Heritage Snapshot: Part 78

During the first two years of the infant heart transplantation program, Loma Linda University Medical Center sent a patient-transport team to bring prospective donor babies back to Loma Linda. The procurement and transplant took place in adjoining operating rooms. Then, an interesting development in organ procurement took place that changed all that: multi-organ procurements. Now, at least two patients can receive life-saving organ transplants from one donor. Conceivably, as many as eight might be recipients. Now, whenever a donor becomes available, a transplant surgeon goes to the donor hospital, removes the organ in cooperation with other organ procurement teams, and returns to Loma Linda. If the donor hospital is on the East Coast, the entire process could take all day. This new development led to an interesting discovery—baby hearts can survive well for prolonged periods of time prior to transplantation. With adult hearts, scientists believed the longest ischemic time (that is, the time the organ is without a blood supply) was about four hours. Bailey’s team discovered that with baby hearts, the “safe” ischemic time is at least 10 hours; more than double what was thought to be the maximum. Therefore, the transplant team can procure hearts for babies in Loma Linda from anywhere in North America and the Hawaiian Islands. Loma Linda University Medical Center surgeons literally opened the State of Alaska for organ procurement. They have been all the way to Anchorage. Also, transport teams have traveled as far as Halifax, Nova Scotia, in Eastern Canada, and to San Juan, Puerto Rico to save a baby’s life in Loma Linda. Another improvement in the program has been to bring the prospective recipients, at least those from far away, to Loma Linda before a donor has been located. This change in procedure avoids delays and red tape in arranging last-minute transportation. The situation of a Canadian patient is a case in point. At 2 p.m. one day, Ann-Marie Gagnon, from Quebec, was notified of an available heart for her daughter, Genevieve. At 4 p.m. the Royal Canadian Mounted Police whisked her through customs and immigration, to board an Air Canada jet for California. Bringing the babies to Loma Linda well in advance of a possible heart transplant reduces stress for all concerned. The cooperation of the United States Air Force has contributed significantly to the program. The former Norton Air Force Base, a Military Airlift Command Base, is about 10 minutes by ground ambulance from Loma Linda. Officials there granted landing and takeoff privileges for air ambulances chartered by Loma Linda University Medical Center. In life-and-death situations it granted clearance for all non-military, medical emergency flights. The Air Force has been a vital part of the team effort that makes a transplant successful. The benefit has been mutual. Several of the transplant babies were military dependents—two of them flown in from England. In 1985 the medical staff agreed to waive all physician fees for the first three transplant procedures, and the Medical Center Board voted to absorb their costs. By 1986, the Board had agreed to cover all of the expenses for the first five transplants, and then to continue to meet the needs as presented. Administration pursued other funding as rapidly as possible for future transplants. In other words, the institution could not turn down a potential transplant just because patients could not afford to pay for the procedure. In May, 1990, Loma Linda University Medical Center became the only California hospital to be approved by Medi-Cal and California Children’s Services to perform pediatric heart transplants. In a letter of approval, T. G. G. Wilson, MD (Chief of the Medical Policy Section of the Medi-Cal Benefits Branch), wrote to Dr. Bailey; “We much appreciate your dedicated efforts on behalf of all the children you treat and your interest in serving Medi-Cal and CCS beneficiaries. We look forward to a long and cooperative relationship.” The agreement also approved hypoplastic left-heart syndrome as a condition to be treated by heart transplantation. More than half of the babies receiving heart transplants at Loma Linda have had this anomaly. The approval process took almost two years, being complicated by the fact that Loma Linda was plowing new scientific ground and had to prove the viability of the procedure itself. In addition, it had to establish the Medical Center’s qualifications as California’s fourth heart-transplant center.