Heritage Snapshot: Part 71

“It’s the first time it’s been done, and it’s fair to say there was some electricity in the air,” reported Elmar Sakala, MD, director of the maternity unit at Loma Linda University Medical Center. He was referring to one of the most incredible infant-heart-transplant cases, that of Paul Holc, a patient who was referred to Loma Linda University Medical Center from South Surrey, British Columbia, before birth. Paul’s surgery became an unprecedented milestone in transplantation history. Not only did he become the youngest person in the world to undergo heart transplantation, but also his donor would spark a debate “heard round the world.” Because of the age of his mother (35) and the heart disease of two close relatives, a series of three fetal echocardiograms was performed. This technique, a specialized form of diagnostic ultrasound, uses high-frequency sound waves to create pictures of the inside of the body. It is used for diagnostic studies on pregnant women to avoid the risks of using X-rays. The last two “echos” showed that the baby had hypoplastic left-heart syndrome (HLHS), a lethal underdevelopment of the left side of the heart. By this time, August, 1987, even though Loma Linda University Medical Center had gained an international reputation for performing successful heart transplants on newborns, some physicians still were wary. The diagnosis was explained to the parents, Gordon and Alice Holc. The prognosis, they were told, was hopeless. The Holcs asked about heart transplantation, but were at first discouraged by their physicians. Several days later, their doctors decided to reevaluate their position and, after further study, referred the Holcs to Loma Linda. Echocardiography at Loma Linda confirmed that the baby had HLHS. The parents consulted with Loma Linda’s multidisciplinary heart-transplant team, who presented various options to the family, including heart transplantation. After extensive discussion and consideration, including talks with another Canadian family whose daughter, Jessica, had received a new heart at Loma Linda, the parents opted for an attempt at heart transplantation. The baby would be placed on Loma Linda’s transplant list at 36 weeks gestation (36 weeks into the pregnancy) and registered with the United Network for Organ Sharing (UNOS), the North American organ-procurement agency. When a donor became available, a transplant would be performed following a cesarean-section delivery. Four days after the baby was listed with UNOS, a two-day-old donor, coincidentally from Canada, became available. It should be emphasized that transplant centers, as a standard practice, do not identify donors. Donors and recipients and their families are almost always kept anonymous. If they want to communicate, they can do so through an intermediary. But in some cases, generally because of unusual circumstances, donor families have held press conferences in which they have told the circumstances of their gift. In this case, the donor family later identified their child as a baby girl named Gabriel. She had been named after the Biblical angel, Gabriel. They reported that she also had been diagnosed before birth. Her condition also was not compatible with life. She was an anencephalic infant (missing all of the brain except for the rudimentary brain stem). The family reported that they had deliberately carried the pregnancy to full term in order to turn their personal tragedy into something good, by donating the organs of their first-born to try to save another baby. They were proud of their daughter and for what she was able to do after her death. She was a little heroine. Baby Gabriel was born at Orillia Soldier’s Memorial Hospital in Orillia, Ontario, Canada, on October 12, 1987. She weighed 5 pounds, 5 ounces, and was almost four weeks overdue. She was breathing on her own. Dr. Timothy Frewen, director of Canada’s largest infant-transplant center, the Children’s Hospital of Western Ontario, was notified that the baby’s parents wished to donate her organs to save another child. The next day, Baby Gabriel’s breathing became shallow. She was given artificial breathing assistance and intravenous medication to help protect her organs. Still attached to a respiratory, Baby Gabriel was flown to London, Ontario, Canada, by a five-member transport team. At six-hour intervals, the respirator was turned off to determine her ability to breathe on her own. The next day, three physicians, not associated with the transplant team, determined during three separate 10-minute tests, that she could not breathe on her own. In addition to being checked for permanent cessation of breathing, Baby Gabriel was checked extensively for spontaneous eye movement, pupil response to light, and gag and sucking reflexes. Baby Gabriel was declared clinically dead and respirator support was reinstituted to protect her organs. Once brain death was established, the procurement centers were notified. Michael Bloch, transplant coordinator for London’s University Hospital, telephoned Loma Linda pediatric cardiac-transplant coordinator, Cheri Mathis, R.N., who in turn contacted Alice Holc, in British Columbia. A potential donor had been found, Mrs. Holc was told, and she should come to Loma Linda immediately. The next day, on October 15, beginning at 4:30 a.m., Bloch, a pediatrician, a nurse, and a respiratory therapist flew Baby Gabriel from Toronto International Airport to Southern California aboard a Skycharter Learjet 25. A ventilator supplied mechanical breaths as she lay in a heated transport incubator. Because foul weather delayed the flight, batteries in the donor’s heating unit ran low and most of her oxygen supply was used up. The plane had to refuel at Stapleton International Airport in Denver, Colorado, where Bloch made an urgent call at 5:30 a.m. to Paul Taylor, transplant coordinator for the University of Colorado. Taylor contacted the Children’s Transport Services of Children’s Hospital in Denver to arrange for oxygen tanks to be delivered to the waiting plane. Meanwhile, Bloch heated some towels in the airport lounge microwave to keep the donor warm. Then the sleek white jet shrieked back into the sky over the Rocky Mountains with its precious little life-giver.