At the Forefront Live: One Year Anniversary of Historic Back-to-Back Triple Transplants
December 17, 2019
About a year ago something extraordinary happened here at UChicago Medicine. Two people received triple organ transplants in a 27 hour time period. The two patients were Sarah McPharlin and Daru Smith. Dr. Talia Baker was the liver surgeon. Dr. Yolanda Becker was the kidney surgeon. And Dr. Valluvan Jeevanandam was the heart transplant surgeon. All five will be joining us on the program today to reflect on this incredible feat and talk about how they're doing today. Plus we'll take your questions for our surgeons and their patients. That's coming up right now on At the Forefront Live.
And welcome to At the Forefront Live. I want to reminder our viewers that we'll take your questions for our experts. But please remember that today's program is not designed to take the place of a visit with your physician. First of all, thanks for being on the program, everybody. It's been a year. Does that even seem possible?
Yeah, an amazing year.
Yeah, an incredible year. So let's just go down the row and have each of you tell us a little bit about yourselves and your position here at UChicago Medicine. And we'll start right here with you.
My name is Dr. Talia Baker. I am the program and surgical director for the liver transplant program at University of Chicago. And I've had the privilege of being part of this very multidisciplinary team, doing these multiple organ transplants.
Sure, my name is Val Jeevanandam. I'm the chief of cardiac surgery and director of the Heart and Vascular Center. And I've been here for 22 years and have seen the evolution of transplant in a fantastic way. And I was really privileged to be working with Yolanda and Talia and getting these patients done. And it's so gratifying to see how great they're doing.
And Dr. Becker.
Hi, I'm Yolanda Becker. And I'm the director of the Kidney and Pancreas Transplant Program. It really is a privilege to be here today. And it's hard to imagine that a year has gone by and how great everybody's done.
And the exciting thing is we're going to have Dura and Sarah on the program here in just moment. In fact, they're sitting here in the studio waiting for their turn. So you'll see how fantastic they look now. And it just blows me away every time I see you guys just walking around in the hallways because you look great.
So I want each of you, if you will, just to reflect a little bit on the year, kind of your thoughts now that a year is passed, and watch what's going on.
So I think one of the things that's really remarkable, as we see Sarah and Daru just looking so phenomenal, is that these events which seem so extraordinary are possible. And they're made possible by a bazillion different factors, including the really incredible donors, who came available to give each of these wonderful people three organs each, which have sustained their lives. And they've done a remarkable job being guardians for these organs.
And so we have to thank you guys also for taking such good care of them. And I think it just reminds me what amazing things we can do at University of Chicago when we decide to move forward.
Yes I mean, I think again it's been a fantastic year in that we knew what we could accomplish and then we were able to accomplish in other patients as well. If you realize that triple organ transplants, there's only been 20 done in the history of the world. And we've done 10 of them here and six in the last 12 months.
And I think that's a testament to the entire team. There are three very specific teams-- the liver, the heart, and the kidney teams-- that have to work together. That's just the start. There's a whole infrastructure of social workers and everybody else, nurses that actually make everything happen.
But once you have that team working, then we can actually perform that miracle many times over. So I think that's what's really been super gratifying.
Yeah, and I also think that the amount of collaboration that's happened during the year is amazing. Every time we've done this we've learned something. We've learned something from our patients. We've learned things from the generosity of the donor families and from all of our colleagues. And so every time, it's a unique case. And every time we learn something.
The three of you obviously are close to this, and you do this every day. And this is probably just another day at work for you, even though it's very special I know for you. But from a layperson standpoint, when I observe and get to see little bits and pieces of what you do-- and I'm just blown away first of all.
But what really amazes me-- and I think what really impresses me is the teamwork and the fact you take these different disciplines and you all work together and put it together in this big puzzle. And it benefits the patient in just extraordinary ways. And that to me really is incredible. I don't know if you want to comment on the teamwork and how you all work together. But it's just fantastic.
I think absolutely. And I think one of the things that we've learned in this process-- because we've learned so much in this evolution since a year ago when we kind of started this journey, although many had been done at University of Chicago. It's almost becoming-- I don't want to use the word commonplace, but it's becoming something that we do.
But as Val said, I think there is a tremendous number of people who come into this, just getting to the operating room, the procurement staff, the OR staff at the donor hospital, the amazing donor families who do this and then, as we enter the operating room, the seamless transition that we really get as the surgeons to just jump into. It's kind of all set up for us so that we can do what we need to do to have a technically complicated but very successful outcome for these patients.
And the post-operative care has really been amazing. It's all of the teams, the social workers, the pharmacists, all of our nursing staff, who are phenomenal, have really transitioned these patients from the OR to the ICU to the floor and ultimately to home in the outpatient clinics. And it's remarkable just to see how amazing the whole team functions as a seamless unit.
Yeah, it's incredible. Val.
I think it's the collaboration that makes us super special, because there are programs that maybe do more heart transplants, more lung transplants, or more kidney transplants than we do but nobody who's been able to put all those three things together and have a seamless team. So we talk about this team being seamless. But there's something that works at the University of Chicago Medicine to make that happen, because all other programs in the country don't do this.
And why do we do this? First of all, there's a lot of resources that the hospital and the University of Chicago Medicine provide us. And they give us the latitude and independence to be able to-- and they trust us to do it. And then, of course, we have a great team that works together. And it's a natural cooperation. But it's also something that we work very hard at by having really a lot of communication.
I think that communication is ongoing. And I think, while we sit here as surgeons, we're only representing actually quite a small part of the entire collaboration, because obviously our patients go to the ICU. And our cardiology colleagues, hematology, and nephrology at that point are instrumental in getting through the early period and, of course, in the post-operative phase and clinic and seeing patients, our anesthesiology colleagues transitioning between the teams.
And actually it goes from huge collaboration to something as simple as where are we putting the drains. We've learned over time where we put the drains because I'm the last one coming in. So we've had conversations about where do your drains go so that I can have some space by the time it's my turn for the kidney. So it is a lot of fun.
I do want to get into the mechanics in just a minute. But first, we've got some sound bytes from some of the other patients. And you mentioned that you have done multiple more of these procedures, which is just fantastic. We're going to hear from some of these patients. And let's talk a little bit about the care team, and John, if we can roll that one now.
I was telling someone, I don't think I had one bad encounter with a health professional at U of C, whether it be doctor. The nurses are fantastic. And I wasn't a guest. I was a permanent resident for 110 days. I mean, it's like I lived there. They see me at my worst. They see me at my best. They see at my grumpiest. They see me at my most disgusting.
And the care was just pretty phenomenal. Every nurse I had was great. Every person who came in, technicians, support service staff was phenomenal. Even when I was grumpy and impatient and maybe not in my best behavior, their behavior was always impeccable and just gracious.
The doctors, the nurses, the staff, and everybody are focused on me and the patient. It's all about what they need and what they want. But if you ask for something-- like you can't have ice cream or pizza-- the answer is no. And the nurse will not back off of that. And you can negotiate. You can cry and beg, but the answer is no. But other than that, they will get you a glass of water, whatever you need.
So we shot those interviews a few weeks ago. And it was not too long after each one of their surgeries. So you see how those gentlemen look, and it's just fantastic. I mean, again, hats off to you guys. You did a wonderful job.
Talk a little bit about the mechanics of the whole process, because this is fascinating to me. There is a very specific process and a timing that you have to stick to as you do the different transplants. And I don't know if you can lead us through that.
Sure. So the donor timing is one thing. So all of the organs come from the same donor. So we actually send out two separate teams. We send out a thoracic team and an abdominal team, who deals with both the liver and the kidney. So once that has been done and we get the go, the heart comes back first.
And then Dr. Jeevanandam comes in and does his heart transplant. And then we very seamlessly and pretty quickly and efficiently have to transition over to the liver piece. Now that transition includes, not just us coming in and transitioning, but the entire OR staff basically transitions in this kind of beautifully choreographed ballet.
And there are different anesthesiologists, who very much, not only just transition one in one out, but they work together so that there's an overlap so that they can know, for example, that the hemodynamics of the heart are of a state where it's safe to proceed with a liver transplant.
The people who help us with our circulators and our coordinators up at the table change also-- so the instruments, if you can imagine, completely change. Perfusion changes. Everything changes, but in a way that is completely seamless and doesn't in any way impact the care of the patient.
And then once we're done with the liver, the heart and liver both close their incisions. And then we transition over to the kidney piece of the operation.
And in the meantime, while they're working on the heart and the liver, the kidney actually is the last thing to come out. So the liver team leaves. And after they leave, the kidney gets packaged. And it actually gets sent to Gift of Hope for pumping and then back to us. It has to go out to Itasca. And then it comes back to the University of Chicago, because the kidney, of all the organs, will keep the longest.
And there are ways that we can help to preserve kidney function by placing the kidney on a pump. So we do that. So there is also a transition team. And there's also the Gift of Hope, who also actively participates to take the organ back and forth to Itasca. And that way it arrives on time so, when the heart and the liver are done, then we will proceed with the kidney. And again, there is a switchover, a complete changeover of where the incision is made. The instruments are different. Even the retraction system is different.
At that point, the patient is hopefully a little more stable. So we actually completely reposition from the liver and the heart, where for the heart team and the liver team, the arms are down, we completely move the patient to put the arms out so that the anesthesiologists have access at that point in the case. Because at that point, there are other things that may happen, and it's nice for them to have access. So it is quite a dance at that point.
So I had no idea that you actually sent-- the kidney goes out and goes to another-- that's very interesting.
And these are large teams. Now the operating rooms are pretty big rooms, but they're not huge. So you've got a lot of people shuffling in and out. How many people, Val, work on this whole process? It's probably hard to even guess on that, isn't it?
Well, for the heart team, we have two perfusionists. We have three nurses. We have two anesthesiologists. And we have three people up on the table. That's the minimum. But these procedures are fascinating enough that there's always residents and medical students and other people watching.
And so that's kind of where we start. And then towards the end of the heart transplant procedure, as Talia said, that liver team will come in and, for a period of time, you have the entire liver team and the entire heart team. And they hand off to each other, right? So this is like switching drivers on an Indy 500 race car.
Because you don't want to slow down, you can't slow down because the heart or the liver or the kidney can't survive outside the body for too long a period of time. So you had to save time. On the other hand, you also have to be meticulous as well. So there is a handoff from the surgeon, from the nurses, the anesthesiologists. And that has to happen without anything actually stopping.
And then of course, we hand it off to the kidney team at the end. So we've developed a technique. And actually, Talia tells me that people call her up all the time and they go, how do you guys do it. And it's just something that we have just done organically. But now we actually have to put it down on paper to teach other people how to do it.
But clearly, you're doing something right because, again, as you look at the folks that have gone through this, they do well. And we've got another sound bite that I want to play real quickly, John, talking about the recovery of these patients.
I knew that I would be all right, if I survived. I did think I might be laid up for six months or a year or just rehabbing and so on. But it was two or three days later, I was walking around the room and then around and around. I couldn't believe it. And there's little complications here and there, but nothing major, nothing serious.
And it's incredible. All my family and friends, everybody is just they cannot believe it because they know how it was last year. I could barely get up and walk.
Post surgery, I felt great. But it didn't seem like this huge transformation from pre to post. I know now that they saved my life and that I've got more energy than I've ever had. And so my wife and I used to joke around-- maybe I wasn't lazy. It was actually a sickness. But now all of a sudden, I'm enjoying a lot more energy, which is great.
That's fantastic. So if you can wrap us up, a couple of quick questions-- are multi organ transplants-- this is one from a viewer-- are they becoming more common? Is this something just that we're seeing more here? Or is that something that's happened nationwide?
Well, I think there's a combination. First of all, we're seeing more because the word is out that we do them. And so a lot of programs have sent those patients that they don't think that they could do. And that's kind of our specialty at University of Chicago Medicine, right? Doing things that other people don't want to do and doing them really well.
So I think we are seeing an uptick in multi organs. I think the other thing is that, with advances in medical therapy and in other medication, we're seeing patients who are sicker. And by the time they come for a heart transplant, they often need a kidney transplant as well or they may need a liver transplant also. And in the past, I think we were reluctant to actually do the those patients because they were too complex. But now we take them on. And it's a challenge, but it's not insurmountable. So almost 50% of our cases for heart transplant this year were multiple organs, which is an extraordinary percentage compared to anybody else in the world.
That's fantastic. So I want each of you, if you will, just leave us with a parting thought. And then we're going to get to our patient Sarah and Daru. I'm very excited about that here in a moment. Before we do that, though, I want to thank you again, first of all, for the wonderful work you do and in coming here to tell us about it. That's so neat. And I think our viewers probably just loved that. I did anyway.
So we can start with you, Dr. Baker.
Sure, I think that again it comes back to having the privilege to be part of these really extraordinary things. As Val just said, we at University of Chicago really want to do things that other people won't do. And that's a challenge. That's exciting. That's scary. But it's also a huge privilege. And I think the expertise that the entire team brings together to have outcomes like this when we see Sarah and Daru just looking so wonderful, and our other recipients as well, I think it's something that makes this institution really unique.
We have that tagline At the Forefront of Medicine, and actually it's true, because the atmosphere, the resources, the infrastructure that is provided to us allows us to do extraordinary things. And it's really a privilege to be able to participate in doing those and seeing how well the patients do. I mean, you've seen the sound bites. And they seemed to have a lot more energy than I do. Maybe I need a triple heart transpant.
Yeah, I think, as we head into the holiday season, it's important to express really gratitude-- gratitude to the donor families, to our teams that make this happen, to our patients. I had the privilege of seeing all four patients in the cafeteria and never realized quite how short I was. So thank you for that.
But truly, it is a great privilege to be working at this institution where we can be at the forefront and also true gratitude to our patients for taking care of themselves, for entrusting us with your lives. We appreciate that.
That's fantastic. Let's take a break. And then when we come back, we're going to talk with Sarah and Daru. And you'll hear their stories and how they're doing today. And just prepare to be blown away by, because it's going to be great.
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And welcome back. We have Daru Smith and Sarah McPharlin joining us now. So excited to have you guys on the program. We just talked to three incredible surgeons. And you guys have the stories, though, because you're the first back-to-back double triple transplant team in history, I guess-- so pretty cool.
How are you guys doing today? It's been a year now almost, and just that blows me away. Let's get kind of caught up with you first, Daru. How are things going?
Pretty good. No, I don't want to say pretty good. I want to say amazing. I'm proud of myself at the progress that I've made. I didn't think that I would progress as well as I did. As Neil said, I thought I would be laying around maybe six months to a year maybe just recovering. But three days later, I was standing up. I mean, it hurted really bad. But I was ready for the journey.
Sarah, how about you? You look fantastic.
Oh, thank you. Yaeh I feel amazing. It's crazy how much has happened this past year. I've been really fortunate to volunteer and do like a turkey trot and just make more memories in the city with my family. But I'm no longer cold. I can eat a lot more. I have definitely more endurance. It's been quite amazing.
So you two really served-- and this impressed me so much. You saw some of the interviews we did with some of the other triple transplant patients. And you two really served as-- I don't know. You kind of got them going. You gave them faith. And it was just so touching to see you.
John, I want to go and roll those sound bites. And then we're going to talk a little bit about that and just talk about your source of inspiration.
They're my heroes. You know you have to I woke up from surgery, a couple days went by. And I was really-- I could feel it. And Sarah and Diane came by to see me and introduced themselves. And we talked probably an hour. Then I was wiped out. I was ready for a nap. And she would come by a lot.
It helps to know that I'm not alone and that, if I do get to a point where I need to reach out to someone, now I know they're out there.
And Daru and Sarah, like I say, they went through there. They blazed a trail, and I went right through it. Then Apu was right behind me and then Jerry. So I'm just so excited about that.
So Daru, how does it feel to be an inspiration?
It feels amazing. I feel it's a lot of responsibility that comes behind it and discipline also, because it's a lot of orders you have to follow. But I am happy that I can be an inspiration and really set the standards for recovery.
Sarah, how about you? Because I think when you were going through that, I know you and Daru talked a lot because you met each other in the hallway and you got to chat. But now you're able to really help people that are coming behind you, because nobody else has experienced this, or very few people on the planet have.
Yeah, I think for them it's really important because they got to see people doing so well after the transplant. And I think all of us have formed a family bond. For example, we have a group text, and we can all talk about like different symptoms we're having. Oh, did you go through that before? It's just been really nice that we're all together and that we're doing so well and able to be together.
It was fun. I was up in the Sky Lobby a few weeks ago with you guys. You were getting your-- the whole group was getting their pictures taken. We were doing some interviews, and you all bonded just like that. And it's neat to see you guys sharing stories and that sort of thing. And I imagine that's just tremendously helpful probably not only to the people who followed you, but it's probably good for you guys as well, don't you think?
Yes, I think it's great to actually share a special moment with someone. A lot of people would say, oh, I understand or I feel you. But to actually have someone walk in the same shoes that you're welcome in, it's amazing. It give you a true sense of relief, a true sense of understanding.
Yeah, actually that specific day, we all went to the 4th floor to visit the most recent triple transplant. And it was so cool to see the response from the nurses and just that family member. The wife came out and was just in awe of how well we were doing. So I think it was really motivating and comforting to her that we are all doing so well and that we have this own bond that eventually her loved one could get involved in.
Absolutely. Obviously, organ donation is critical to the success of what you guys went through and it's very important. It's a difficult thing for families obviously to agree to an and deal with. But I wanted to play a sound bite or two from our other patients. And then I want to talk to you about organ donation. John, let's go ahead and roll that one. And then we'll come out and we'll chat with you too about the importance of organ donation.
It's truly the gift of life. I mean, you had this chance amidst tragedy that's happening in your own life or whatever has befalled your life-- if it's an organ transplantation that happens postmortem-- you have a way to impact another generation, another life with that gift. And then also living organ donor transplants have a way to pay it forward in the sense that you have an ability to give someone else the opportunity to live a life.
Yes, I could not imagine losing someone. My life has been tragic free. And I've kept alive. And I'm so thankful to the family of the donors whom I do not know yet. But anyone who's ever made that sacrifice for their family is-- we're grateful, very grateful.
And I want to use my life to help others as much as I can. I don't care about making money more. I don't care about fun things to do, working at an office job. I just want to help, help, help, and I'm excited about getting a degree in nutrition. I think I have good insight into that and fitness. So that's what I want to do. And thanks to all the donors. It's so important for that.
I'm one person who took three precious gifts. And those could have been used for three different people. And so I feel a huge responsibility honoring that gift. But the people I've met, the people who have received similar gifts as me, I think all to the person feel that same way. And I think that's a testament to the awesome power of the gift, the fact that it does change lives and transform lives and transforms people.
So I don't know. I feel like if I could have that conversation with families, it's just the power of your gift is going to change someone and allow them to live a more fruitful, productive, healthy life. And that person might end up doing nothing more but raising a strong family and raising two young boys. But that might be all that's needed to do.
So Daru, what would you say to someone considering an organ donation or a family consider organ donation?
I would say that's life altering in an amazing way. It's just a lot that can be done with-- as you can see, me and Sarah, we wouldn't be here. I wouldn't be able to celebrate my family, celebrating being here. I believe that organ donation makes a major difference. You can save a lot of lives. I would think that the goal in life would be to make a difference and give back. And an organ donation would definitely be a way to do that.
And Sarah, one of the things you've told me about organ donation is that you take this gift so seriously. And to you, you want to honor the person who did that. So it's very important.
Yeah, and I think it's important for families and other people to know that because then it might make their decision easier to become an organ donor. And I think I'm a living testament that organ donation does work, because I had my first transplant when I was 11. And now 18 years later, I'm still doing healthy and well.
And I kind of wish it was an easier conversation on tables with families that way they knew when their love one did pass away, that it was a decision that they wanted to do. Oh, and I also had the opportunity to go to the US Transplant Games. And when you're there, there's just transplant recipients from all the states and the donor families.
So for families that have been donors families, I think it'd be really important for them to go there as well as-- gosh, I had something on my mind. I forgot.
That's OK, but it's exciting to see the positive, obviously, that comes out of that. And I'm sure you can see that at those games, because you see all the recipients who are doing so well. So we're about out of time. But I do want to ask the future. The sky's the limit, and Daru, I want to start with you. You've got your whole life ahead of you. You got a young son. You have a wonderful family. It's an exciting time, I imagine.
Yes, it's very exciting. Again, like I said, the sky's the limit. I'm looking to open a few businesses, definitely raise my son. That's my most powerful moment right there.
I bet he's just getting bigger and bigger, isn't here?
Smart, too, smart, smart, smart-- he's making me nervous.
That's awesome, though.
Sarah, how about the future for you?
Yeah, I'm excited. I just got permission to go back to work. So in the new year, I plan to get a job. And I recently got my OT license in Illinois. So that's exciting. And yeah, I'm just really excited that I am feeling so well. I'm able to eat. I'm no longer cold. And my mom and I are looking forward to doing the hustle, the John Hancock building. So that shows just how well I'm doing and how much energy I Have
Wow. That's tough, too.
Yeah, it is.
Hats off to you on that one. Guys, thanks so much for doing this. It's wonderful to see you again. It does not seem like it could be a year. You both look fantastic.
Thank you. Thanks for having us.
That's awesome. All right, we are out of time. That's all the time we have for the program. Please remember to check out our Facebook page for future programs and helpful health information. Also if you want more information about UChicago Medicine, please take a look at our website at uchicagomedicine.org. If you need an appointment, you can give us a call at 888-824-0200. Thanks again for being with us today. Hope you have a great week
About a year ago something extraordinary happened here at UChicago Medicine. Two people received triple organ transplants in a 27 hour time period. The two patients were Sarah McPharlin and Daru Smith. Dr. Talia Baker was the liver surgeon. Dr. Yolanda Becker was the kidney surgeon. And Dr. Valluvan Jeevanandam was the heart transplant surgeon.
One Year After Triple Transplant Surgery
In December of 2018, Sarah McPharlin and Daru Smith received new hearts, livers, and kidneys. The story of their friendship captured the attention of millions. Since their surgeries, UChicago Medicine has performed four more triple transplants. No other medical facility in the world has done as many.
Leaders in Complex Transplants
With one of the nation’s leading organ transplant programs, UChicago Medicine has performed more heart-liver-kidney transplants than any other institution. We continue to build upon our success and history of innovation to bring the best possible outcomes to our patients, including (left to right) Neil Perry, Daru Smith, Sarah McPharlin and Apurva Patel who all received triple-organ transplants within a year’s time.
Meet the Triple-Organ Transplant Physician Leaders
Hepatology (Liver Disease)