Transplant surgeries are being resumed by many teaching hospitals in Southeast Michigan, with Donna Arm being the first patient at Henry Ford Health System in Detroit to receive a replacement heart during the COVID-19 crisis.
Arm, 68, received her heart transplant on April 25. Like many patients, she was reluctant to call her doctor for nearly a month — even though she felt progressively worse and has had congestive heart failure since 2014 — because COVID-19 patients were filling hospitals with very sick patients.
"I didn't want to go and have another problem on top of a problem," said Arm, a mother of three, grandmother of eight and great-grandmother of four from Romulus, adding: "I got to where I couldn't breathe."
Henry Ford and Michigan Medicine in Ann Arbor are among systems in Southeast Michigan that are resuming typical organ transplant schedules. Spectrum Health in Grand Rapids never paused transplant services, a spokesperson said.
Because of the coronavirus outbreak, transplants of kidneys, liver, lung and heart, bone marrow and stem cells at Michigan's 12 centers slowed, primarily to protect bed capacity along with patient and staff safety, said Dr. John Magee, director of the University of Michigan Transplant Center.
"We never stopped. We just adjusted the risk-benefit," said Magee, adding that UM has conducted six lung, two liver and four kidney transplants the past two months. "All were deceased donors. We haven't done any heart transplants yet, but we think fairly soon."
One reason is the number of positive COVID-19 cases is falling along with hospitalization rates, Magee said.
"We are close to resuming our typical schedule. The living donor side close to ramping up, but people have to feel comfortable coming into the hospital," Magee said. "I am encouraging people to donate and come in. If cases spike up, we may change that, but now we think it safe to do. We will make it safe."
Adnan Munkarah, Henry Ford's chief clinical officer, said patients shouldn't be afraid to call their doctors or come in for emergency or urgent care. Despite delaying nonurgent surgeries since mid-March, he said emergency procedures and surgeries continued after the first positive COVID-19 patient arrived on March 12.
Munkarah said Henry Ford has resumed many delayed surgeries and procedures.
"People have been very anxious and afraid of coming to the hospital. This is very understandable," Munkarah said. "But there are times where we have seen that the delay in care has resulted in very serious outcomes. People are trying to delay care, whether it's related to a heart condition or cancer, or a transplant that is needed, and they are deferring them. I strongly encourage you to come see your doctor in the hospital."
'Hours or days' away from death
When Arm's condition worsened to life-threatening, her family dropped her off at Henry Ford Hospital in Detroit, but because of visitor restrictions were unable to go inside.
"It's been really hard not being able to be there for her … to drop her off as sick as she was and leave her there knowing she's always been there for us," said daughter Sheila Woods, who was on the Zoom teleconference call with her mother, the doctors and reporters.
"The heart was extremely enlarged," said Dr. Hassan Nemeh, the cardiothoracic surgeon who performed Arm's 6 1/2 hour surgery. "The left chamber, particularly, wasn't pumping much. ... She was starting to have organ dysfunction. ... She was in significant advanced level end stage heart failure. ... Her heart was functioning at probably 10 percent capacity. .... (A transplant) "was the only way out of her situation. She had a mortality potential within hours or days. She was in a very, very critical stage."
Dr. Marwan Abouljoud, director of the Henry Ford Transplant Institute, said two liver transplants and a kidney transplant took place at Henry Ford Hospital after Arm's transplant. The patients also are successfully recovering, he said.
"In Detroit and in Michigan, it was very hard. (We) became an epicenter of COVID disease and the impact was very significant. We started thinking what is the safest approach to maintaining organ donation and transplantation when there was basically a sudden halt of all living donors, and deceased donation went down by a good 40 percent to 50 percent and only (continued) in cities where they didn't have COVID yet," Abouljoud said.
Friday morning, Henry Ford began performing another liver transplant. "So we've opened up for business, but when we feel for our patients who are on the waiting list for transplant, and we want to make it happen," Abouljoud said.
Each year, Henry Ford performs about 300 organ transplants. During the last two months, 20 percent of those were delayed. There are now about 600 people at Henry Ford on the transplant wait list.
"I just want everyone to know how important organ donation is," said Arm on Thursday from her hospital room, her voice often breaking with emotion as she thanked the donor and promised to write a letter to the family. "I am grateful for their gift and for the extra time with my family, which I love so dearly."
Arm, who went on the donor list April 23, accepted the next day and had the surgery April 25, is expected to go home from the hospital this Mother's Day weekend.
"It was just a miracle," Arm said. "I'm so happy I did it because I have so much to look forward to. I have a new life, a new beginning. ... I'm just going to look forward, be strong and do what I have to do to enjoy the rest of my life."
"Henry Ford, University of Michigan resume organ transplant schedule" originally appeared in Crain's Detroit Business.