April 15, 2004

Avis Thomas-Lester

 

They had worked together for two years, the determined military intelligence analyst with a malfunctioning heart and the committed transplant coordinator and nurse assigned to his case.

 

They had argued together. At first, he had a difficult time comprehending that his heart was no good and that his health would be restored only if he were given a new one. They learned together, poring over research in his room at Inova Fairfax Hospital about heart transplants and the options he would face until a donor heart became available. They prayed together in January, when an external pump was attached to his heart, allowing him, in March, to become one of only a handful of people in the country who could go home to await a transplant.

 

Finally, Micheal King and Tonya Kraus rejoiced when, just a week after he went home, a heart became available to replace his failed one. A random bit of fate had left a donor matching King's blood and body type brain-damaged, and the victim's family had decided to save someone else's life.

 

Kraus called King back to the hospital from his Forestville home, and workers began prepping him for surgery. She checked on him again as he was about to be wheeled into the operating room.

 

"He wanted to know if he could send a letter to the donor family," said Kraus, who lives in Reston. "I started to cry."

 

This week, King, 43, remained hospitalized in fair condition at Inova Fairfax's cardiac intensive care unit. He is eating and breathing on his own and has been allowed to stand up and stretch his legs.

 

LaRenda King said her husband was in good spirits and getting stronger every day. He's been allowed to talk on the telephone and has spoken with some relatives and friends who called to console him on the loss of his mother, who died in New York City two days after the March 27 transplant.

 

"He doesn't remember anything about the transplant," LaRenda King said. "He was a little mystified when we told him he'd had the transplant."

 

"Micheal is going to be fine. He's a fighter," she said. "He always says he fights hard so he can live so he can love me more."

 

Doctors expected to keep him in the hospital until the end of the month. During that time, King is to learn about the new medications he will be required to take for the rest of his life. He will learn about diet and exercise and begin to adjust to life as a recovering transplant patient. He will then spend three to four months recuperating at home, visiting the hospital for weekly checkups.

 

After that, he should be able to return to work and his regular life with no restrictions, officials said.

 

April is National Donate Life Month, to raise public awareness about the need for organ donations. Nationwide, 84,000 people are awaiting transplants, including 2,400 in the Washington area, according to statistics from the Washington Regional Transplant Consortium, based in Falls Church. About 57,000 people are awaiting kidneys, the most frequently transplanted organ, and about 17,000 are in need of a new liver. About 3,500 are awaiting heart transplants.

 

Locally, about 1,800 people are awaiting kidneys, 400 are in need of livers and 18 need hearts. About 17 people die every day in the United States awaiting transplant, WRTC statistics show.

 

Inova Fairfax Hospital, which performed its first heart transplant in December 1986, does 12 to 20 of the surgeries each year, Kraus said. The hospital performs about 20 lung transplants a year; it also has programs for kidney, liver, pancreas and bone marrow transplantation. It is one of two hospitals in the region -- the other is Washington Hospital Center -- that offer heart transplants.

 

"There are only certain centers in the country that do heart transplants," Kraus said. "Originally, it was the surgical team who pushed for it for the patients in our area. There wasn't anything around at that time."

 

Fairfax was first, with Washington Hospital Center applying for a transplant program shortly afterward.

 

A heart transplant, still considered an amazing medical feat, takes four to eight hours. The malfunctioning heart is taken out, except for a small part that is used to anchor the donor organ. The major vessels are connected to the donor organ with sutures. Patients are generally not awakened for at least 24 hours and are kept on a ventilator for about 36 hours. Patients are encouraged to sit up on the second day and are given liquids as soon as the ventilator comes out, Kraus said.

 

"Each patient recovers at their own pace," she said. "We tailor everything based on how the patient is recovering."

 

Joel Newman, spokesman for the Richmond-based United Network for Organ Sharing, which maintains the waiting list for people needing transplants, said that improvements in anti-rejection medications and treatments for transplant patients have lengthened patients' survival. More than 85 percent of heart transplant recipients survive at least one year, and nearly half survive for 10 years or more, he said. Some patients have survived more than 20 years.

 

"All transplant recipients, once they get past their initial transplant, are looking at the combined issues of organ rejection and infection, and the medical management is very important," Newman said, adding that some anti-rejection medications increase the risks of kidney damage, skin cancer and other ailments.

 

Kraus said she has checked in with King since his surgery and is encouraged. Although they worked together for two years before his transplant, a new protocol is called for now, and a different coordinator has been assigned to his case.

 

A cardiac care nurse for 18 years, Kraus began her career at an urban hospital in Buffalo. She started working at Inova Fairfax 15 years ago with heart patients who were treated with heart pumps in the same program to which King was assigned when he began his treatment at the hospital.

 

King had been suffering bouts of exhaustion so extreme that walking from his car to his office required him to rest. A series of tests showed that he suffered from cardiomyopathy, a disease of the heart muscle that affects its ability to pump blood normally.

 

After denying that he needed a new heart, King finally realized how ill he was last year and set about educating himself, with Kraus's help.

 

In January, he was implanted with a Thoratec Biventricular Assist Device (BiVAD), one of a series of devices designed to extend the lives of patients awaiting transplant. King became so knowledgeable about the technology that he assisted Kraus in seminars on the device, even traveling to Prince George's County on a day pass from the hospital to train paramedics in what to do in case an emergency situation arose with the BiVAD.

 

On March 19, he was allowed to go home to await transplant surgery. A week later, King and his wife were resting at home when Kraus called: A donor heart that looked like it might match King had become available. After a five-hour surgery beginning at 2:30 a.m. March 27, King had a new heart.

 

Paul Massimiano, the Inova Fairfax cardiac surgeon who implanted King's heart pump and new heart, said that King's transplant was more complicated than most because of the heart pump. Scar tissue had built up around the device. He said King was placed on a heart-lung machine while he was prepped for the heart, which came available at Fairfax.

 

After surgery, King was progressing well until his kidneys were affected by some of his medications, Massimiano said. Doctors gave him the medications so he could sleep and allow his body to repair itself without having to work so hard, the surgeon said.

 

"He's had a rocky course for the past several days," he said. "Every patient reacts to the heart [transplant] differently."

 

Massimiano said that King was getting progressively better. "He needs more support now, and it's easier to ensure his oxygenation is good and his vital signs stay stable if he's asleep."

 

LaRenda King, 38, a former Air Force active-duty reserve medical technician who works as an intelligence analyst, said she and King hope to have a child together to complete their family, which includes her three children from a previous marriage: Alicia, 17, Shanielle, 14, and Brian Newton, 10.

 

But the first thing they have pledged to do is to write to the donor family.

 

"He just wants to say 'thank you' that they were able to do what they did at a time when they were obviously in a lot of pain," she said. "We both want them to know how much we appreciate what they did."

 

Kraus recalled conversations she had with King about his conflict over praying for a heart. King said as much in an interview before his transplant.

 

"I often feel conflicted about it, because for me to get a heart means that someone else will die," he said. "I know that it won't be my fault, but still you feel for the person who died and what the family is going through during that very difficult time."

 

Kraus said such feelings are not unusual. But statistics show that the need for organ donation is increasing. At the same time, education is helping increase the number of families agreeing to donate their loved ones' organs. The number of people who died awaiting transplant fell to 5,968 last year, after exceeding 6,000 each year since 1999, statistics from the United Network for Organ Sharing show.

 

"We never wish that people die," Kraus said. "Micheal, like other patients, feels very sad for the families who face this and what they are going through. We just hope that families in that position make a giving decision."