Sitting on a bed in the infusion room at The Transplant Center at University of Minnesota Medical Center, Fairview, Hannah Olson is hunched over a practice sheet, carefully studying mathematical equations in preparation for a statistics class she wants to take this fall. It’s summer, but the 20-year-old Iowa woman is more than happy to be doing schoolwork, a little taste of normalcy she now enjoys.
Since she was diagnosed with cystic fibrosis (CF) at 2 weeks of age, Olson had endured a routine of treatments three times a day, and the need for an oxygen tank last winter, to survive. Now, thanks to a lung transplant earlier this year at the medical center, Olson can breathe easier for the first time in her life.
Four months ago, Olson’s disease completely took over her lungs, causing her to be admitted to the medical center.
"She was as sick as I’ve ever seen a CF patient," says Cynthia Herrington, MD, surgical director of lung transplantation.
Her second night in the hospital, Olson recalls waking up unable to breathe. Turning up her oxygen seemed to help.
A few hours later, it happened again, this time worse. "The last thing I remember that day is staff trying to put a BiPAP [Bilevel positive airway pressure, also known as a respiratory ventilator] on me," Olson says. She was stabilized, but her health took another turn later that day, and she was intubated.
Knowing Olson’s health was on a downward spiral, Herrington put her on the waiting list for a lung transplant. Because of her dire condition, her listing score was high, and she was put near the top of the list. In the early hours of the next morning, staff at an organ procurement organization (OPO) called, saying they had a lung donor.
Herrington weighed her options. A snowstorm had brewed, delaying a flight to retrieve the lungs. But Herrington knew Olson was dying; she couldn’t wait for another donor. Later that day, a crew flew out to retrieve the lungs while intensivists kept Olson stabilized. By that evening, Herrington was transplanting the lungs into Olson. Shortly after midnight, the surgery was complete, and Olson was breathing air into her new lungs.
"We always say, ‘If the lungs aren’t just right, we’ll wait for the next call.’ With Hannah, there was never going to be a next call," says Herrington. "These lungs truly saved her life."
Shortening, then eliminating, the list
Olson’s story is at the crux of Herrington’s passion to increase the number and availability of donor lungs and transplants. She partnered with colleagues at Mayo Clinic’s transplant program in 2004 to share best practices and make consistent protocols for lung donations and transplants.
As a result, University of Minnesota Physicians at the medical center and University of Minnesota Children’s Hospital, Fairview, increased their number of lung transplants from 39 in 2003 to 45 last year—the largest number of lung transplants performed by the lung transplant program ever. The program, which celebrates its 20th anniversary this year, is on track to increase that number to 60 by the end of the year.
In the past, patients who needed lung transplants were on the waiting list for two to three years at the medical center; now they’re on it for about a year. By the end of this year, Herrington hopes to eliminate the waiting list altogether. "Our list used to carry 80 active patients; now it carries 20," Herrington says. "We’re able to transplant faster than the rate of names added to the list."
The turnaround is a result of the strength and depth of the lung transplant team—surgeons, pulmonologists, transplant coordinators and social workers—whose tireless efforts helped increase the number of lung transplants at the medical center, Herrington says.
The initiative’s success garnered the attention of the Organ Donation Breakthrough Collaborative, a gathering of national leaders and practitioners from transplant centers and hospitals to share best practices in hopes of achieving organ donation rates of 75 percent or higher. The collaborative, launched by the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA), is part of a similar initiative held earlier with leaders from the nation’s OPOs. Herrington was accepted onto the collaborative’s faculty and shared her learnings from the Mayo partnership with other transplant centers.
"The goal is to maximize the gift—to figure out how we can maximize the number of organs procured from a donor," says Herrington. "Mayo’s program and ours are competitive in transplant. But more lungs are more lungs."
Their work is paying off
And, it’s worked. Nationally, the number of organs procured from deceased donors has steadily climbed from 3.06 of the eight potential organs that can be donated per donor toward the goal of 3.75. This will translate into 16,000 organs. In the past, in some states where lung transplant programs don’t exist, family members of deceased donors weren’t ever asked for a lung donation, Herrington says. "We have jets; we can go anywhere to retrieve a lung. None of them should ever be buried just because you don’t have a lung program in the state."
Locally, LifeSource, the OPO of which the medical center is a member, increased the number of donated lungs, for instance, from 28 in 2004 to 96 last year. It rose from the bottom third of OPOs in terms of the number of lungs procured in 2004 to the top quarter in 2005.
According to the HRSA, about 1,200 people receive lung transplants each year. However, in any given year, there are about 3,000 people on the waiting list, and more than 300 of them die each year waiting for a lung transplant.
For Olson, her transplant was not only a life-saver, it was a life-changer. Inspired by physicians and staff at the medical center, she’s decided to pursue a social work degree in college. "I want to be a hospital social worker," she says. "I want to be an advocate for patients."
