By Daphne Sashin
The Penn Transplant Institute at the Hospital of the University of Pennsylvania (HUP) in early June completed its 1,500th lung transplant, joining only six other lung transplant programs in the U.S. to mark that achievement.
Since its first lung transplant 30 years ago, Penn’s lung transplant team has given patients an additional 7,500 years of life. Patients once on oxygen and close to death have seen a dramatic improvement in their quality of life, getting to travel the world, see their children grow up, and laugh again.
Penn's 1,500th lung transplant milestone represents the unique commitment of a multidisciplinary team dedicated to the patients and their families, said Maria M. Crespo, MD, medical director of the lung transplant program.
“Our mission is to give patients a new breath of life by providing the best patient-centered care through exceptional teamwork, research, and innovative treatments. We take challenges, giving patients with many complexities often turned down in other lung transplant centers the opportunity to undergo a lung transplant,” Crespo said. "The highest-performing teams deliver the most incredible satisfaction not from each other, but from the work and commitment they do together for the patients and their families.”
These aren’t just surgeries, said Christian Bermudez, MD, surgical director of the lung transplant program. Lung transplant is an intense treatment option that requires a significant commitment from patients, families, and staff. “The amount of work behind each one is intense. That’s why we like to acknowledge these milestones in the history of the program,” Bermudez said. “And while we celebrate the victories, we also acknowledge those patients we’ve lost.”
Once patients become transplanted here, Bermudez said, they become part of the Penn family. There’s Evan Rood, a young designer with scleroderma, a rare rheumatic disease, who traveled from Seattle two years ago to receive his bilateral lung and heart transplant at Penn; and Fred Rahmanian, a 54-year-old data scientist who became Pennsylvania’s first COVID-19 lung transplant patient when only a few had been performed in the world. Bri Iacona, a 30-year-old math teacher and new mother, was kept alive by Extracorporeal Membrane Oxygenation (ECMO) at Penn Presbyterian Medical Center (PPMC) for 97 days while a multi-disciplinary team worked to condition her body for transplant, her only hope of survival.
“Penn, Maria, and Christian took a chance on me after I was rejected from four other transplant programs on the West Coast,” Rood said. “Not only did they save my life, they saved my family as well.”
COVID-19 brought a whole new set of challenges for lung transplantation. During the pandemic, HUP’s team, like other major transplant centers, found itself caring for a new population of patients whose lungs were destroyed by the virus and were spending months on life-support machines. As of June, Penn had performed 21 COVID-related transplants.
Supporting each patient through transplant is an army of staff that includes nurses and nurse practitioners, operating room schedulers, medical assistants, transplant surgeons and pulmonologists, transplant psychiatrists, environmental services attendants, infectious disease specialists, the transplant pharmacist, dieticians, social workers, physical therapists and respiratory therapists, perfusionists, financial counselors, transplant coordinators, patient service representatives, the organ procurement team, and the lung-rescue team at PPMC, among others.
Hear from some of them, in their own words:
Malika Thomas
Clinical Service Associate-Referral Coordinator
“I’m the first person people talk to when they call the Penn Transplant Institute about a lung transplant. On that first call, we spend a lot of time together … Lung disease is terrible. Sometimes patients can only speak one word at a time because they are so out of breath. My favorite part of the job is being able to see them laugh and have a normal conversation after their transplant. These are people who I first saw in wheelchairs and now they are running past me in the clinic! I don’t mean to boast, but this is the perfect job for someone like me – I love people, I love talking to them. My job gives me the chance to provide warmth and reassurance to so many people every single day during their most difficult days.”
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Derek Zaleski, DPT
Physical Therapist
“I describe the lung transplant process as a wild ride with an incredible ending. Patients begin their journey in the worst medical condition you can imagine, and they come out the other end breathing easier, now free of [supplemental] oxygen and most of their previous limitations … I definitely form lifelong relationships with my patients. [One] was a gentleman who was so sick he was receiving upwards of 70 liters of oxygen flow – that’s like a fire hose of oxygen in his face. He was so motivated to get transplanted, but he could only manage 10 minutes of activity a day. His hard work paid off, and he got his lung transplant. He now volunteers his time recruiting organ donors for the Gift of Life Program, and he has lectured to Penn’s medical students about his experience. There’s a photo of him hanging in our therapy gym.
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Melissa Johnson, MSN, ACNP
Nurse Practitioner (pre- and post-transplant)
I think I have a unique perspective on transplant thanks to the five years I spent as a transplant coordinator at the Gift of Life Donor Program. It’s common for patients to feel guilty that they get to live while someone else died … I tell my patients that most families view donation as a way for their loved one to live on in some way. It’s the only good thing to come from their death: someone else will get to live, enjoy their life, see their children get married, see grandchildren grow up. I would often hear families say the same thing when I was getting their consent for donation: 'Please tell the recipient to savor their gift and take good care of it.'"
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Gerald “Jerry” Broniec, CCP, RRT-ACCS
Cardiovascular Perfusionist
"In most cases, patients will never get to meet me. But I’m right there with them anyway, in the operating room on transplant day, right beside their surgeon. I’m responsible for operating the heart-lung machine that literally takes over the function of the heart and lungs during surgery, allowing surgeons to work while the patient’s blood is diverted to the machine rather than returning to the heart ... The saying, 'it takes a village' couldn’t be more appropriate than when it comes to the operating room team for organ transplants. I truly enjoy working with this amazing team – the surgeons, the nurses, anesthesiologists and physician assistants. We are a close-knit group which helps us function like a well-oiled machine. It is inspiring to see the dedication, skill, focus and precision in the operating room when we come together. It’s challenging work, which makes it even more rewarding.”
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Andria Alderfer, MSW
Lung Transplant Social Worker
"I had a liver transplant at The Children's Hospital of Philadelphia (CHOP) when I was 11 – that experience changed and shaped my life. I don’t often tell my patients about my transplant, but having personal knowledge of what it’s like to receive a transplant helps me help them. I see patients from the very early pre-transplant evaluation appointments through to their post-transplant follow up. It’s one of my favorite parts of my job, being able to stay closely connected to them through their entire transplant journey. Sometimes I hear from patients many years after their transplants – it means so much that they carry the connections I’ve made with them for so long.”
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Christina Taing Vo, MSN, CRNP
Nurse Practitioner (Inpatient)
“The patients I care for need a transplant or they’ll die – it’s as simple as that. But there is nothing simple about it. Making it through the transplant journey is complex. I primarily work with patients who have advanced lung disease like cystic fibrosis or interstitial lung disease. A lot of pre- and post-lung transplant patients, too. I never get tired of seeing patients who were once close to death walk out of the hospital and into a new and renewed life. We all love when a patient comes back to visit us on the floor. It’s amazing seeing how healthy they look compared to when we first met them.”
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Read more staff and patient profiles at Facebook.com/PennTransplant