When Lorene Parker stops to notice the long scar that runs the length of her chest and branches off sideways just below each breast, she feels blessed. I’m alive, she thinks. In 1998, flu-like symptoms prompted Ms. Parker, then 42, to pay a visit to the emergency room. Turned out that her heart was barely pumping. Within 24 hours, she was rushed to two separate hospitals.
She’d experienced life-threatening arrhythmias, or irregular heartbeats, and ventricular tachycardia, which is a dangerously fast heartbeat. The next step was ventricular fibrillation, which can result in sudden cardiac death. Ms. Parker, a cardiac nurse, perhaps knew too much. Her heart was trying to save itself.
Sedated but aware, the Detroit resident watched her heart on a monitor. “I could hardly believe it,” she says. “You could barely see it moving.” Then her doctor gave her stinging news. “You might need a heart transplant,” he said. Ms. Parker closed her eyes. “I can’t believe this,” she said.
Short-Term Solution
Her condition was diagnosed as cardiomyopathy, most likely as a result of a viral infection. Ms. Parker was told that her heart might actually come around and get stronger. And for several years, she was able to live with her condition with the help of medication and a heart defibrillator.
In 2004, however, her heart began to fail. She started retaining fluid. She couldn’t climb a flight of stairs without sitting down to rest. She began oxygen therapy and IV therapy at home. Her daughter and grandsons moved in to help her.
Her physicians concluded there was nothing else they could do. “I’m going to die,” Ms. Parker remembers thinking. “I’m not going to live too much longer. Sometimes it’s good to know, to have medical insight. But when you have too much knowledge, it really works on you mentally.”
Her left ventricle, in addition to the right ventricle, was now affected. Again, Ms. Parker knew too much. ”Once that occurs,” she says, “you’re talking heart transplant.”
Insult to Injury
Just when Ms. Parker thought her situation couldn’t get worse, it did. One of the hazards of being a nurse is needle stick injuries, which can expose workers to dangerous diseases. Ms. Parker contracted hepatitis C from a needle stick injury years before. There is no cure for hepatitis C, and her liver was damaged as a result. If she were to receive a heart transplant, she would need a liver transplant at the same time. Her liver, weakened by the hepatitis, would not tolerate a major surgery such as a heart transplant.
Her physician referred her to Cleveland Clinic because of its reputation as the No. 1 heart center in the nation, according to U.S.News & World Report. When she learned she might be the first heart/liver transplant patient at Cleveland Clinic, her confidence didn’t waver.
“Expertise-wise, they were at the top of the list of the best hospitals,” she says, citing Cleveland Clinic’s overall ranking as one of America’s top hospitals by U.S.News & World Report.
Randall Starling, M.D., Head of Heart Failure and Cardiac Transplant Medicine, and Medical Director of the Kaufman Center for Heart Failure at Cleveland Clinic, evaluated Ms. Parker and agreed that she needed both a heart and liver transplant.
In the fall of 2006, following a complication with her kidneys and the threat of dialysis, Ms. Parker was placed on the transplant list. She remembers thinking that she might be on the list months — even years—but at least she was on it.
A Donor is Found
Then in the early hours of November 14, her nurse came into her room and said, “I’ve got good news and bad news. The bad news is I need to draw a whole lot of blood. The good news is that we’ve got a donor for you.”
Her transplant was scheduled for noon that day. “It was just so fast that I didn’t have time to be afraid!” says Ms. Parker.
In an 11-hour operation, cardiothoracic surgeon Nicholas Smedira, M.D., transplanted Ms. Parker’s heart, and general surgeon Charles Miller, M.D., transplanted the liver. Seven days later, she was discharged to a special transplant unit. A month later, she was back home.
Today Ms. Parker feels good. Her strength has improved. She has energy. She’s not short of breath, and she’s able to walk up and down stairs with no problem. Tests to check for rejection have so far been negative. Because of the transplants, her immune system is delicate. Rather than return to nursing, which would be risky, Ms. Parker is interested in being involved in organ procurement, perhaps mentoring candidates for transplant.
“I tell people not only how important it is to donate organs, but also that things can happen to you when you’re young, not necessarily when you’re old. I’m living proof.”
The Surgeons
Cleveland Clinic surgeons Nicholas Smedira, MD, and Charles Miller, MD, performed Ohio’s first heart/liver transplant late last year.
“My concerns for a multi-organ transplant are to make sure that both organs are needed and that we will not put the patient or the organs at increased risk,” says Dr. Smedira, who transplanted the heart into Ms. Parker. “The heart/liver teams must make sure the patient and organs have a high probability of survival to justify taking two organs, which, in the case of a heart and a liver, technically could save two patients’ lives. Multi-organ transplants should only be considered when the surgeons have tremendous experience with all solid organ transplants.”
Since Cleveland Clinic’s heart transplant program began in 1984, more than 1,000 hearts have been transplanted. Cleveland Clinic’s liver transplant program recently reached that same milestone, performing its 1,000th liver transplant.
