February 18, 2005

VUMC, VA transplant programs mark milestone

Featured Image

Troy Mickens attends cardiac rehabilitation three times a week at the Dayani Center since his heart transplant in December.
photo by Dana Johnson

VUMC, VA transplant programs mark milestone

For 20 years the transplant programs at Vanderbilt University Medical Center and the Nashville Veterans Hospital have worked together to offer lifesaving procedures to scores of men and women who have served in the United States Armed Forces.

Vanderbilt, through a contractual agreement with the Nashville VA, is one of four approved transplant centers in the United States to provide transplants to veterans. It is this unique relationship, and strong referral base, that helped the Vanderbilt Transplant Center reach a recent milestone — transplantation of its 500th heart.

The lucky recipient was a 25-year-old U.S. Air Force Reservist.

When Troy Mickens awoke from his eight-hour long surgery, he was not sure what all the hullabaloo was about. Besides his family, he was not aware that anyone else was celebrating his new heart.

“I vaguely remember talking to someone about being the 500th transplant, but it still has not really registered,” Mickens admits. “I was still a bit groggy. I guess it's a big deal, huh?”

Vanderbilt's heart transplant program started in 1985. The first patient survived 10 days. It was only the fourth attempt in the state. Three months later, the second heart transplant was performed. The recipient, Jim Bunning, also a VA transplant patient, is still living.

Vanderbilt is among the 20 centers — of 184 nationwide — to reach the 500-plus heart transplant mark.

For Mickens' family, it's not about celebrating the milestones of a medical center. It's the second chance at life that the doctors of the collaborating hospitals were able to provide.

Mickens received his heart on Christmas Eve 2004, one day after turning 25. Diagnosed with cardiomyopathy (an enlarged heart) in February 2004, he began seeing heart specialists at the VA in Atlanta. Later that year, a defibrillator was implanted to help with the irregular heart rhythms.

Soon after that surgery, it became evident that he would need a transplant to survive. He was placed on the transplant list in early November.

While celebrating his birthday with family, Mickens received the call that a heart became available. He was just about to eat a piece of his favorite dessert — a Carvel ice cream cake.

“It had to have been the best gift ever,” Mickens said. “I was able to eat my cake on my father's birthday a few days later.”

Although everyone around was excited about the news of a heart, Mickens said he remained reserved.

“I was trying not to get my hopes up,” he recalled. “I had asked God to bring me a heart for the New Year and this was great because it was early. But I also knew that the heart could get here and not be suitable or something else. You know, there's always Murphy's Law.

“But it all worked out. I could tell a difference after I had the surgery. My complexion came back. My toenails became clear. I could walk around the room one day after my transplant. I even went shopping and out to eat after I was discharged. I could finally do things because I had energy.”

Rashid Ahmad, M.D., assistant professor of Cardiac Surgery, was the lead cardiac surgeon who performed Micken's heart transplant.

There is still one more thing Mickens hopes to do as he continues his recovery.

“I cannot wait to play with my son,” he said. “When he was born, I was taking more naps than he was. I couldn't pick him up or anything. I still won't be able to pick him up at first. He weighs about 23 pounds and he's only 6 months!”

Once Mickens was discharged from the hospital following his transplant, he was placed on a six- to eight-week follow-up schedule with Tracy Johnson, nurse practitioner at the Nashville VA. He and his mother stayed at a local hotel, the Guest House.

His plan included weekly biopsies, cardiac rehabilitation at Vanderbilt's Dayani Center three times a week, and twice weekly educational meetings to learn about day-to-day, post transplant management.

Mickens was allowed to go home to Atlanta in February and will continue to make routine visits to the Nashville VA for checkups.

“We have to make sure the patient is secure with the medication schedule and various lab work that must be done, expectations of their health post transplant as well as the overall recovery process,” said Johnson. “Most of our patients have been sick for a long time, so they are healing not only post surgery, but also from prior illness that led them to transplant.

“We also must ensure that the patient's support person is also well educated about the procedures and care necessary. All of this can be very overwhelming for the entire family and we want to make sure everyone is comfortable and knowledgeable about what is to come, especially before heading home.”

Mickens agrees that the VA does a thorough job, both pre and post transplant.

“The VA has been so instrumental in all of my care,” he said. “Everyone here has been so terrific from transplant to telemetry to the MICU.

“My transplant has given me renewed hope and I've applied to schools in the Atlanta area. I hope to study theology, religion and sociology.”

Javed Butler, M.D., medical director of the heart transplant programs at both Vanderbilt and the VA, said the relationship shared by the medical centers has been a win-win situation for the medical community as well as its patients.

Although both centers house their own transplant programs, all the surgical procedures are performed at Vanderbilt. The VA was responsible for all of Mickens' pre- and post-transplant care, just like the other 59 VA patients before him.

“The Nashville VA is one of only four veteran's hospitals in the country with a heart transplant program,” Butler said. “I think that speaks volumes and is a true testament to the fact that our VA is a center of excellence for advanced cardiac disease care.”

Donor awareness

In recognition of Black History Month, the Transplant Center wants to highlight the need for organ donors, specifically minorities. Although there is a shortage of organs nationwide for all races, there has historically been a disproportionate representation of minorities on the donor lists.

The following statistics will give a better perspective of the problem facing minorities in Tennessee, with a focus on the black population. The information includes numbers for all solid organs.

Between January 1998 and Dec. 3, 2004 there were:

• a total of 1,738 people on Tennessee's waiting list — 1,026 white; 671 black.

• a total of 2,253 Tennessee donors — 1,952 white; 243 black.

• a total of 7,716 transplant recipients in Tennessee — 5,769 white; 1,782 black.

• a total of 2,539 transplant recipients at Vanderbilt — 2,105 white; 365 black.

• a total of 666 on Vanderbilt's waiting list — 466 white; 178 black.

Source: Tennessee Donor Services