shot at making it. In fact, the success rate for heart and liver
transplants is between 85 percent to 90 percent. And for kidneys,
the figure climbs to between 85;Percent and 95 percent.
- As the number of transplants continues to grow, the role and
need for rehabilitation professionals grows as well. "Rehab
works the best when the patient is motivated to learn and get
better. They have a new organ and they' re thinking, 'I'm lucky to
be alive,' and they're willing to do whatever it takes to get
healthy again," says Milena Matzinger, PT, critical care
specialist of Stanford Health Services' heart and lung program in
Stanford, Calif., site of the first successful heart transplant in
the United States in 1968.
- Although rehab doesn't have a bearing on whether a new organ
will be accepted or rejected, postsurgical rehab can speed recovery
time. In the post-transplant phase, rehab components include
assessing progress over time, discovering appropriate levels of
exertion, addressing nutritional concerns and overcoming
misconceptions that exercise will damage the new organ.
- Presurgical rehab can provide a healthy foundation.
Pre-transplant rehab involves educating patients, identifying
baseline problems, maintaining the body and establishing a
structured program that can be continued as soon as possible
post-transplant. It plays a"preparatory role in terms of
maximizing the patient's functional capacity and minimizing risk,"
says Robert M. Kotloff, MD, director for advanced lung disease and
transplants, University of 'Pennsylvania Medical Center,
Missing a Golden
- With organ transplants increasing in frequency-from 12,788 in
1988 to 20,260 in 1996, according to UNOS stats - the population of
potential pre- and post-transplant rehab candidates continues to
grow. In many cases, though, therapists are being left out of the
- Rehab pros should become part of the transplant team, asserts
Patricia Painter, Ph.D., by being more involved in the education
phase, in post-transplant follow-up and long-term quality of life
issues. "We' re not progressing in our need to increase
rehabilitation," says Dr. Painter, director of the transplant
rehabilitation program at the University- of California, San
- "Physical therapists are missing the opportunity."
- Part of the problem may be a lack of contact with patients, in
both the pre and post-transplant phases. With managed care reducing
hospital stays to a minimum, rehabilitation is done primarily on an
outpatient basis. Surgeons monitor a patient's progress for one or
two months to ensure that the organ is accepted, but over the years,
quality of life remains a mystery, Dr. Painter says.
- "We need to really optimize physical functioning afterwards
and physical therapy and exercise physiology have an important role
with that. So if we can be proactive as a profession and make sure
physicians know what our services could offer and why it's important
for these patients, then there are going to be more opportunities
for physical therapy to be involved," she says.
- MaryJo Modica, RN, MS, BSN. at the Ohio State University Medical
Center.. Columbus, Ohio, agrees that rehab professionals should be
on the team from the beginning. "We need to develop postop
protocols and assess physical therapy needs and risk factors,"
she says. Having an illness leading to transplantation almost always
predisposes people to PT, OT or other forms of rehab, adds Modica,
president of the International Transplant Nurses Society.
A Stage of Preparation
- Pretransplant rehabilitation means taking a proactive approach,
says Ginny Bumgardner, MD, Ph.D., assistant professor of surgery at
Ohio State University Medical Center. A pretransplant exercise
program serves two purposes: It gives the patient a structured
program, which is necessary because patients often don't feel well
and find motivation difficult. And it establishes a familiar routine
they can continue after surgery when they're physically able.
"[Patients] ...need help early on," says Dr Bumgardner.
"We're trying to give them the tools to do things themselves.
We have to give them motivation."
- When a patient's name goes on the lung waiting list at the
University of Pennsylvania Medical Center, pretransplant outpatient
rehab is mandatory. If a patient, in spite of his best exercise
efforts, still becomes bedbound, he is no longer considered viable
for transplant. Harsh perhaps, but a patient must be able to
withstand the physical toll an impending surgery will take.
- Throughout the pretransplant stage. patients continue to mark
time. Everyone accepted onto a transplant center's waiting list are
registered with UNOS, which maintains a central computer network
linking all organ procurement organizations and transplant centers.
when a donor organ becomes available, the transplant center or organ
procurement organization accesses the UNOS computer, which generates
a list of patients ranked according to UNOS policies. Each organ has
its own allocation criteria.
- Candidates could spend one month or one year in a state of
limbo. As such, depression is common, which triggers noncompliance,
says Dr. Kotloff. For heart, lung and liver candidates, who can
become more debilitated, patients may use their weakness as an
excuse not to exercise, and in turn, may make family members back
off from pushing therapy. 'There is a tendency to pamper a patient
with far advanced disease," Dr. Kotloff admits.
- Yet, therapists must strike a balance between making patients do
too much or making them do too little. 'You do want to caution
against pushing them too quickly and doing too much too fast, "which
can breed frustration if positive results aren't accomplished, adds
- Despite the cautions, building an aerobic component is critical.
Even though an organ is failing, exercise strengthens the
surrounding muscular, vascular and pulmonary systems which puts the
patient in better position to resume rehab more quickly after
transplant. "Even though they have a sick heart, they have a
healthy vascular system, and we try to make it a better system,"
- Matzinger makes a parallel between two former heart patients at
Stanford. One patient, bedridden six Weeks prior to transplant, took
four weeks postsurgery just to get out of bed and walk to the
bathroom. Another man, who regularly walked and played golf, was
fully ambulatory within seven days of receiving his new heart.
- Aside from producing known physiological effects, exercise also
decreases the stress patients experience, particularly at a time
when much of their life is out of their control, says Dr. Painter,
who started the kidney rehab program at UCSF in 1989. The program
has since expanded to include all transplant patients.
- For instance, patients may be plagued with anxiety-provoking
questions: How quickly is my organ failing? Will I get an organ?
What's going to happen? Am I going to die? Exercising is the one
variable a patient can control. "Exercise reduces stress,"
Dr. Painter says. "When you have a chronic illness, so much is
going on around you and so much is happening that you feel out of
- To give patients control and to address the nurturing side of
rehab, the program at the University of Pennsylvania mixes pre- and
post transplant patients. The pretransplant patients, who go through
a treadmill workout set at 1 m.p.h. and wear an oxygen mask, get to
see the tremendous strides made by the post-transplant group, who
are cruising on the treadmill at 3 m.p.h. without a mask.
- If the initial transplant procedure goes smoothly, patients can
be ambulatory as soon as two days post transplant. Within two to
three weeks, most patients can be in a structured, outpatient
exercise program of stretching, strengthening and conditioning three
times a week. Liver, heart and lung recipients tend to be more
debilitated from the progressive effects of longer illness prior to
transplant, and consequently require longer recovery periods.
- "The task now is getting the rest of the body to catch up
with this new organ. The body must still recover from months, or
even years, of debilitating illness," Dr. Kotloff says.
- Post-transplant rehab ambulatory techniques begin as soon as the
patient's feet hit the floor. In some situations, ambulation begins
with sitting up in bed and moving to a chair. When the patient
becomes stronger, he can walk short distances, take longer walks or
go up a ramp. The theory is that as soon as people can walk, they
should be doing some form of rehab, even if it means standing with
chest tubes still in or walking around wheeling multiple IVs. Even
slow-to-recover, bedridden patients should be doing minor muscle
strengthening with range of motion activities.
- Post-transplant rehab typically focuses on the lower
extremities, due to the tenuous condition of the upper extremity
chest cavity. As such, patients must be careful not to tear sutures
and are restricted from pushing, pulling or lifting more than 5
pounds for at least six weeks.
- Fear of damaging their new addition makes many patients shy of
activity, anyway, experts say. Family members also reinforce that
notion with the"take it easy, I'll take care of everything"
mentality, says Dr. Painter.
- Stanford's Margaret Dougherty, MS, OTR, changes that mentality
by instilling confidence and putting fears to rest. "We spend
time talking about the advantages of getting up and around to
increase strength, and try to convince them that they should walk to
the sink to brush their teeth instead of having the nurse do it for
them," says Dougherty. "It' s very important that they
take responsibility for the situation they are in right now."
- It is a fear that was reinforced prior to surgery, she adds."
They are used to being out of energy. They've been sick for so long
that they couldn't do anything, and if they did do something, they'd
be tired the rest of the day."
- Therapists typically don't have this problem with children, who
are active anyway. Plus, kids usually don't have pre-existing health
risks, such as cardiovascular problems, high cholesterol or obesity
often seen in older patients.
- Along with exercise, drug therapy is another component of
post-transplant rehab. Heavy doses of cyclosporine, administered to
reduce the risk of rejection, and the steroid prednisone do produce
side effects, but they do not impede the ability to do rigorous
exercise, says Dr. Kotloff.
- Cyclosporine may cause blood pressure increase, shaky hands,
hyperactivity and nausea. Prednisone causes increased appetite.
weight gain, and even compression fractures because the drug weakens
bone and muscle. Also. kidney recipients may develop hyperglycemia
and require insulin for a short time. Temporary dialysis may be
necessary if the body is slow to accept the new kidney.
- Weight gain is a primary concern because it can easily turn into
a life-long problem. Severe diet restrictions during the long
pretransplant stage skew the patient's perceptions of adequate
intake levels for protein, calories and fluids. An exercise program
helps balance the caloric increase.
- Some patients gain up to 100 pounds during the first year post
transplantation. says Dr. Bumgardner. And if the patient were obese
prior to transplant, this weight gain exacerbates obesity-related
problems, including deficiencies in wound healing.
- Fitness professional Vanessa Underwood. AFAA, ACE, believes
every transplant program should have a wellness component to address
specific exercise, fitness and dietary needs. Underwood, who's
received two kidney transplants since 1979-one from her sister and
the other from her mother-speaks to health care professionals about
incorporating exercise into their rehab units with her program:
"Moving into wellness: A fitness approach to renal and
- "Exercise is metabolic," says Underwood, a fitness
editor for the Transplant Chronicles newsletter and the
author of a monthly fitness column. "It's a way to fight back.
It's a panacea that we have at our fingertips that we don't use. If
you believe it works, you will be able to fight the side effects of
- Underwood is living proof of the potential longevity of organ
recipients through a healthy lifestyle. One-year survival rates for
all organ recipients range from 91.3 percent for living kidney
donors to 73 percent for lungs. In between are cadaver donor kidneys
(93.4), heart (82.8) and liver (80) , according to UNOS statistics.
People with a kidney from a live donor have a 92.4 percent chance of
living four years. according to UNOS figures. Other four-year
survival rates are 84.4 percent for a cadaver kidney. 71 5 for heart
transplants, 71.3 for the liver and 48.9 for lung transplants.
- "We' re looking at good out comes for organ recipients, so
physical therapy is really becoming more and more important,"
- advance for
Directors in Rehabilitation. Sept 97 pp. 24-7
- Contributed by T.
Michael Smith. M.S. Ed. Certified Athletic Trainer: Official
Personal Trainer to UpBeat's Staff. Phase III cardiac
Rehabilitation, Riverside Walter Reed Hospital, Gloucester, VA
IMPORTANT NOTICE TO ALL UPBEAT READERS:
- With this issue, UpBeat has completed 10 years of
publication. It started as a very simple local document put together
by a very recent Tx recipient still quite "high"
prednisone. In fact the first couple of issues were made by pasting
news clips on paper and then Xeroxing same. It was less than pretty
and in fact it was pretty awful.
- Quite frankly in recent years I have debated whether it is of
any real service to continue, in that news of transplantation is so
much more widely disseminated now than it used to be. In fact a year
ago I inserted a question on the survey as to whether UpBeat
should be continued. Rather surprisingly to me, the response was
something on the order of a resounding 99%, "yes".
- Well, the services of the editor are free and they always have
been. However, the rest of the program costs about $450 per
month/issue. All of this money comes from donations. Some readers
have given small amounts very, very regularly - they regard it as a
subscription, which is fine. Others have given larger amounts from
time to time, and they are much appreciated also. And every now and
then a doctor, or transplant program, or pharmaceutical house will
come through with a surprise donation that is enough to help upgrade
the computer printer, or even assist a bit in upgrading the computer
- Unfortunately, not everyone remembers to keep up their
donations, and at present UpBeat is in a very tight cash position.
Whenever the separate Upbeat checking account gets below $1,000, or
about 2 months expenses, I start to worry. Just recently it dropped
below $500 and I have started thinking seriously of cessation.
- In previous years I have notified everyone who appears to be
behind in payment i.e. we haven' t received anything in more than a
year - by means of a personal letter. This year in order to conserve
funds remaining, I'm not going to do that.
I'm asking everyone to
take a look at their address label and see when their last donation
was received by UpBeat. In most cases it shown as a date after your
name. That date is the last time you contributed to UpBeat. If it's
more than 12 months ago, i.e. 11/96 or prior, please do what you can
to make a renewed donation now. If nothing is received from you prior
to February, 1998, you risk removal from the mailing list.
- If there is no date after your name, you have never
contributed to UpBeat and you will be discontinued in February,
If there is an "*" after your name it means one of
several things: a. Your last contribution was large enough to "carry"
you for several years. b. You have indicated you just can't afford to
donate, which is absolutely acceptable. Anyone in that situation
merely has to drop us a postcard and say so. c. You are being
"comped" for your contributions to the field of
transplantation, or the editor's life.
STAMP TO PROMOTE ORGAN
- Washington (AP 11/6/97) -- Greeting cards, letters and bill
payments can do double-duty next year when the U.S. Postal Service
issues a stamp promoting organ and tissue donation.
- The stamp design shows two intertwined figures with hands
reaching inside and touching each other's heart. It carries the
slogan "Share your life."
- It was unveiled Thursday at a Capitol Hill ceremony with members
of Congress who have pushed for two years for a stamp. Among them
were Sen. Bill Frist, R-Tenn., a transplant surgeon; Rep. Joe
Moakley, D-Mass., a liver transplant recipient; and Sen. Mike
DeWine, R-Ohio, who became an advocate for organ donation after his
22-year-old daughter, Becky, was killed in an auto accident.
- The DeWines donated Becky's eyes, which provided transplants for
two recipients in different states. "This is no ordinary
stamp," said Postmaster General Marvin Runyon. "It is not
meant to be an attractive ornament for a letter or a keepsake that
will be stashed away in a stamp album... It is meant to be part of a
- "We hope that this stamp will cause families to talk about
this," added DeWine. "I'm convinced the issuing of this
stamp will in fact save lives."
- More than 55,000 Americans are awaiting organ transplants,
according to the United Network for Organ Sharing. Last year there
were fewer than 9,000 U.S. donors. The stamp will be issued next
summer; the date has not been set.
- Well golly, if only
Ed Heyn could read this article/And wasn't it here in UpBeat
several months ago where the editor said it seemed in order to make
progress on the donor stamp we needed to get political. Of course,
"getting political" is also making them think it was their
idea, or at least making it look like it was their idea. Well after
about 8 years we finally got the stamp, that's the important thing.
- UpBeat apologizes for the apparent "copy crunching
monster" appearing last month and creating a mixture of two
Texan's comments. Here's what they really had to say:
- Tx Ralph Thornton reveals what may be the coming protocol
in "annuals". "My transplant team (UT Southwestern
Health Sciences Center/ St. Paul Medical Center, Dallas) really
surprised me at my annual. I am 8 1/2 years post-transplant. They
said that out of all the left-right caths that had been done on
those more than a year out. the procedure only revealed four
problems. and they already suspected two. So this time I just had
the right cath/biopsy (what I call a "quickie"). Also,
they cut back on the periodic testing schedule. This is especially
important for those of us who, are employed. The multiple visits to
the Docs. even for labs, leave one's coworkers with an impression of
illness that is hard to overcome.
- And a Texas Tx writes: "l continue to be amazed and
amused at the transplant world. how little the medical establishment
seems to consider asking questions of a large number of transplants
when it comes to survival, procedures. etc. I am amused that every
time I go to a hospital -- which is often, not necessarily for my
heart (best organ in my body) but associated ills -- how the nurse
or the technician always asks, with a bright smile. "How are
you today?" As if I would be there if I knew how I was. But
that's not a gripe, just a comment. Beats what one MD specialist
said to me a couple of years ago when it was discovered I had brain
cancer, "You aren't ever going to get better." I was sorry
to have to fool this esteemed Fellow. etc., but I got better and 3
MRIs have shown no sign of the cancer. You learn a few things as a
transplant, and one of those is: Don't ever quit and don't ever look
- A personal note: Many of us as transplant recipients
develop some unpleasant side effects. some much worse than others.
One of the only real solaces in such situation is the quasi-comfort
of knowing that others have been, or are. in the same condition.
With that in mind, is there anyone who has, or has heard of, a
transplant recipient developing polyps on the vocal cords most
probably due to long-term immunosuppression? I have had slime
recently and the resulting surgery has pretty much resulted in the
loss of an acceptable voice. I would be very interested to know
whether this problem has cropped up in other recipients as the
medical literature is quite silent on the matter.
- And again, for about the 10th year. sincere best wishes for all
the Holidays. and be sure and stay well in the New Year. Buy and use
the donor stamp in '98 and remember the late Tx Ed Heyn of
Baroda, MI got it all started a long time ago.
STUDY CASTS DOUBT ON
PIGS FOR ORGAN TRANSPLANTS
- By Patricia Reaney
London, (Reuters 10/15/97) -
Scientists cast doubt on Wednesday about the feasibility of using
pig organs for human transplants after finding two types of viruses
that could infect human cells.
- In a letter in the scientific journal Nature, Jonathan Stoye and
colleagues at the National Institute for Medical Research in London
said the finding has reinforced fears about the potential risks of
viral infections associated with xenotransplantation -- using organs
from one species in another.
- "Further support for these fears comes from the discovery
of two different classes of porcine endogenous proviruses (PERVs),
capable of infecting human cells," they said.
- Endogenous viruses are passed on in the germ line as proviruses
and are very difficult to remove when producing animals for organ
- Doctors do not know if the virus would cause an infection in
humans, or, if it did, what that infection could lead to. Doctors
and patients would have to decide if the risk outweighs the benefit.
- "Even if it proves impossible to breed pigs that are free
of these viruses, it doesn't necessarily mean they would do anything
in a transplant setting," Stoye said in an interview.
- But he added that whenever the first human trials occur, which
some scientists think could be within a year, there will inevitably
be question marks.
- Stoye and his colleagues cloned the region of the proviruses
with the infected cells. In all the pig tissues they tested, from
the heart, spleen and kidney, they found both classes of the
provirus that could infect human cells.
- Stoye also tried to find a breed of pig without PERVs but
discovered that both classes of it are inherited in a range of pig
breeds and are likely to be present in pigs genetically modified to
be used as sources for organ transplants.
- "Although we do not yet know which proviruses are capable
of yielding infectious virus, the number of proviruses present
suggest that the breeding of virus-free pigs, if at all feasible,
will represent a complex task," he said.
- Many scientists believe that xenotransplantation may be the only
solution to the increasing shortage of human transplant organs. More
than 50,000 people are currently waiting for a transplant in Europe,
but there are not enough available organs.
- Demand is growing at 15 percent per year, far outweighing
- The first attempts at xenotransplantation, in the United States
and Europe, used baboon livers, hearts and kidneys. People survived
with the animal organs for up to 70 days.
- But scientists believe the greatest potential is with pig
organs, which are approximately the same size as their human
equivalents. Pigs also breed quickly and with big litters, so large
quantities of potential organs can be produced.
Contributed by Dr. Maud A. Marshall, Norton, MA
- By Geir Moulson - Associated Press Writer
- Geneva (AP 10/30/97) -- Transplanting animal organs into humans
offers such promise that nations should work together to overcome
scientific and ethical problems, experts said Thursday at a
- Scientists have suggested in recent years that animals not only
could ease the shortage of kidneys, hearts and livers for
transplantation, but also supply brain tissue to treat diseases like
Parkinson's and pancreatic tissue to treat diabetes.
- Attention has focused on the pig, which has internal organs the
right size for transplant to humans and breeds rapidly, meaning a
large potential organ supply.
- There is concern, however, at the risk of infections crossing
species barriers. Experiments so far have focused on limited
transplantation of animal tissue rather than whole organs. The World
Health Organization sponsored a two-day meeting ending Thursday to
examine the possibilities and implications of "xenotransplantation."
- British bioethics expert Dr. Rachel Bartlett said the starting
point is the situation faced by people in need of transplants but
unable to find donor organs.
- Professor Jeffrey L. Platt of Duke University said as little as
5 percent to 15 percent of the donor organs required may be
- About 2,000 heart transplants are carried out every year in the
United States. while an estimated 40,000 hearts are needed. The
problem is magnified in developing countries, where the resources
are in far shorter supply.
- Platt said every conceivable way to increase the amount of
organs available for transplant in the United States has been tried.
but all have fallen well short of meeting requirements.
- The use of nonhuman organs could solve the dilemma of how
available organs are distributed, he also denied that the need for
organs could be met by using dialysis and other mechanical
procedures. The experts said they also discussed the implications of
transplants from pigs with scholars of Islam and Judaism, both of
which forbid eating the animal as unclean. and had received a
generally favorable response.
- "The Koran and the Old Testament -Leviticus particularly --
talk about the pig only in dietary terms," said Professor
Abdallah S. Daar of Oman University. "Neither restrict the
introduction of porcine material through other orifices or through
surgical incisions," Daar said.
- Some concerns have been raised over the development of
"transgenic" animals. containing a human gene, to reduce
the risks of patients rejecting organs. Such animals could be viewed
as hybrids, but Bartlett said the human gene was "one gene of
many" which would bring about only a "small anti specific
Discussion between countries is necessary, she said, "to make
sure xenotransplantation goes ahead as safely as possible."
especially as "viruses and bacteria do not carry passports."
- By Brendan Riley - Associated Press Writer
- Mount Whitney, Calif. (AP 9/26/97) -Two years after her old
heart gave out. Kelly Perkins put her new one to an amazing test:
She scaled the nation's highest peak outside Alaska.
- No other heart transplant patient is known to have climbed
14,495-foot Mount Whitney, a daunting trek even for those with no
- Perkins, a 36-year-old real estate appraiser, made the rugged,
22-mile hike over three days, tearfully hugging her companions atop
Whitney on Tuesday, and blowing bubbles to celebrate.
- "You basically live in fear for so long that you' re afraid
to try to push your limits at all," she said. "And so it's
very freeing to be able to push those limits and to succeed and know
that you're back."
- Perkins -- 5-foot-3 and 95 pounds -had a go-ahead from her
doctor because she was an experienced climber and had worked hard to
rebuild her strength after her 1995 transplant.
- But she also knew that of the thousands of people who try to
climb the Sierra Nevada peak every year, many are forced to turn
back. Sprains and other injuries are always a concern, along with
altitude sickness, hypothermia, dehydration and violent changes in
- But the weather was perfect for Perkins. And her only problems
were a slight knee bruise from a fall as she got out of her tent,
and a mild headache.
- As a precaution, her climbing team -including her husband,
Craig, also 36, and four others -- shared her load, carrying her
blood pressure monitor and oxygen canisters. As it turned out, she
didn't use the oxygen at all, and her blood pressure was found to be
OK during the periodic checks.
- Perkins also drove from her sea-level home in Laguna Niguel,
Calif., to the start of the trail a few days ahead of time to adjust
to the high altitude, and started hiking slowly -- a necessity
because it takes a few minutes to get her heart rate up.
- (The heart is normally stimulated by nerves and adrenaline. But
a transplanted heart no longer has nerves linking it to the brain.
Perkins had to rely on adrenaline alone.)
- "It was really hard there at the end, and I really didn't
know if I was going to make it or not," she said.
- Perkins had climbed Whitney once before, when she was 25 and
there was no hint of the obstacles ahead.
- But in 1992 she was diagnosed with viral cardiomyopathy, which
made her heart race wildly. By 1995, her heart was failing and she
was taking up to 30 pills a day. Her husband had to carry her up and
down the stairs of their home.
- Perkins got her new heart on Nov. 20, 1995, from a 40-year-old
woman killed when thrown from a horse. By the following August, she
had climbed 8,842-foot Half Dome in Yosemite National Park.
- Mount Whitney became her next goal, but her husband had his
doubts because of the altitude, which made him sick and kept him
from reaching the summit when the couple first climbed Whitney II
- During the climb up the rocky. zigzagging trails this time, he
worked to assure his wife "that it wasn't her illness; it was
our illness, something we had to deal with together as a couple."
- Perkins' doctor, Jon Kobashigawa. is the medical director of the
transplant program at UCLA Medical Center, the largest transplant
center in the world. He said he knows of no other transplant
patients who have attempted a high-altitude climb like Perkins'
Whitney ascent. "She is physically quite active, she works out,
and she has trained her new heart to achieve a high level of
capacity," he said. "She's an inspiration to many other
transplant patients, to show that they can get back to a good
quality of life."
Perkins is now looking for a new goal. "But it won't be Mount
Everest," which is twice as high as Mount Whitney, she said.
"That's all I know for sure. I'm not that crazy."
TRANSPLANT IN ISRAEL
SAVES ARAB KID
- By Laura King - Associated Press Writer
- JERUSALEM (AP 10/13/97)-- At the bedside of an Arab toddler who
received the heart of a Jewish child killed by a car, two mothers
wept in each other's arms.
- "Do you know what heart she received? She received an
angel's heart -- you don't know what a heart this boy had,"
said Braha Kaveh, whose 8-year-old son Yuval was killed while riding
his bike last Thursday.
- Aani Aljaroushi -- whose 3-year-old daughter Rim was listed in
good condition on Monday, three days after the transplant --
embraced the other woman. "I know that it's very hard, but I
thank you," she said through her own tears.
- The story struck a powerful chord in a country where Arabs and
Jews are most often depicted in bitter strife.
- It was a medical milestone as well. If Rim recovers -- and her
doctor says the prognosis is excellent- it will be Israel's first
successful pediatric heart transplant, the hospital says.
- Footage of Sunday night's emotional hospital meeting aired on
Israeli television and was front-page news in Monday morning papers.
"Heart of Gold" said a banner headline in the Maariv
- When the Kavehs were told their son' s heart was beating in the
chest of an Arab child, "they were really happy," said
cardiac surgeon Dr. Yakov Lavie, who headed the transplant team.
"They thought it might bring the two peoples closer together."
- Yuval, only days away from his ninth birthday, was riding his
bicycle with his brother in his hometown of Herzliya. north of Tel
Aviv, when he was hit by a car and thrown from the bike. He suffered
- As it became clear he would not survive, doctors gently asked
his Jewish parents about the possibility of donating his organs.
- Little Rim, whose family is from the town of Ramle near Tel
Aviv, had been in danger ever since she was born with an enlarged
heart. For two of her three years. as her condition steadily
worsened. she had been waiting for a donor heart.
- The surgery at Sheba Medical Center near Tel Aviv took only two
hours. Lavie said the toddler is making an extremely rapid recovery;
the day after the operation. she was able to sit up and sip juice.
- "She was very small for her age. and her motor activities
were underdeveloped." he said. "But now she can have a
normal life." Sizan Aljaroushi, Rim's father. said he hoped the
Kavehs would be part of his daughter's life. "I want the Kaveh
family to visit Rim, and I want her to visit them because they gave
part of their son-- a very, very precious part, the heart," he
- Organ transplantation is a complicated subject in Israel. Both
Orthodox Jews and traditionalist Muslims believe that bodies should
be preserved intact after death, and transplants are thus taboo for
- It wasn't an easy decision, Yuval's father told Maariv, but the
family decided to donate his organs. His liver and one kidney were
transplanted into a 14-year-old boy, and a 19-year-old man received
his other kidney.
Said his mother: "Yuval' s death was not for nothing ... and
others are living thanks to him."
Allergy Passed on in
- Boston (AP 9/17/97) -- A man who received a new liver and kidney
in an organ transplant also got something he didn't want -- an
allergy to peanuts.
- French doctors described the unusual case, which occurred eight
years ago, in Thursday's issue of the New England Journal of
- A 22-year-old man who knew he was allergic to peanuts ate them
by mistake when he had Chinese food with satay sauce, which contains
peanuts. He fell into a coma and died.
- Doctors gave his liver and right kidney to a 35 -year-old man
and his pancreas and left kidney to a 27-year-old woman. Neither was
told of the cause of the organ donor's death.
- Three months later, the man suffered a skin rash and difficulty
breathing after eating peanuts. After concluding he had a newly
developed allergy, the doctors fed peanuts to the woman under close
medical supervision, but she showed no ill effects.
- Doctors are unsure why one patient got the allergy and the other
did not. However, they speculated that blood cells primed to
recognize peanuts as foreign were passed along in the transplanted
- The man was told to avoid peanuts, and he is still healthy. The
case was reported by Dr. Christopher Legendre and others from Necker
Hospital in Pads.
NEW DRUG REDUCES
REJECTION IN KIDNEY TRANSPLANTS
- London, (Reuters 10/24/97) - A new drug designed to reduce
rejection in kidney transplant patients has shown promising results,
doctors said on Friday.
- In a report in the Lancet medical journal, doctors who tested
the drug basiliximab, which is made by Swiss life sciences group
Novartis AG, said it"reduced the incidence of acute rejection
- Dr. Bjorn Nashan and colleagues in Germany, Britain, Switzerland
and France studied 380 adults who were first-time kidney transplant
patients. Nearly 200 were given basiliximab on the day of the
surgery and four days later and 187 patients received a placebo.
- Six months later, 44 percent of the placebo group had acute
rejection problems but' only 29.8 percent of the patients who had
- Acute rejection occurs when the recipient's blood begins to flow
through the new organ and white blood cells recognize foreign
antigens on the graft cells.
- Basiliximab interferes with a protein dial causes the
proliferation of the white blood cells that form part of the body's
immune response to the new organ.
- If a transplanted kidney is rejected. the patient can go back to
dialysis and may receive another kidney but demand far outweighs
"This study indicates that basiliximab ix an
immunosuppressant with a simple short-term administrative regimen
that has a significant impact on the incidence of acute-rejection
episodes, without giving rise to clinically relevant safety or
tolerability concerns," Nashan said.
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