Transplant doc finds himself on receiving end of procedure

A new heart for a surgeon
Transplant doc finds himself on receiving end of procedure

Home News Tribune Online 12/26/07

By CLEM FIORENTINO
STAFF WRITER

As a transplant surgeon, Dr. David Laskow has presided over thousands of miracles. But two years ago, at this time of year, he needed a miracle of his own.

Laskow, director of kidney and pancreas transplant surgery at UMDNJ-Robert Wood Johnson Medical School in New Brunswick, had just turned 50, had always been in good health (a self-described "fairly athletic guy") and was getting ready to go to Atlantic City with his neighbor, Alan Potechin, for a bit of a celebration. Little did he know he was about to have a life-altering experience.

It was Saturday morning, Dec. 10, 2005. His wife, Mary, a medical librarian at Bristol-Myers Squibb in Lawrence, was working. So he was alone at his home in the Skillman section of Montgomery.

"I got out of the shower and starting having chest pains," he said. "They started getting worse. I broke out in a sweat. I started getting dizzy. I called my wife. I called my neighbor. I never called 911, because they found me on the floor."

Luckily for Laskow, Potechin knew the combination to Laskow's front door and was able to get into the house, find Laskow and call for help.

When Laskow awoke, he found himself in bed, unable to move. He had been intubated for almost two weeks and was sick with a bad infection. He was told that, after the heart attack, his blood pressure was low and he had suffered renal, respiratory and liver failure.

He was first treated at Somerset Medical Center in Somerville, where he suffered an allergic reaction to heparin. The drug, prescribed to thin the blood, had instead caused his blood to clot. After the insertion of a balloon pump and a "whole host of medications," he was transferred to New Brunswick.

"It was touch-and-go," Laskow recalled. "They got me to Robert Wood and put me on a mechanical heart. I did better, but over the next 10 days, I started clotting off the mechanical heart. We were worried about a stroke."

The diagnosis had been confirmed. His family had "put the word out from Day One." The transplant surgeon needed a heart transplant.

He had been placed on the list for a transplant with the New Jersey Organ and Tissue Sharing Network in Springfield. As his condition deteriorated and when no appropriate donors were found in New Jersey, the network broadened the search from just New Jersey to the Northeast region. In less then 24 hours, a match was found on Dec. 20.

Laskow was taken to the operating room and given the heart of a 51-year-old Delaware woman.

"I think she died in a car accident," Laskow said. "She was an organ donor who had spent her life helping the handicapped."

Still, Laskow's saga continued.

"On Christmas Day, I became infected with a drug-resistant bacteria," Laskow said. "One drug did work, but it was toxic to the kidneys. Between that and the anti-rejection drug (which is hard on the kidneys), I had to have my medications adjusted just to get through the day."

Two weeks later, he was able to breathe on his own. In January, the infection was under control, his blood thinned, and he regained liver and kidney function.

"I had come in at 190 pounds and now I was down to 135," he said. "I had no strength. I couldn't move my hands and couldn't move much."

In February, Laskow started rehab, but after a week signed himself out. "I thought I could do more at home," he said. "I could work six hours a day at home."

Laskow was back to work six months after the event, "probably too soon," he said. "It's a real miracle that I didn't lose anything mentally."

Laskow, who with Dr. Diane James had started the liver, kidney and pancreas transplant unit at Robert Wood in 1998, was lucky. He knows that. And now, he's committed to helping other transplant patients.

"The act of donating one organ has an exponential effect," he said. "What a powerful event. It winds up affecting thousands of lives. You interact with the world."

More than 4,200 people in New Jersey and close to 100,000 nationwide are on the waiting list for transplants. Of those 100,000 patients, about 70,000 are waiting for kidneys, according to the New Jersey Organ and Tissue Sharing Network, a nonprofit, federally certified, state-approved organ-procurement organization. It is estimated that a name is added to the waiting list every 20 minutes and that 3,000 people die each year while waiting for transplants.

"Bottom line, there is not enough to go around," said Joe Roth, chief executive officer of the network. "Organ donation should be on everybody's list."

Roth blames the organ shortage on misinformation and misperceptions.

"No major religions object anymore," Roth said. "And sometimes people think that if doctors know they are registered, they won't treat them aggressively. This is certainly not true."

There are two easy ways to become an organ donor, Roth said. First, let your interest be known to your family. Sometimes families don't know their loved one's wishes.

And secondly, put it on your digital driving license. This will ensure your consent.

Organs are computer-matched according to compatibility of donor and recipient tissue, determined by various tests, waiting time and the medical need of the recipent.

It is based on factors such as acuity, how sick the patient is, whether he or she is intubated, kidney function and if the patient is being supported mechanically.

"Every hospital in the United States is required — when death is imminent — to call a group like the Sharing Netowrk," said Bill Reitsma, the network's clinical director. "We do an initial exam to see if they're suitable. We dispatch a team and work with the hospital collaboratively."

When the call comes, Reitsma first sends a transplant coordinator, who is skilled in assessing patients and the physical nature of the injuries, and a family-support person, generally from pastoral care or a social worker — "someone who is very, very gifted at sitting with the family," Reitsma said. "First we want to understand the gravity of the situation and then offer the family the option to save someone's life."

Typically, the potential donor has been the victim of a catastrophic injury and has been placed on a ventilator.

The Sharing Network has up to 12 professionals on call 24 hours a day, seven days a week.

Once consent is given, doctors from the network are sent to recover the organs. Doctors from the hospital are also part of the process.

Also, Reitsma said, doctors take into account the concept of "risk-beneift."

In Laskow's case, Reitsma recalled: "David Laskow was so sick, he wouldn't have survived 24 hours. He was in cardiogenic shock. Under ideal circumstances, we would have waited for a bigger patient. We thought that maybe a smaller heart would work, and it's worked great. It's a matter of what's going to help a patient live."

http://www.thnt.com/apps/pbcs.dll/article?AID=/20071226/NEWS/712260386/1001