America’s First

Alyssa Smith was born with biliary atresia, a condition of the liver which would be incompatible with life by the time she was around three-years-old. She needed a liver transplant but chances of an infant donor becoming available were bleak.

In those days only a cadaveric donor liver transplant was possible in the United States. Partial livers had been transplanted in a few places and a handful of living donor liver transplants had been done in Germany, not all successfully. Fortunately for the Smith family the surgeon who had been performing these living donor transplants had moved to the U.S. He was currently on staff at the University of Chicago Hospital.

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Alyssa and her parents Teresa & John

At the age of twenty-one months Alyssa was the recipient of part of her mother’s liver in the first ever living donor liver transplant in the U.S. I was privileged to be on hand for this historic occasion. On the day after Thanksgiving, 1989, Teresa gave 40% of her liver to her infant daughter and although there were a couple of complications it was a successful transplant covered by the media all over the world.

Over the next several years I was able to follow Alyssa’s progress and then to meet her again in 2006 when she was graduating high school. Alyssa is now over thirty years old and has given birth to her own son. This family was special in so many ways and I am grateful to have known them and shared in their amazing journey.

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Alyssa Smith at Age 21

“Once you’ve given your heart it is easy to give a little bit of liver.” Teresa Smith

 

More of Alyssa’s story and extensive details of the procedure are available in this Chicago Tribune article:  https://www.chicagotribune.com/news/ct-xpm-1999-11-30-9911300225-story.html

 

 

 

 

The Ritz

Recollections of Travel 

One of my favorite places to stay during my travels was the Ritz-Carlton Pentagon City in Arlington, VA just outside Washington, DC. It was right on the Metro (subway) line and even attached to a first rate shopping mall, not that I had much time to shop while working. I was supposed to be at this venue on 9/11/2001, but two days before I canceled my plans for reasons I do not recall. Others who attended that meeting spent several days getting home because all flights were grounded for days. One of my associates got back home to Florida via train. While I would have been in no danger, I am glad I was not so close to the horrendous disasters of that day.

Before you think I’m bragging about staying at the Ritz-Carlton, I will hasten to add I also stayed at Holiday Inns, La Quinta Suites and once at what must have been a truck stop motel in Bluefield, WV. So West Virginians don’t become offended, let me clarify it was many years ago and I know from a current Google search Bluefield has many nice hotels today. I was in Bluefield briefly to observe an eye operation at the Ophthalmic Center of Excellence. Back to the Ritz story. I was attending a conference, I believe it was sponsored by the North American Transplant Coordinators Organization (NATCO), a group to which I belonged. In the middle of the night before the conference was to begin the next day the fire alarm jolted me out of bed. I grabbed my robe and room key and followed the emergency exit lights. Down many flights of stairs, as the alarm continued to scream, I finally arrived at a door that surprisingly led me straight into the kitchen. Several people who appeared to be employees did not seem in a hurry to evacuate, but the sight that will always remain in my mind is chicken and a few other food items scattered about the floor. Pieces of fried chicken and I distinctly remember kicking a piece aside as I made my way to another door opening into the main lobby.

As I looked about the lobby I saw people looking dazed, some women were wearing fur coats, others were tightly clutching purses and a couple of men had brought their luggage down with them. I felt a bit underdressed, but I was proud of the fact I had followed emergency procedures and left valuables in the room, exiting quickly. Never mind I was wearing terry cloth, had a severely broken nail from the stair rail and no shoes. I wish I could tell you what was on fire, but I do not recall. Obviously, it was nothing significant because the firefighters soon allowed us to return to our rooms. I will never know why I did not encounter other guests on all those flights of stairs or why I ended up in the kitchen with the chicken.

Winding Up

It is time to wind up my recollections of business travel. If only I could remember more details, i.e., dates and exact locations, I don’t think I would ever run out of true stories to share. Of course some, because of confidentiality or intellectual property rights cannot be told. During those twenty-plus years, I visited over one-half of the states in the US and went to Canada three or four times.

The Transplant World

In those many cities, I worked with a diverse collection of people. There were transplant professionals, contract specialists, hospital administrators, lawyers, government and military officials and on very rare occasions a patient or family member. It was a humbling experience because each person had personal gifts, amazing intellect, and made contributions that helped to build not only a strong transplant network but a better and safer approach to life-saving procedures.

When I began my own journey in the transplant world, after a few years developing the immediate care centers, I found each day intriguing whether in the office in Louisville or in some distant city. When the first living liver donor transplant was done in the US, I was present at the hospital where the baby girl received part of her Mom’s liver. Years later, they looked me up and I was so privileged to see this young woman, healthy and ready to enter college. Her donor, (mother), was equally as healthy. Contracts were a challenge, but real people were the inspiration.

Kidney transplants from living donors were first performed in the 1950s and it was about eight years before kidneys from deceased (cadaveric) donors were viable. I became involved at the time heart transplants were first reimbursed by Medicare in the 1980s and one by one other solid organs and even double organs, e.g. heart-lung, were successful particularly after the development of anti-rejection drugs. Bone marrow and stem cell transplantation as better matching has been developed between donor and recipient have developed rapidly as well. I will always find transplantation fascinating. I was never in a clinical transplant role, my expertise in this field was administering benefits , contracting for services and third party reimbursement.

If you would like to know more about solid organ transplantation or becoming an organ donor see the United Network of Organ Sharing (UNOS) at https://www.unos.org

Information regarding bone marrow transplants can be obtained through the National Marrow Donor Program (NMDP) at https://bethematch.org which matches patients and donors internationally.

And, here’s a bonus site for those who love technology. The so-called “heart in a box” is a development by TransMedics, Inc. Check it out here to see a video (<3min.) of the device with a cadaveric heart actually beating prior to being transplanted into the recipient. http://www.transmedics.com/wt/page/ocsheart-improve-tx_med

The company has also developed a similar device for lungs and livers which can allow donor organs to be transported further as well as tested and treated prior to transplantation. There is little doubt that these technologies will extend and improve life for many.    http://www.transmedics.com/wt/page/organ_care

The future is truly now. 

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Thank you for following along with me in my Recollections of Travel. 

 

Photos by Pixabay

 

Flights Home

Recollections of Travel 

From 1984 through 2005 I traveled nearly every week for work. At first, it was to train clinical staff and open ambulatory care centers (frequently called “Docs in a Box”) in eighteen states. Later, I began Centers of Excellence network development for the same company. Among other things, I contracted for marrow and solid organ transplant services. This position took me to even more destinations including a few times to Canada. In 1997, I incorporated a consulting company still working with transplant centers coast to coast until I reluctantly retired. I believe that I am finally over airport withdrawal but it did take a while. 

During those years of planes, taxis, subways and airports, I made many observations of fellow travelers and others I encountered along the way. I will share some of those recollections that, for some reason, I recall after all these years. Some were intriguing, many more mundane. I’ll let you consider why these memories persisted when so many critical medical and technical facts from those years have evaporated. 

Tampa

While sitting in the airport in Tampa one Friday afternoon, I looked around and noted that almost without exception travelers were either holding or working with a similar small book. Some of these were wire bound, others looked like leather and they came in various sizes. How we loved our Day-Timers back in that day. fullsizeoutput_b02They were badges of our busy lives and demanding careers. One could clearly see that we had a lot to keep up with, places to go and people with which to network. Perhaps few other 20th-century icons made a more important business statement. At that time some kids were using pagers, drug dealers even had mobile phones, but we were reluctant to transition to that digital age back in the 80s, so we proudly carried our Day-Timers everywhere, placed them lovingly into our briefcases and at intervals made critical notes. As I think back to that era, I wish I had saved at least one that recorded a year’s meetings, flights, and appointments. Today we use our smartphones to carry calendars, do banking, prepare and store documents, keep up with e-mail and social media, even monitor or control our homes, but I still recall the small paper pages that functioned on a much more limited basis but seemed equally important at the time.

A man sitting across from me in the waiting area had been dozing off and on. He was dressed in a very finely tailored suit, but the effect was minimized by his splayed legs and occasional snort. One hand was cupped over that bulge between his legs. Was he afraid that someone might steal it if it was not shielded in this manner? When he moved around for a more comfortable position, he changed hands but remained protective. Finally, the flight was called and he awakened, folded his Wall Street Journal and gathered up his leather attache. Standing, he straightened slowly and slightly shook one leg, then the other. Apparently unsuccessful,
he quickly removed the troubling wedgie with a snatch before proceeding down the jetway.
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Atlanta

After a transfer in Atlanta, I’m was finally on the way to Louisville in a much smaller commuter plane. The one busy flight attendant informed us that she was from Columbia and judging from her accent, I assumed that she did not mean South Carolina. Her pre-takeoff instructions included the fact that in an emergency we were to “pull the red liver” to open the door. As we approached Standiford Field (currently Louisville International Airport) for landing the flight attendant’s voice over the speaker gave the following instruction: “If you are enjoying a beverage please pass it to a flight attendant at this time.” So, what do I do if I am not “enjoying” it, but I am simply thirsty, do I keep the cup? I am way too literal to follow instructions tonight.

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Home at Last 

 

Photos by Pixabay