Short-term VAD support worsens high emergency transplant outcomes: Spanish study

Ventricular assist devices have been in the news recently as both a bridge-to-transplant and as a substitute for heart transplantation. I personally know several patients who have had successful heart transplants after being on VAD's and the conclusions of this article suggest that VAD's not be used for severe heart failure patients.


Worse Postoperative Outcomes for Critically Ill Patients Bridged to Urgent Heart Transplantation With VADs Than With Conventional Therapy, Study Suggests

ScienceDaily (Aug. 28, 2011) — Postoperative outcomes of severe heart failure patients bridged with short-term VADs to urgent (- status UNOS 1A) heart transplantation are significantly worse than those of patients bridged with conventional support, recent data of the Spanish National Heart Transplant Registry suggest.

Spanish investigators led by Drs. Eduardo Barge-Caballero and Marisa Crespo-Leiro from the Hospital Universitario A Coruña conducted a multi-institutional retrospective study of 704 patients with critical heart failure, who underwent urgent, high-priority heart transplantation in 15 Spanish hospitals from January, 2000 to December, 2009. One hundred and seven patients had been supported with short-term VADs before transplantation, while the remaining 597 had been bridged with conventional therapy, that included intravenous inotropes, invasive mechanical ventilation and / or intraaortic balloon pump. Implanted VADs were paracorporeal pulsatile-flow devices in 58 cases and extracorporeal continuous-flow ones in 47. Interestingly, mean waiting list time was extremely short, around 5 days, a characteristic fact of the well-organized Spanish high-emergency organ procurement and allocation system.

Despite fairly similar pre-transplant clinical status and end-organ function, VAD bridged patients showed a higher incidence of severe surgical bleeding, longer bypass times and higher rates of primary graft failure than conventionally bridged patients, so as resulting in a significantly reduced post-transplant survival.

In Dr. Barge-Caballero´s opinion, "our data suggest that routine short-term VAD implantation in stable patients awaiting high-emergency heart transplantation should not be recommended, at least in countries with expected short waiting list times, as this strategy might compromise heart transplant outcomes." For the main investigator of the study, "short-term VAD support as a bridge to high-emergency heart transplantation should be reserved for critically ill patients with a deteriorating haemodynamic status, in which conventional therapy is not enough to ensure adequate peripheral perfusion and to avoid irreversible end-organ damage."

This research was presented at the European Society of Cardiology in Paris, France, August 28, 2011.

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Has your life been saved by an organ transplant? "Pay it forward" and help spread the word about the need for organ donation - In the U.S. another person is added to the national transplant waiting list every 11 minutes and 18 people die each day waiting for an organ or tissue transplant. Organs can save lives, corneas renew vision, and tissue may help to restore someone's ability to walk, run or move freely without pain. Life Begins with You

Liver recipient wins big at transplant games

Naomi Smith brings home the gold

Driffield Times Post, UK

For most athletes bringing back one medal from a world championship would be reason enough to celebrate.

But College student Naomi Smith, 18, has scooped no less than seven medals in two major national and international transplant games, taking her overall medal haul to a staggering 39 in six years.

Naomi, who underwent a liver transplant as a baby, took gold in the 100m relay race while competing in the adult category (18-29) for the first time at the 18th World Transplant Games in Göteborg, Sweden.

She also brought home bronze in the cycling 5Km time trial while competing as part of the 120 strong UK transplant team.

“It was really good because it was my first year in the adult category. In the other World Games and certainly in the British Games you knew the people you were up against.

“The 100m is a highly contested competition and I didn’t think I would get anything but I was literally about a 100th of a second off getting a gold,” said Naomi.

“The 100m finish was unbelievable, my leg was in front of hers but her shoulders were in front of mine and it’s the shoulders that count,” she added.

And two weeks ago Naomi proved once again why she is at the top of her game when she took two gold medals for javelin and long jump at the British Transplant Games held in Belfast.

Naomi, of Nafferton, also won three silver medals at the British Games in the 100m race, 200m race and cycling 5K time trial.

“I have 39 medals in total from the Games. My dad has put lots of hooks up in my bedroom to hang them on but I’m running out of hooks now,” said Naomi who is now setting her sights on the next World Games in South Africa in 2013.

“Going to South Africa will be pretty amazing really. For now it will just be training and trying to get a bit fitter for that,” said Naomi who will start her fund-raising for the trip once she has completed her national diploma in sport at Hull College next year.

And once her studies are finished Naomi hopes to help others improve their fitness and lead healthier lifestyles as a personal trainer.

“I would love to help people get as fit as I am. It’s not like it’s a career where nobody needs it, there is always somebody that will need help whether to lose weight or getting healthier,” she said.

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Has your life been saved by an organ transplant? "Pay it forward" and help spread the word about the need for organ donation - In the U.S. another person is added to the national transplant waiting list every 11 minutes and 18 people die each day waiting for an organ or tissue transplant. Organs can save lives, corneas renew vision, and tissue may help to restore someone's ability to walk, run or move freely without pain. Life Begins with You

Don’t let your kidneys fail you

By Dr Vikram Kalra Deccan Chronicle

Diabetes is the common thread running between Basic Instinct star Sharon Stone and Miss America, Vanessa Williams. And with this disease can come the risk of diabetic nephropathy. This is the single most common cause of end-stage renal disease (ESRD) throughout the globe accounting for a whopping 25-45 per cent of all patients enrolled in ESRD programmes requiring renal replacement therapy.

A major cause of morbidity and mortality not only in the developed world, but also in developing countries, the burden of chronic kidney disease (CKD) in India cannot be assessed accurately. What we do know is that about 10 per cent of the new ESRD cases get renal replacement therapy, as the therapy is expensive and there is a scarcity of dialysis and renal transplant centres. Thus, the screening of high-risk individuals for CKD is the best bet.

The CKD link
To begin with, each kidney contains up to one million nephrons — the filtering units of the kidneys. Inside a nephron is a tiny set of looping blood vessels called the glomerulus. Damage to these filters caused by diabetes is called diabetic kidney disease — also known as Diabetic Nephropathy. The problem eventually leads to large amounts of protein in the urine, high blood pressure and declining kidney functions. Even when drugs and a diet are able to control diabetes, the disease can lead to nephropathy and kidney failure.

It is possible for individuals to have serious kidney damage without being aware of it. There may be no specific symptoms of diabetic kidney disease until the kidneys fail completely. The early signs and symptoms that could help include: albumin (a type of protein) in the urine, tiredness and swollen ankles.

However, the symptoms related to kidney failure usually occur only in late stages of the disease, when the kidney function has diminished to less than 25 per cent of the normal capacity. For many years before that point, kidney disease related to diabetes exists as a silent process.

The earliest and the most simple method to detect kidney disease in diabetics is to check for microalbuminuria (albumin in very small quantity in the urine). All diabetics should follow up with the nephrologist for treatment at this stage, as this is a reversible stage of kidney disease in diabetics.

The possible causes
Diabetic nephropathy is a long-term complication of diabetes, but only 20-30 per cent of people with diabetes will develop diabetic nephropathy — it is not entirely understood why this happens. The factors that increase the risk of kidney disease include high blood pressure, high blood glucose levels (particularly in the early stages of diabetes), smoking, a family history of diabetes and diabetic nephropathy and obesity, high cholesterol and triglycerides in the body.

If a person’s kidneys are about to fail, they might experience symptoms such as tiredness, nausea and vomiting, fluid retention and breathlessness. They may also find that they need less insulin than usual. When the kidneys fail, wastes and fluids will accumulate in the body and dialysis or a kidney transplant is needed. People with diabetes who receive transplants or dialysis may experience more medical problems and other diabetic complications.

Detection and prevention
Some people with diabetic kidney failure are suitable for a combined kidney and pancreas transplant. If successful, they regain normal kidney function and have normal blood sugar levels meaning they can stop using insulin.

There are also treatments which may help to delay kidney failure. It is usually necessary to start these treatments as soon as the doctor notices any of the early signs or risk factors.

Here are some ways to help prevent kidney damage

• Ensure that your diabetic control is excellent — follow your doctor’s advice regarding insulin injections, medicines, diet, exercise, and monitoring your blood sugar.
• Control high blood pressure. Have your blood pressure checked several times a year and preferably monitor it yourself at home. If your blood pressure is high, follow your doctor’s plan for keeping it at normal levels. Drugs used to lower blood pressure (anti-hypertensive drugs), especially certain groups of drugs called ACI inhibitors and A2 receptor antagonists, can slow down the progress of kidney disease.
• It is important to consult a doctor or dietician to determine a suitable diet.
• Stop smoking or don’t start smoking.
• Have urine infections treated immediately.
• Control blood cholesterol and triglyceride levels with diet and medication.
• Drink alcohol in moderation; preferably switch over to red wine.
• Aim to achieve and maintain your weight within the correct range for your height and age.
• Exercise regularly.
• Have your urine, blood and blood pressure checked regularly by your doctor.

- The writer is Consultant Nephrology, Fortis Escorts Heart Institute, New Delhi

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Has your life been saved by an organ transplant? "Pay it forward" and help spread the word about the need for organ donation - In the U.S. another person is added to the national transplant waiting list every 11 minutes and 18 people die each day waiting for an organ or tissue transplant. Organs can save lives, corneas renew vision, and tissue may help to restore someone's ability to walk, run or move freely without pain. Life Begins with You

Half of Americans Projected to Be Obese in 2030

Obesity is one of the major criteria when evaluating a patient for an organ transplant. For example,The Journal of Heart and Lung Transplantation stresses that caution should be exercised in considering obese patients for transplantation. Obese patients have a greater risk of morbidity and mortality after open-heart surgery. This is manifested in poor wound healing, increased risk of infection, lower-extremity thrombosis and pulmonary complications. The following report is scary, especially the prediction that 50% of the U.S. population will be obese. Now is the time for all of us to take a look at our lifestyle and aim for one that includes an acceptable body mass index for ourselves and our children.

If the current "obesity epidemic" continues unchecked, 50% of the U.S. adult population will be obese -- with body mass index values of 30 or higher -- by 2030, researchers said.

By John Gever, Senior Editor, MedPage Today

If the current "obesity epidemic" continues unchecked, 50% of the U.S. adult population will be obese -- with body mass index values of 30 or higher -- by 2030, researchers said.

Drawing on data from the National Health and Nutrition Examination Survey (NHANES) series from 1988 to 2008, Y. Claire Wang, MD, of Columbia University's Mailman School of Public Health, and colleagues projected that, compared with 2010, there will be "as many as 65 million more obese adults" in the U.S. by that year.

Obesity prevalence in both men and women in their 40s and 50s would approach 60%, the researchers indicated in the Aug. 27 issue of The Lancet, part of a series of papers on the growing worldwide burden of obesity.

Wang and colleagues also projected that, as a result of the burgeoning obese population, the U.S. will see the following health impacts:

• 6 to 8.5 million more people with diabetes
• 5.7 to 7.3 million more cases of heart disease and stroke
• 490,000 to 670,000 additional cancers
• 26 to 55 million quality-adjusted life-years lost

The economic burden of these increasing morbidities will be substantial, the researchers indicated -- medical expenditures alone will be higher by $48 to $66 billion annually by 2030, without taking into account lost productivity and other indirect costs associated with a generally sicker population.

Reduced productivity would add another $390 to $580 billion to the annual tab, the researchers said, based on a 2009 study linking obesity to lost work time.

Another country with an aging population and a growing problem with obesity is Great Britain. Wang and colleagues analyzed NHANES-like health data collected in England from 1993 to 2008, finding slightly lower prevalences of obesity relative to the U.S., but similar rates of increase.

If the current trends in England continue, they would project to obesity prevalences in 2030 of about 40% in men and 35% in women.

Both NHANES and the Health Survey for England (HSE) involve interviews and physical exams in more than 10,000 people per iteration. The HSE is repeated annually, while NHANES is conducted over two-year periods. In both programs, the individual participants change from one survey to the next, but they are selected to be sociodemographically representative of the national populations.

Wang and colleagues used epidemiological and outcomes data in the literature to estimate the disease burdens that would result from the growing prevalence of obesity.

They also calculated what would happen if everyone's BMI was 1% lower -- approximately 1 kg (2 lb) in an average adult.

"This change might sound small, but such a scenario would have a substantial effect on consequent health burdens," the researchers wrote.

In the U.S. more than 2 million cases of diabetes, roughly 1.5 million cardiovascular disease diagnoses, and about 100,000 cancers would be avoided, their models showed.

Wang and colleagues acknowledged that their calculations were "mere extrapolations from available data" and that current trends may very well not continue.

"Past trends do not always predict the future," they wrote.

An important finding was the rising burden of obesity among people 60 and older, the researchers emphasized. Of the 65 million additional obese people projected in the U.S. in 2030, 24 million would be in this age range.

This population -- already the sickest and most expensive in terms of medical costs -- is the fastest-growing in the U.S. and Britain. Therefore, the overall disease burden and economic effects of obesity may be magnified.

In addition to their caveat about extrapolating trends into the future, Wang and colleagues cited other limitations to the study: methodological issues related to the NHANES and HSE surveys; uncertainties in the relationships between obesity, other diseases, and economic impacts; and the study's 20-year timeframe, which may underestimate future impacts of pediatric obesity,

NOTE:
The study was supported by the National Collaborative on Childhood Obesity Research, which coordinates childhood obesity research across the National Institutes of Health, the CDC, the Department of Agriculture, and the Robert Wood Johnson Foundation.

Study authors declared they had no relevant financial interests.
Primary source: The Lancet
Source reference:
Wang Y, et al "Health and economic burden of the projected obesity trends in the USA and the UK" Lancet 2011; 378:815-25.

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Has your life been saved by an organ transplant? "Pay it forward" and help spread the word about the need for organ donation - In the U.S. another person is added to the national transplant waiting list every 11 minutes and 18 people die each day waiting for an organ or tissue transplant. Organs can save lives, corneas renew vision, and tissue may help to restore someone's ability to walk, run or move freely without pain. Life Begins with You

Liver recipient Steve Jobs resigns as Apple CEO - has pancreatic cancer

'I said if there came a day I couldn't meet my duties I would let you know... that day has come.' Steve Jobs resigns as CEO of Apple

By Rachel Quigley The Daily Mail

Biography: The front cover of Steve Jobs, written by Walter Isaacson, in which he details the Apple boss's battle with cancer. The book will be released in November
Steve Jobs has resigned as CEO of Apple Inc in a stunning move that ended his 14-year reign at the technology giant he co-founded in a garage.

In a letter to the board of directors, he hinted at his on-going battle with pancreatic cancer as the reason, saying: 'I have always said if there ever came a day when I could no longer meet my duties and expectations as Apple’s CEO, I would be the first to let you know.'

He named COO Tim Cook as his successor and said he looks forward to watching the company which he nourished and made into one of the world's most powerful and recognized brands.

Jobs will remain in position as board chairman and is simply relinquishing his seat as CEO.

Apple shares were suspended from trade before the announcement. They had lost more than six per cent yesterday, and lost a further 2.3 per cent in pre-market trading today.

Analysts reminded market investors the news was expected due to Mr Jobs' ill health and it was 'positive' that he would remain as chairman and continue to influence the company.

Apple board member Art Levinson, chairman of Genentech, issued the following statement on behalf of the Apple board: 'Steve's extraordinary vision and leadership saved Apple and guided it to its position as the world's most innovative and valuable technology company.

'Steve has made countless contributions to Apple's success, and he has attracted and inspired Apple's immensely creative employees and world class executive team.

'In his new role as Chairman of the Board, Steve will continue to serve Apple with his unique insights, creativity and inspiration.'

The industry icon, who has been on medical leave since January 17, only briefly emerged in March to unveil the iPad 2. He later attended a dinner hosted by President Barack Obama for technology leaders in Silicon Valley.

Jobs, who was diagnosed with pancreatic cancer in 2003 and underwent surgery, began to grow noticeably gaunt in 2009 and pulled out of appearances, prompting fears that he was seriously ill.

But he denied rumors, releasing a statement saying it was simply a 'hormone imbalance that was robbing his body of the proteins it needs'.

It was then, on 5 January, 2009, that he promised: 'I will be the first one to step up and tell our Board of Directors if I can no longer continue to fulfil my duties as Apple's CEO.'

He received a liver transplant that same year.

Though his resignation letter was short and to the point, it was obviously full of emotion as he thanked 'the best friends he made for life' at the billion dollar company.

He is seen as the heart and soul of Apple, with analysts and investors repeatedly expressing concern over how the company, based in Cupertino, California, would handle his departure.

BGC Financial analyst Colin Gillis said today: 'I will say to investors: don't panic and remain calm, it's the right thing to do. Steve will be chairman and Cook is CEO.

'But Tim has been de facto chief executive for some time and the company has been hugely successful. The vision and the roadmap is intact.'

Tim Cook ran Apple when Jobs went on medical leave and has essentially been running day-to-day operations since early this year, with the company racking up record revenue and profit.

Mr Cook was previously responsible for Apple's worldwide sales and operations, including management of the supply chain, sales activities, and service and support in all markets and countries, according to ABC.

He has been at the company since 1998 and was recently given a $5million bonus as well as 75,000 restricted stock units as a thank you for his 'outstanding performance'.

Apple officially became the most valuable company in America this month and is now worth $338billion, $1billion more than Exxon Mobil.

It was confirmed in February that Jobs was receiving treatment for cancer after the 56-year-old's gaunt appearance fuelled rumors that he might resign any day.

Pancreatic cancers are generally some of the most lethal of all tumours, and the most common type often kills within six months.

Jobs has battled a less common variety that grows far more slowly and develops in the hormone-secreting section of the pancreas, according to USA Today.

Although diagnosed in 2003, his illness was not disclosed until the following year, after he'd had surgery.

The fiercely private CEO has said relatively little about his health problems, although he did acknowledge his bout with cancer during a commencement speech at Stanford University, saying: 'No one wants to die. And yet death is the destination we all share. No one has ever escaped it.'

In June, Jobs got a standing ovation at a software developers' conference in San Francisco to introduce an operating system called Lion and a wireless service called iCloud.

From the conference people tweeted that he looked 'gaunt', 'exasperated' and 'very ill'.

He stayed on stage for only three minutes before handing it over to Phil Schiller, Apple's senior vice president for worldwide marketing.

He demonstrated how photos taken with an iPhone were visible on a user's iPad moments later.

The iPhone 5 is due to hit the shops in September with almost 40 per cent of Apple customers saying they would buy it even before they had set eyes on it.

As news of Jobs' resignation spread, Twitter and Facebook exploded with tributes to him.

Teresa Kopec tweeted: 'Few *things* have given me more sheer pleasure to own than iPods, iPads, & iPhones. I'll miss your brain Steve Jobs.'

SusaNorlean wrote: 'Very sad hearing about Steve Jobs. That can't be good news about his health.'

Late Will posted: 'Steve Jobs proves all the money in the world means NOTHING if you're not healthy. Take the time to take care of yourself.'

Others worried about the future of Apple without its mastermind behind it.

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Has your life been saved by an organ transplant? "Pay it forward" and help spread the word about the need for organ donation - In the U.S. another person is added to the national transplant waiting list every 11 minutes and 18 people die each day waiting for an organ or tissue transplant. Organs can save lives, corneas renew vision, and tissue may help to restore someone's ability to walk, run or move freely without pain. Life Begins with You

Cystic Fibrosis steals simple joys

By John Maslin Wanganui Chronicle, New Zealand
Cystic fibrosis (also known as CF or mucoviscidosis) is a genetic disease which affects the entire body, causing progressive disability and often early death. However, the prognosis has improved. In 1970, children with CF were lucky to reach 19. In the US, the life expectancy for infants born in 2008 with CF was 37.4 years. John Maslin meets three people with an intimate knowledge of cystic fibrosis

Whenever they hold a cystic fibrosis conference, any of those with the disease who want to attend have to get a medical clearance before they can go.

And meeting old friends is usually restricted to an "air hug" for fear of transmitting an infection.

Welcome to the world of the cystic fibrosis sufferer.

Erin Bartrum is a bright, ebullient woman who celebrated her 42nd birthday on August 19. Born with CF, her life expectancy was dismal, but she has beaten the odds and received a double lung transplant in January last year.

From living like an invalid, where every action was a struggle because her breathing couldn't cope, Mrs Bartrum is doing the normal things a house-proud woman does.

CF is an insidious killer, with the average carrier having a life expectancy of about 40 years. When Mrs Bartrum was born, 41 years ago, that life expectancy rarely exceeded 19 years.

Her younger brother had CF too, but he died aged 10, so Mrs Bartrum knows her transplant was a lifesaver.

For those with CF, hospitals can become second homes, while physiotherapy and medication are daily necessities.

Before her lung transplant, Mrs Bartrum's life was a living hell. Breathing was such a struggle that she had problems doing something as simple as eating.

"Think of trying to eat while you're running and you get the idea," she said.

Her transplant was not without complications, and instead of being out of hospital in two or three weeks, she was there for about four months.

"The lung transplant was good from the start, but my stomach packed up and then they found a bowel cancer and that meant another six operations."

One in 25 New Zealanders carry the CF gene, but it's often not until they have children that they know that.

Both parents have to carry the gene before it can be transmitted to their offspring.

Mrs Bartrum's mother, Madeline McCrea, said being born with CF meant her daughter didn't gain weight until she was 9 weeks old.

"She just couldn't absorb any food," she said.

It was after Erin's birth that she and her late husband discovered they both carried the CF gene, which was being transmitted to their children.

That's why Mrs McCrea joined her daughter and another mother, Anna Scoullar-Jones, in helping with CF Awareness Week in Wanganui from August 15-21.

The theme of the week was bubbles.

"It takes breath to blow bubbles and some of these CF kids just don't have the breath to blow bubbles," Mrs Bartrum said.

Ms Scoullar-Jones' son Lockie, 11 - like most other sufferers - was diagnosed with CF at birth.

For Lockie and others afflicted with this debilitating disease, diagnoses and treatment have come a long way.

"The lifespan is increasing, largely through medical research and treatment," Ms Scoullar-Jones said.

Lockie has physiotherapy about 20 minutes every day to ease his congested lungs, but other than that he lives life as most 11-year-old boys do.

"He occasionally has problems with his digestion and the occasional chest infection and that will require hospitalisation."

But Ms Scoullar-Jones said the disease could still claim people at a very young age. "When Lockie was born, they told us that time would tell how long he would live."

After her transplant, Mrs Bartrum was shown her old lungs. Only about 20 per cent of both lungs was functioning properly.

With that sort of incapacity, day-to-day routines were a real struggle. Mrs Bartrum was on oxygen 16 hours a day.

Now, with her new lungs, she's working part-time, her appetite is back (it's "impressive", according to her mum) and she does usual around-the-home tasks like the laundry and vacuuming.

"To see her do her own housework, gardening, things like that, is a joy to watch from my point of view," Mrs McCrea said.

"It's about being normal," her daughter agreed.

WHAT IS CF?

Cystic fibrosis is a progressive, life-long condition in which the glands that produce mucus, sweat and intestinal secretions do not function properly.


Thick mucus accumulates in the lungs, leading to breathing difficulties and infections. The severity of the disease varies.


There is no cure for CF, but treatments are available to help improve quality of life.

Although some people with CF still die in infancy, many live into their 30s or older.

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Has your life been saved by an organ transplant? "Pay it forward" and help spread the word about the need for organ donation - In the U.S. another person is added to the national transplant waiting list every 11 minutes and 18 people die each day waiting for an organ or tissue transplant. Organs can save lives, corneas renew vision, and tissue may help to restore someone's ability to walk, run or move freely without pain. Life Begins with You

Female heart/lung surgeon thrives in Australia

Medicare Supplement Plans

Still a man's world?

All in a day's work … Emily Granger is one of only a handful of female heart/lung surgeons in Australia. Photo: Andrew Goldie

I find transplantation fascinating: taking a donor heart and sticking it in someone who's at death's door, then watching that heart spring to life. All of a sudden, this patient who's been wobbling around has almost got headaches because their blood pressure is so good. It's absolutely amazing

By Alyssa McDonald The Sydney Morning Herald
From mine sites to operating theatres, gender barriers are still being broken at work.

From Sunday Life
Women may make up half the Australian workforce, but there are still plenty of careers where only a tiny proportion of workers are female. The lack of women in the boardroom and in parliament is much discussed – but what about in operating theatres or on building sites?

There is an economic incentive to enter these occupations. Male-dominated industries tend to be better paid than their female-led equivalents. It's a disparity highlighted in May by the Fair Work Australia tribunal, which ruled that ''gender has an important influence'' in the underpayment of predominantly female community workers in ''caring'' roles.

But it's not all about money. These four women from various parts of Australia have followed different career paths and live very different lives. But each of them has chosen an occupation in which few women are found. Here, they tell their stories:

Emily Granger, 36
A cardiothoracic and heart/lung transplant surgeon at St Vincent's Hospital, Granger lives in Sydney with her husband and two daughters.

We have approximately 100 cardiac surgeons in Australia, and about eight are female. But that's changing; there are more females training now. People are more understanding when it comes to maternity leave – or paternity leave.

I operate two days a week. On the third day, I see my outpatients and new patients. For the other two days, I try to spend time with the girls because they're still very young. A lot of the time you get emergencies or extra operations. But, generally, at least one day a week I can do the kindy drop-off and pick up, and I try most nights to get home in time to put the girls to bed.

To become any sort of surgeon takes a good 10 years after graduation. I find transplantation fascinating: taking a donor heart and sticking it in someone who's at death's door, then watching that heart spring to life. All of a sudden, this patient who's been wobbling around has almost got headaches because their blood pressure is so good. It's absolutely amazing.

Because I was still pretty young when I was training, I thought, "I'll have my children after I've got the piece of paper, then no one can take that away from me." These days, with the change to postgraduate medical degrees, most people are two or three years older, and that is going to put a lot of pressure on women.

Ever since I came to Sydney, I've had the same nanny; she's like a third grandmother. And my husband is very hands-on; he does fly-in/fly-out with mining, so when he's home, he's home. He seems to take the girls to a lot of car yards at weekends, so they have this appreciation of expensive cars.

Personally, I've never had any issue being a female heart surgeon. In the operating theatre, people will test the boundaries a little bit because the only other females are nurses. So you have to make sure your decisions are respected; my manner is very businesslike. As a surgeon, you're a leader in the operating theatre, and I think your behaviour reflects on other people.

A lot of the people we operate on come from out in the bush. They're generally pretty easy-going. Some patients get a little confused and say, "Well, I never saw my surgeon, but this lovely nurse came to see me every day." But it doesn't upset me at all. The point is that they get well.

Kirsty Liddicoat, 29
A planning engineer, Liddicoat works at two iron ore mines in Western Australia.

There are always going to be some men who are horrid; it doesn't matter what industry you're in. Just because you're on the mines doesn't mean there's more of them. But you may have to live in the same area as them for nine or 10 days at a time, and some of the older ones, I find, just don't think females should be there. There are some you just have to ignore, and that can be tough. But then there are some who become like brothers and uncles – good friends.

As a planning engineer, I schedule what equipment is going where and at what time. I'm pretty lucky at the moment, I don't start until 6.30am. We do planning work, we look after reporting, and I also do design work – designing ramps, changing wall angles, all the incidentals.

On my site, there are quite a few women. There are more females than people perceive on mine sites. I've worked in two teams of professionals where more than 50 per cent of the team was female. But that's not including everyone on site. And it does vary.

When I was a geologist I spent time working on oil rigs, where only the chef and I were female. We lived on a boat, there were 30 people, and the chef and I had completely different hours. I worked with really good guys – we got along as friends, they didn't harass me, they didn't expect anything of me. But I have heard stories that were the other way around.

Since the start of this year, I've been the deputy chair of the Women in Mining group. There's about an 18 per cent pay difference for women in the mining industry, there's a lack of access to flexible work practices, and then there's bullying. Men face it as well, but women are targeted slightly more.

My key aim is to set up a phone support line for females in the industry. As a woman, when you go to a new site, everyone knows who you are. It never gets any easier. You do need to establish yourself: "I can change a tyre; I'm not going to put up with you saying things." You can't be a prima donna.

Mining life is tough on relationships. You hear that from men as well. I'm single, and I think part of that is due to the fact I've lived in mining towns for four or five years. I decided about three years ago to work fly-in/fly-out, so I could live in a city and get away from some of the people I work with sometimes. I like the lifestyle. But if you're looking at having a family, then your options are residential or a city-based role. I intend to be at a point in the next five to 10 years where I can work in a city-based managerial position.

I'm working towards my quarry manager's certificate and for that you need time on a blast crew – sometimes you carry buckets that weigh 20 or 30 kilograms each. I'll carry half buckets where the guys will carry full buckets. Most females just don't have the same strength as guys. But as long as you're willing to do a job, they don't mind if you can't carry quite as much - you're doing as many loads. And any excessively heavy lifting is done mechanically these days, anyway.

Ellen Mills, 28
A painting apprentice with the Queensland government's Women in Hard Hats training program, Mills lives in Townsville with her four children.

On an average day we do a lot of internal painting, and some external, depending on the weather. A lot of plastering and sanding. We do a lot of Department of Housing places, but last week we were on a cherry picker, and it was my first time using a spray gun. The best part is the clients' faces once you've done their houses; some have had paint peeling for years.

I'm the only woman on the team, and it's the first time they've had a woman on board, too. It's good. If we have issues, we deal with them right away; just minor issues, like miscommunication between myself and tradies about what I'm supposed to do. But we've kind of bonded; we work well together now.

Before this, I was working part-time as a nurse's assistant. I'd never done any painting in my life. I didn't think I was going to get the apprenticeship. Being a woman from an Islander background, my family and friends just thought, "Nah, you can't do a man's job." At first I thought it was going to be hard because of cultural stuff, but once you give it a go, you learn how to work it. I grew into it, and I love it now.

There's not really any part of the job that's more difficult for me because I'm female. The only challenge I have is being a single mum of four. I've gone through a marriage break-up in the past eight months. Work is very good, but I still have to go home to a full-time job, you know? But I've finally got a routine – daycare is very helpful.

I want to carry on painting, but I also want to try other things. A program like [Women in Hard Hats] will help a lot of women, because it gives them a way to get in the door. We had a family funeral at the weekend, and we had a lot of family come. The majority of them are unemployed, but they're like, "How did you get into where you are now?" And I'm like, "I gave it I a go." People have to be aware that it won't come to you. I've got three daughters; I don't want them growing up thinking they can't do whatever they want to do.

Cheryl Praeger, 62
One of Australia's top pure mathematicians, Praeger is a professor at the University of Western Australia.

I was really lucky as an undergraduate in having two wonderful women as lecturers. That was at the University of Queensland in the mid-'60s, and there were very few women on the teaching staff at universities then. I also had a mentor in [influential mathematician] Bernhard Neumann. And I married a mathematical statistician, who has really supported me throughout my life - I mean, neither of us knew if I was going to get a job.

For the last couple of years I've been on the Federation Fellowship, the premier research fellowship in Australia. So my life has changed quite a bit – I used to have a spread of responsibilities across undergraduate teaching, postgraduate supervision, administrative leadership. These days I am more focused on research. I have a lot of postdoctoral researchers, I'm editor-in-chief of a lecture notes series ... I work all the time.

At my very first international conference in the US, I was the only invited lecturer who was a woman, and in other conferences I've been in a very small minority. It used to feel quite strange, so I'm pretty sensitive to getting to know some of the younger women and trying to be supportive of them. At the moment I've got two women in my research group and one of six PhD students is a woman. It's still a minority, but it is a mix. I am seeing more women now at conferences. I'd love to see more – it will be wonderful when it's 50-50, or even 30-70.

When I entered the mathematics profession, all the women wanted to pretend that they were just like everybody else. Except they weren't. It's only been in the last five to 10 years that we've had meetings of women participants at the national gathering of the Australian Mathematical Society. I don't know what that indicates. There's enough of us to do it? That we still need to do it because it's not completely normal to be a woman in that discipline?

It was really important to me to have a family – I've got two grown-up boys. But I felt to be taken seriously as a mathematician, I shouldn't be taking a lot of time off. I think it's easier these days. It would have been easier for me if I'd had a little more time. I don't know how people do this running around and changing locations. I've been incredibly lucky. I thought [my husband] John and I were coming to Western Australia for two years, and we ended up staying – I became a professor here at the age of 35.

As a woman in academia you have all kinds of roles: being a role model, being involved in helping shape the institution you work for. Somehow you feel like women have to be superwomen and I think a lot of women overachieve in senior roles. Which is good for the profession. Maybe not so good for the women!

“You Have the Power to Donate Life – Sign-up today!
to become an organ and tissue donor
Tell Your Loved Ones of Your Decision”

Canada Ontario,
Canada - British Columbia, other Canadian provinces

United States, organdonor.gov

United Kingdom, register at NHS Organ Donor Register

Australia, register at Australian Organ Donor Register

Your generosity can save or enhance the lives of up to fifty people with heart, kidneys, liver, lungs, pancreas and small intestine transplants (see allotransplantation). One tissue donor can help by donating skin, corneas, bone, tendon, ligaments and heart valves

Has your life been saved by an organ transplant? "Pay it forward" and help spread the word about the need for organ donation - In the U.S. another person is added to the national transplant waiting list every 11 minutes and 18 people die each day waiting for an organ or tissue transplant. Organs can save lives, corneas renew vision, and tissue may help to restore someone's ability to walk, run or move freely without pain. Life Begins with You

Australian liver recipient promotes organ donation

For Todd, life is looking rosy

''We are so grateful'' … Todd Bratfield with his wife, Sharon.
By Jim O'Rourke The Canberra Times

YELLOW is not Todd Bratfield's favorite color.

The father of two from Stockton, in Newcastle, was getting fed up with people telling him his eyes were a ''bloodshot yellow'' and that his skin was the color of a pale banana.

Over 20 years, the former dairy farmer's coloring slowly changed because his liver was deteriorating because of a disease called primary sclerosing cholangitis. Nine months ago, he was told the organ was on the verge of total failure and he needed a transplant to save his life.

In February The Sun-Herald reported that Mr Bratfield was one of the four faces of Transplant Australia's Journey of Hope campaign aimed at encouraging people to discuss organ donation and to register as donors. The campaign, supported by The Sun-Herald, also wanted to attract more funding to support organ recipients and their families.

Mr Bratfield received that new liver at Sydney's Royal Price Alfred Hospital this month. The 44-year-old was one of about 170 people waiting for a liver transplant to help save their lives. There are about 1700 other Australians needing transplanted organs and tissue.

''Even the day after the operation that yellow jaundice colour was disappearing,'' Mr Bratfield said. ''That bloodshot yellow in my eyes was gone and I don't look as old or tired as I did. I'm just thinking about getting myself up and going and looking forward to being able to do things like camping with my kids again.

''We are so grateful to the donor's family, who have given me another chance and grateful to the liver transplant unit at RPA.''

On Wednesday, Transplant Australia and campaign media partner 2GB, as well as 2CH, are staging a radio appeal for donations from the public and corporate Australia. To donate on Wednesday call 1800 827 757.

Transplant Australia's CEO, Chris Thomas, said 2GB presenters Alan Jones, Ray Hadley, Chris Smith and Ben Fordham would interview recipients, donor families and medical staff to highlight the difficulties faced by families as they wait for transplants.

''The life of someone waiting for a life-saving transplant is very challenging,'' Mr Thomas said. ''Not only do they have to deal with uncertainty, their families are often dislocated as they move interstate to be next to a transplant unit while they wait … Lives are put on hold.''

Another Journey of Hope participant, Patricia Scheetz, 28, visited Mr Bratfield and his wife, Sharon, at RPA to congratulate them a few days after the operation. Ms Scheetz, who has diabetes, was given a new kidney and pancreas in June after spending nine months on the waiting list.

''She looked really, really good,'' Mrs Bratfield said.

The campaign's two other faces - Geoff Bromley, 41, and 16-year-old Tianna Buller-Rushworth- are waiting for heart transplants.

“You Have the Power to Donate Life – Sign-up today!
to become an organ and tissue donor
Tell Your Loved Ones of Your Decision”

Canada Ontario,
Canada - British Columbia, other Canadian provinces

United States, organdonor.gov

United Kingdom, register at NHS Organ Donor Register

Australia, register at Australian Organ Donor Register

Your generosity can save or enhance the lives of up to fifty people with heart, kidneys, liver, lungs, pancreas and small intestine transplants (see allotransplantation). One tissue donor can help by donating skin, corneas, bone, tendon, ligaments and heart valves

Has your life been saved by an organ transplant? "Pay it forward" and help spread the word about the need for organ donation - In the U.S. another person is added to the national transplant waiting list every 11 minutes and 18 people die each day waiting for an organ or tissue transplant. Organs can save lives, corneas renew vision, and tissue may help to restore someone's ability to walk, run or move freely without pain. Life Begins with You

Ottawa, Canada teen is waiting for new lungs

Family urges public to register as organ donors

By Alex Weber Ottawa Citizen

Fourteen months.

That's how long Thomas Quinet has been waiting for his third set of lungs.

The 14-year-old Ottawa teenager was born with cystic fibrosis, a genetic disease that causes mucus to build up in the lungs and pancreas making it difficult to breathe and digest food.

He had his first double lung transplant in 2007. It went well, and, according to his father Marc, Thomas was able to enjoy two-and-a-half years of normal life.

He could walk, run, play sports, all the things boys his age normally did. In fact, months after his operation Thomas competed in the Canadian Transplant Games, bringing home a gold medal in badminton and a bronze in five-pin bowling.

"He really made the most of that, and that in fact has been the hardest part I think, with the exception of where he's at right now, that taste of the good life and how it has been taken away from him," Marc Quinet said.

By late 2009, though, Thomas wasn't responding well to treatments and his body began rejecting his new lungs, something that happens in 50 per cent of transplant cases.

When their doctor suggested a second double lung transplant in January 2010, Marc, Thomas and his mother Suzanne Camu were shocked. "It was a tough pill to swallow," Marc said. Thomas, who was 13 at the time, wanted to explore other options, so the family went to Alberta to get a second opinion, but the verdict was the same.

On June 15, 2010, Thomas's name joined 1,556 others on a list to receive transplants and the family moved from their home in Ottawa to a temporary apartment near Toronto's SickKids Hospital, where Thomas was receiving treatment.

Over the next eight months, Thomas tried to live a normal life. Four months ago, though, he took a drastic turn for the worse.

On Aug. 7, he was hooked up to a novolung, a ventilator to help him breathe. Since the technology is so new and rarely used on children, Marc says doctors don't know how long the machine will keep him alive, but said it probably wouldn't be longer than a month.

Marc and his wife, Suzanne, are on a mission and are appealing to the public to help save their son's life. They're asking anyone who hasn't already done so to register as a potential organ donor, and anyone who has already signed up to donate is asked to spread the word.

Since Thomas's name was recently added to a North American-wide list for organs, his chances of receiving new lungs have improved.

"We're hoping," Marc said. "We've been through a lot, especially Tom, and people like Tom deserve help."

To become an organ donor in Ontario visit www.beadonor.ca (see below for donor links in other areas)

“You Have the Power to Donate Life – Sign-up today!
to become an organ and tissue donor
Tell Your Loved Ones of Your Decision”

Canada Ontario,
Canada - British Columbia, other Canadian provinces

United States, organdonor.gov

United Kingdom, register at NHS Organ Donor Register

Australia, register at Australian Organ Donor Register

Your generosity can save or enhance the lives of up to fifty people with heart, kidneys, liver, lungs, pancreas and small intestine transplants (see allotransplantation). One tissue donor can help by donating skin, corneas, bone, tendon, ligaments and heart valves

Has your life been saved by an organ transplant? "Pay it forward" and help spread the word about the need for organ donation - In the U.S. another person is added to the national transplant waiting list every 11 minutes and 18 people die each day waiting for an organ or tissue transplant. Organs can save lives, corneas renew vision, and tissue may help to restore someone's ability to walk, run or move freely without pain. Life Begins with You

Double-lung transplant gives goaltender chance to move from beer league to the big leagues

This is a follow up to my earlier post about 43-year-old cystic fibrosis patient Trevor Umlah who has been invited to the professional hockey camp hosted by the East Coast Hockey League's Elmira Jackals in New York state. Trevor received a double-lung transplant four years ago at Toronto General Hospital and has been an avid advocate for organ and tissue donation awareness ever since. Trevor's story is another fine example of how life-transforming an organ transplant can be.

Back in the game

By Laura Fraser The Chronical Herald, Halifax, Nova Scotia

EIGHT SECONDS into his first game in two years, a slapshot ricocheted off Trevor Umlah’s breastbone. The goaltender sucked a breath into the pair of healthy pink lungs that had been transplanted into his chest only six months before. He touched his sternum — strengthened, perhaps, by a little titanium.

Then he smiled and got ready to block the next shot.

"My only worry (was) that my sternum would not hold up, but that was put to rest in about 10 seconds," he laughed Wednesday, recalling the game in early 2008.

"I was really surprised that I still had the skills. I didn’t have the strength or the endurance at the time, but I still had the reflexes. My mind was still with the game."

Today, Umlah’s lungs are stronger, his goalie pads brand new. The Dartmouth man hopes both will serve him well when he tries out next month with the Elmira Jackals of the minor-pro ECHL.

Umlah, a contract manager with Air Canada Jazz, turned 43 earlier this month. That’s the same age at which Gordie Howe first retired from the NHL in 1971. (Umlah points out that Howe later returned for an incredible seven more seasons.)

But Umlah doesn’t expect to be the next Gordie Howe. He doesn’t expect to make the Jackals.

"There were no scouts looking for me," he jokes. "I’m really doing this to promote organ and tissue donation. A lot of people may be hesitant to be an organ donor simply because they think the quality of the person’s life who may receive that organ may . . . not be up to their expectation.

"So I’m trying to show that this is the quality of life that can be achieved."

Since Umlah’s transplant in August 2007, he has started biking again, and he runs and swims. He did all three sports together in his first triathlon last month.

And he’s back in the "beer league" hockey he’s been a part of for 22 years. He had to take a sabbatical in March 2006 when his cystic fibrosis became so advanced that he would soon begin using a portable oxygen tank.

The next spring, he started playing the waiting game.

Umlah learned in February 2007 that he needed a double lung transplant to survive. He left for Toronto that June — the surgery isn’t performed in Nova Scotia.

"It felt like lugging a refrigerator on my back everywhere I went," he says. "Towards the end, I was really . . . tethered to an oxygen line so I didn’t have a lot of freedom. When I had the opportunity for a lung transplant and an improved quality of life, I jumped at it. There was no decision for me."

Some people wait months for a donor to be found. Umlah got the call about three weeks after he arrived in Ontario, while he was at St. Michael’s Hospital listening to a doctor tell him he would have to be put on a ventilator to breathe at night.

He spent a month in hospital after the surgery and three more in rehab. By the six-month mark, he was back in net.

And while he doesn’t expect the New York state team to sign him, he hopes to hold his own against men 20 years his junior who have been groomed for the sport since they first laced up a pair of skates.

"I play at the rink on a weekly basis with a number of my buddies (and) most of them are in their 20s and 30s so they work me pretty hard," he says. "I get a lot of difficult shots . . . so I think I’m as prepared as I’m going to be to face these pro-level shooters."

And if he does get an offer?

"Then I’ve got a real big decision to make," he laughs.

“You Have the Power to Donate Life – Sign-up today!
to become an organ and tissue donor
Tell Your Loved Ones of Your Decision”

Canada Ontario,
Canada - British Columbia, other Canadian provinces

United States, organdonor.gov

United Kingdom, register at NHS Organ Donor Register

Australia, register at Australian Organ Donor Register

Your generosity can save or enhance the lives of up to fifty people with heart, kidneys, liver, lungs, pancreas and small intestine transplants (see allotransplantation). One tissue donor can help by donating skin, corneas, bone, tendon, ligaments and heart valves

Has your life been saved by an organ transplant? "Pay it forward" and help spread the word about the need for organ donation - In the U.S. another person is added to the national transplant waiting list every 11 minutes and 18 people die each day waiting for an organ or tissue transplant. Organs can save lives, corneas renew vision, and tissue may help to restore someone's ability to walk, run or move freely without pain. Life Begins with You

First baby born to parents who both received liver transplants

Photo: EMILY MICHOT/MCT
Howard Cohen - McClatchy Newspapers
The Toronto Star

MIAMI — America fell in love with Trine Engebretsen when she made headlines as the first Florida-born person to receive a liver transplant.

Barely 2-years-old in 1984, little Trine rode a wave of national affection when President Ronald Reagan mentioned her name during one of his radio addresses to spark interest in organ transplantation.

Now 30 and a medical student in the inaugural class at Florida International University’s Medical School, Engebretsen is ready to share another first.

She and husband Ryan Labbe, also 30, introduced their son, Andersen Thomas Labbe, born July 21, at the University of Miami/Jackson Memorial Medical Center Wednesday afternoon.

Most parents don’t net a news conference to announce a newborn but Engebretsen and Labbe, who live in Pembroke Pines, are not most couples.

Labbe, who works in computers, is also a liver transplant recipient.

Doctors believe Andersen is the first baby born to two liver transplant recipients.

“Sometimes it doesn’t hit me. I had to stop and go, ‘Oh, I’m a dad!’ It’s wonderful,” Labbe said, as the couple giggled. “There’s so much more to experience and every day it’s something new.” The newborn has entered into a large extended family. Engebretsen’s donor family sent “a huge box of stuff for the baby” and are considered grandparents by the couple, the new mother said.

Transplant surgeon Dr. Andreas G. Tzakis, a director of the Miami Transplant Institute at UM/Jackson, assisted his mentor, Dr. Thomas Starzl, in Engebretsen’s liver transplant in 1984 in Pittsburgh. He has been doctor and friend ever since.

“I’ll never forget how hard she kicked me every time I examined her,” Tzakis said, smiling at that ‘80s moment when the three made history. “I was blessed to see her grow.” Tzakis performed her husband’s liver transplant in Miami in May 2008. Seven months later, the couple married in Miami Beach.

Labbe, who had suffered with health problems throughout his childhood, met Engebretsen via a website, liverfamilies.net, that serves as an online forum. Online chatter developed into telephone calls. Three months later, Labbe flew from his Connecticut home to South Florida.

“I convinced him to come down here and visit me,” Engebretsen said.

The attraction was immediate.

“We already felt we had a connection and had a lot in common so it felt like a natural progression.” When Labbe returned to Connecticut, “I couldn’t stop thinking about her,” he said.

Around that time, his health began to decline. Born a malformation of the bile ducts, he turned jaundiced overnight.

“He called me and said, ‘I’m kind of yellow.’ That’s not good,” Engebretsen recalled. She flew up to see him.

She convinced him to move to South Florida to meet Dr. Tzakis.

Labbe was transplanted about seven months later.

Once wed, the couple discussed the opportune time to have a baby. Despite careful planning, nature ignored class schedules.

“I came in the living room and said, ‘We’re going to be parents.’ And, even though we talked about it and planned for it, I think Ryan was terrified.

His eyes were huge,” Engebretsen laughs.

There would be many more items to consider, beyond fitting pregnancy into Engebretsen’s schooling. Pregnancies for transplant recipients are considered high risk. Engebretsen worked with Dr. Salih Y. Yasin, director of obstetrics and patient safety at the Women’s Hospital Center at Jackson, who had experience in delivering babies from transplant patients.

Engebretsen was no longer on medications.

“She was just another pregnant lady having her first baby,” Yasin said.

She delivered Andersen, a 7-pound, 8-ounce boy, at Jackson.

Engebretsen planned well, devouring every obstetrics book she could find.

“We still don’t want to give the message that with liver transplant (patients) it’s an easy pregnancy,” Yasin said. “There are risks of infections and multiple complications.” Engebretsen tears up when she talks about why she wants to become an emergency room doctor upon graduation.

“I heard at the white coat ceremony at FIU’s inaugural class I’m making medical history twice. I guess, yeah, we’re doing that again. I like to show our donor families their generosity and trying to make the most of the gifts we’ve been given.” As for the baby’s name, “My family’s Norwegian and we wanted something that had Norwegian roots,” Engebretsen said. “Andersen is actually the Norwegian form of Andreas.”

“You Have the Power to Donate Life – Sign-up today!
to become an organ and tissue donor
Tell Your Loved Ones of Your Decision”

Canada Ontario,
Canada - British Columbia, other Canadian provinces

United States, organdonor.gov

United Kingdom, register at NHS Organ Donor Register

Australia, register at Australian Organ Donor Register

Your generosity can save or enhance the lives of up to fifty people with heart, kidneys, liver, lungs, pancreas and small intestine transplants (see allotransplantation). One tissue donor can help by donating skin, corneas, bone, tendon, ligaments and heart valves

Has your life been saved by an organ transplant? "Pay it forward" and help spread the word about the need for organ donation - In the U.S. another person is added to the national transplant waiting list every 11 minutes and 18 people die each day waiting for an organ or tissue transplant. Organs can save lives, corneas renew vision, and tissue may help to restore someone's ability to walk, run or move freely without pain. Life Begins with You

Nanotechnology Researchers Turn Embryonic Stem Cells into Heart cells

The push towards growing organs for transplantation has received a boost from the latest discovery by the Institute of Bioengineering and Nanotechnology (IBN), the world's first bioengineering and nanotechnology research institute. Researchers from IBN have shown that human embryonic stem cells (hESCs) can be transformed into heart cells using a 'decellularized' heart as a scaffold.

The IBN research team comprising Dr Shujun Gao, Serina Ng, Dr Andrew Wan and Dr Karthikeyan Narayanan (from left to right).
azoano.com
Every day, 15 people die from heart disease in Singapore, which accounted for 31.6% of all deaths in 2009.1 Worldwide, the number of severe heart failure patients waiting for transplant far exceeds the number of available donor hearts. The severe shortage of available donor hearts necessitates the development of other options for heart replacement. Now, with IBN's research breakthrough, we are one step closer to growing a new replacement heart from human embryonic stem cells.

Every organ in the human body has a scaffold or a structure, which provides it with its shape, and within this scaffold are many different types of cells with different functions. Tissue engineering aims to create the organ scaffold - either through the use of synthetic materials such as polymers, or through decellularization, which uses the whole organ as a scaffold after removing its cells.

Decellularization is ideal for tissue regeneration because it preserves the three-dimensional structure of the organ and the extracellular matrix (ECM) - the framework between the cells - that are complex and difficult to mimic. While current methods use specific ECM proteins to transform stem cells into a particular cell type, scientists have found it difficult to imitate the natural ECM.

Using the decellularization approach, a team of researchers led by Dr Andrew Wan, IBN Team Leader and Principal Research Scientist and Dr Karthikeyan Narayanan, Senior Research Scientist and Project Leader, removed the cells from the heart of a mouse and implanted the empty heart scaffold with hESCs to observe if these cells could attach to the scaffold and develop into heart cells. After 14 days, the cells developed into two different types of cells found in the heart: cardiac marker expressing cells and endothelial or blood vessel cells.

The cell-laden scaffold was then implanted back into the mouse where it was observed to develop visible blood vessels. The formation of blood vessels in the scaffold is critical for the transport of nutrients and oxygen to the heart, and has posed a major challenge in tissue engineering.

Dr Wan explained, "By exploiting the intact scaffold of a heart, we have directed the differentiation of human embryonic stem cells into cardiac cells. This study is the first proof-of-concept that addressed the complexity of obtaining different cell types in a scaffold using stem cells. The positive results we have derived encourage us to take this one step further, to achieve functional cardiac cells, and bring whole organ regeneration to the next level."

Professor Jackie Ying, IBN Executive Director, added, "IBN's Cell and Tissue Engineering research is actively developing bioartificial organs using a combination of stem cell technology and biocompatible materials as alternative treatments for organ failures."

Stem cells are an attractive cell source for seeding decellularized organs. Besides hESCs, the team also used progenitor cells derived from the hESCs, which are found in a subset of tissues including heart tissues, to see if the two cell types would regenerate differently. The findings revealed that both stem cell types developed different types of cardiac marker expressing cells and the progenitor cells exhibited the same gene expression pattern as cells in a beating heart.

Published recently in a leading peer-reviewed journal, Biomaterials, this new finding could pave the way to the development of a bioartificial heart, and realize the decellularized organ approach for organ transplantation. If successful, xenogeneic organs - animal organs seeded with human stem cells - could then be explored as a feasible alternative for regenerative medicine.

Source: Singapore Heart Foundation

“You Have the Power to Donate Life – Sign-up today!
to become an organ and tissue donor
Tell Your Loved Ones of Your Decision”

Canada Ontario,
Canada - British Columbia, other Canadian provinces

United States, organdonor.gov

United Kingdom, register at NHS Organ Donor Register

Australia, register at Australian Organ Donor Register

Your generosity can save or enhance the lives of up to fifty people with heart, kidneys, liver, lungs, pancreas and small intestine transplants (see allotransplantation). One tissue donor can help by donating skin, corneas, bone, tendon, ligaments and heart valves

Has your life been saved by an organ transplant? "Pay it forward" and help spread the word about the need for organ donation - In the U.S. another person is added to the national transplant waiting list every 11 minutes and 18 people die each day waiting for an organ or tissue transplant. Organs can save lives, corneas renew vision, and tissue may help to restore someone's ability to walk, run or move freely without pain. Life Begins with You

Michigan Heart program brings together doctors and patients to celebrate new leases on life

By Garret Ellison | The Grand Rapids Press

GRAND RAPIDS –Harry Konynenbelt spoke three simple words on Sunday that together signaled pride, perseverance and promise of the future not just for himself, but the hospital program that saved his life.

“I’m number eight,” said the 61-year-old grandfather from Hudsonville.

That would be eight of the 10 heart transplant recipients to get a new lease on life through Spectrum Health’s new transplant program at the Fred and Lena Meijer Heart Center in Grand Rapids that was certified by the United Network of Organ Sharing last year.

Several of the transplant recipients as well as a dozen or more ventricular assist device patients gathered Sunday at the Frederick Meijer Gardens and Sculpture Park for a day of support and mingling with doctors and hospital staff.

The get-together followed a golf outing sponsored by the Wizard Foundation, started by the family of Rhan Bentley, the program's first patient last November. Bentley was not at the gathering but Spectrum staff said he is "doing great."

“To be honest, it’s good therapy for us to see you living your lives,” Michael Dickinson, the heart failure program medical director told the gathered crowd.

There was a lot of love in the room for Spectrum doctors from both transplant and assist device patients, who undergo regular check-ups with the hospital the rest of their lives.

Konynenbelt, who got his new heart on March 15 after a little more than two months on the waiting list, said Dickinson told him one day while he was in the hospital that a heart had come in the night before, but it went to another patient.

“(It) wasn’t right for you, he told me.” said Konynenbelt, adding that was a sign that “you’ve got the best (doctors) in the world and they’re looking out just for you.”

Charlie Nawrot, 53, of Grand Rapids got a new heart on Jan 3 and said the staff at Spectrum are “very personable. They take care of you.”

Nawrot’s surgery was one of four that took place in January, a busy month for the heart transplant program said Dr. Asghar Khaghani, head transplant surgeon. They performed four procedures that month alone.

He said it’s not unusual for transplant centers to see a spike in procedures twice a year.
Khaghani, who came to Grand Rapids from a world-renowned transplant program in London, said it was very important for Spectrum to hit their initial target of 10 to 12 procedures they hoped for at the program inception.

The track record is important because the hospital carries the program cost on the front-end. Each transplant is expected to cost about $544,500 and the program is expected to lose about $2 million in the first year.

Hospital leaders expect a net loss of about $226,600 per transplant because of the assumption that two-thirds of patients will not be able to pay.

Khaghani, who has an unusually high number of procedures under his belt — over 1,000 — said Spectrum’s program can easily handle about one procedure per week, but for the next couple years, he thinks 20 to 25 surgeries per year is a good mark.

He called the program “quite standardized” already. Changes will come in the form of new medications and the decision-making on who should be getting transplantation, which he expects to evolve due to the advances in artificial heart device technology.

Advances for that as well as in the ventricular assist device (VAD) — a mechanical circulatory device that is used to partially or completely replace the function of a failing heart — make demand for transplants hard to predict.

Neither device is typically considered a permanent replacement option, although they are used that way with some patients due to age or other factors.

Khaghani believes within about five years, more patients will be getting artificial hearts than actual transplantation because the organ supply can’t meet the patient demand, and the devices are becoming more reliable and durable.

Former auto body shop manager Jim Butts, 57, of Greenville, said mobility on the VAD is “as much as you want to do, within reason.”

Butts, who had congestive heart failure, hunts with bow and gun, snowmobiles, rides a four-wheel off-road vehicle every day, and goes out on a boat.

“I’ve had six open heart operations and I refuse to lose,” he said.

Nearby, former Grand Rapids gynecologist Kathy Williams said her father, Wayne Collins, 77, of Reading, nearly didn’t make it through the hospital bureaucracies in Kalamazoo and Coldwater before getting referred to Grand Rapids for surgery.

“I raised my voice and said ‘he’s going to be dead by the next time you have an appointment scheduled for him,’” she said. “I had to be like that.”

“I’m really happy with all the care he got through the steps,” she said. “But if he didn’t have someone who knew how to push, who to talk to and what they fight for.”

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