The Road to a Heart Transplant ... A Journey Made One Step at a Time

One hundred-thousand miles of blood vessels – veins, arteries and capillaries – crisscross the human body like a road map of life. Every drop of blood travels along various routes and makes its way through the heart, the body’s busiest intersection.

By the time his own heart started to give out, Thomas Barnett had traveled considerably more than 100,000 miles in his lifetime. As a truck driver, he traversed the country for 30 years, eating road food and smoking two packs of cigarettes a day.

In 1999, congestive heart failure pulled him over. He gave up driving and took a job working as a radio dispatcher for his old trucking company. Finally, he was placed on a list to await a heart transplant.

The Call Comes

Barnett’s wait ends last Sept. 26, when he receives a page from the transplant coordinator at The Methodist Hospital. A heart may be available within hours, the coordinator says.

Barnett, 56, and his wife Bonnie leave their respective workplaces, unite at their home in League City, and prepare to make the 30-mile journey to the hospital – during the after-work rush hour. Bonnie Barnett tells her husband she is too excited to drive. So Tom, who has been behind the wheel most of his life, drives himself to his own heart transplant, with Bonnie by his side.

At work, Barnett had joked to his co-workers, “I think I’m about to get a three-month vacation.” To his wife, he makes no jokes: “Tomorrow, I’m going to be healthy.”

Hours before, a motor vehicle accident in north Texas suddenly took the life of a young man whose only connection to Tom Barnett is an identical blood type. The victim’s fate sends a team of doctors, nurses and other health care professionals toward an intersection that will result in a new life for Barnett.

6 to 7 p.m.

When Barnett walks into the hospital the night of his transplant, he looks healthier than he really is. Bonnie suspects that, without a transplant, her husband has about six months left to live. Guillermo Torre, M.D., Barnett’s cardiologist at Methodist, agrees.

“Congestive heart failure is a progressive illness,” he says. “Although the rate of progression is not always predictable, the end result is.”

Barnett’s health had deteriorated progressively over time. He could not walk a long distance or do simple tasks without becoming short of breath. Although his failing heart kept working, it failed to pump blood efficiently. Torre had initially managed to increase the strength of his patient’s heart by prescribing medication. For a number of years, the therapy worked, but Barnett’s condition began to go downhill last fall.

“We tried a stronger medication, delivered by use of a portable IV pump strapped to his waist,” Torre says. “But these types of medications are toxic when used for long periods of time, so it was inevitable that he would need a transplant.”

7 to 10 p.m.

The Barnetts register and make their way to the fourth floor of The Methodist Hospital’s Dunn Tower. They are directed to a special hospital room set aside for transplant patients.

Shortly after settling in, the Barnetts are met by transplant coordinator and registered nurse Kristine Dahl, who was the first to receive notice that an organ was available. LifeGift, the organ procurement organization that serves most of Texas, matched the heart from the automobile accident victim to a computer list of potential recipients, and Barnett’s name was chosen.

Dahl informs the Barnetts it is not certain he is going to get a transplant this night.

“Although the outward signs look like the heart may be a good match, we cannot be certain the organ is OK for transplant until the surgeon actually, physically examines the heart,” Dahl explains.

This examination is called visualization. Because most donors die in accidents, visualization ensures no damage was done to the organ. The harvest (surgery to remove the organ) only is performed when doctors are certain the organ is usable.

While Dahl explains this, Matthias Loebe, M.D., a surgeon at Methodist, is aboard a LifeGift-chartered Lear Jet flying to the north Texas hospital where the deceased donor was taken. Upon arrival, Loebe will visualize, and if usable, harvest the heart.

At the same time, the nursing team moves efficiently and rapidly. They carry in papers for Barnett to sign, including consent for the surgery and agreement to receive blood products. They record his vital signs and draw vials of blood. They wheel in equipment to perform an electrocardiogram and a chest X-ray.

Dahl speaks on the phone to Torre, and keeps in touch with Loebe’s progress through a LifeGift representative.

10 to 11 p.m.

While waiting for the go-ahead, Barnett thinks about what he would like to do after the surgery.

“Work on the car, take out the trash, the little things,” he says. “My sister-in-law lives in Arizona, and there’s a mountain close to her house. I want to walk up that thing ... that’s what I plan on doing.”

Bonnie comes close to her husband and squeezes his hand. They have been married 23 years.

During all the years Tom Barnett was on the road, Bonnie stayed at home. The couple made a decision to home-school their two children, so that meant Tom worked constantly to support the family, while Bonnie handled teaching duties.

“He really worked hard to care for us,” she says. “But we missed him ... the kids didn’t see him that much. We needed him as much as we needed the money.”

But when Tom got sick in 1999 he couldn’t drive any more. In some ways, that was a blessing for Bonnie and the children.

“He didn’t realize how much he was missing by being on the road,” Bonnie continues. “We have gotten so much closer over these years.”

11 p.m. to midnight

George Noon, M.D., a surgeon and senior attending physician at Methodist, comes by to talk with Tom Barnett.

Noon is internationally renowned as a transplant surgeon. He has performed 221 heart and lung transplants at Methodist since the late 1980s. Noon tells the Barnetts what to expect when Tom goes into surgery and when he comes out. He anticipates the surgery will last three to five hours. A gurney is wheeled into the room, and Barnett is taken downstairs to prepare for surgery. Ghazala Butt, M.D., the anesthetist, begins to administer the first doses of immunosuppressant medication designed to prevent the body from rejecting the donor heart.

The Barnett’s son Michael, a junior in high school, and daughter Danielle, a college student, come by to be with their dad. Both kids are athletes, strong and blonde. Their dad beams when he talks with them.

Back in north Texas, Loebe is beginning the visualization procedure. Dahl is in touch by phone, waiting to hear the outcome. She checks her watch as the heart is approved. Just after midnight, the donor heart is cut off from the deceased body’s blood supply – a technique called “cross clamping.”

Now the clock starts ticking. A heart can be disconnected from circulation for about four hours and still work properly. At Methodist, doctors prefer to have the heart in three hours or less. Loebe must remove the organ, place it in a special cold solution to keep it alive, and rush back to Houston.

Danielle and Michael hug their father. Bonnie gives Tom a quick kiss. He is wheeled a few hundred feet into the operating room.

Midnight to 1 a.m.

Noon and the surgical team scrub in and prepare Barnett to receive a new heart. The patient is put on a cardiopulmonary bypass machine to take over the functions of the heart and lungs. Noon makes the first incision on Barnett’s chest at about 12:45 a.m.

Noon expects the surgery to be routine, and it is. He begins to trim away the diseased heart and some tissue surrounding it.

Meanwhile, Loebe is flying back to Houston’s Hobby airport with the harvested donor heart. When the plane lands, an ambulance takes him back to Methodist. Loebe tells the driver to hurry, to turn on the siren and lights.

1 to 6 a.m.

At 1:15 a.m., the ambulance wheels into Methodist. Loebe, carrying a blue-and-white cooler with the words “LifeGift” on the side, run-walks into the hospital.

Once in the operating suite, Loebe carefully removes the donor organ from the cooler. The heart, which must be kept at about 5 degrees Fahrenheit, is placed in a bowl of ice. Loebe makes sure there are no malformations in the organ, then cradling the donor heart in his gloved hand, he places it into the open cavity in Tom Barnett’s chest. Then the meticulous work begins, sewing the arteries and veins to the new heart. Small pacemaker wires are also attached to the new heart to help regulate the rate of heartbeat, if needed.

The new heart went in just after 2 a.m. At 3:15, the defibrillator paddles with long handles were applied to the new heart and an electrical jolt kicked the organ alive.

“I have been doing this more than 15 years, and when that heart starts beating, it still amazes me,” Loebe says.

The patient remains on the operating table until 5 a.m., as surgeons repair any leaks along the sutured blood vessels and close up the incision.

Tom Barnett is then wheeled into the intensive care unit, where he spends the day.

First Steps and Going Home

For the next week, Barnett will take his first steps after surgery. Most of his pain comes from the incision, but he has a bit of stomach distress one day. After that passes, he feels great.

Bonnie makes friends with other families in the ICU. The husband of one of her new friends dies of congestive heart failure.

“My prayers go out to them, I know that could have been me,” she says.

Finally, six days after his surgery, Tom Barnett is given the OK to be released from the hospital and go home.

“I feel really good,” he says. “I know I don’t have congestive heart failure anymore. I look forward to going home to my own bed, and not having anything plugged into me.”

The Barnetts will continue to visit Methodist for the next six months. Tom will return to have a biopsy – a catheter procedure in which a small amount of heart tissue is removed – to determine if his body is rejecting his new organ.

He will have one biopsy a week for four weeks, then one a month for the next six months. If there is no sign of rejection, Barnett will need no more biopsies, says cardiologist Torre.

“The immunosuppressant drugs that we have developed over the last decade are very effective in selectively preventing rejection without reducing the body’s entire immune system,” Torre says.

Eventually, Tom Barnett would like to write a letter to the family of the heart’s donor.

“It was God’s will and God’s timing that brought me here and our families together,” he says. “We feel a special bond with these people who we don’t even know.”

Bonnie will continue to work at home while she watches her husband recuperate. She looks forward to the time the family will spend together.

“We finally got Tom back,” she says, “and we’re not letting him go.”

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©2006 Texas Medical Center

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