Sixteen children at Lucile Packard Children’s Hospital Stanford received life-saving organ transplants in October, setting a record for the most transplant surgeries performed at the hospital in a single month.
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A few of the faces of the organ transplant recipients this October at Lucile Packard Children’s Hospital Stanford (Photo: Business Wire)
One of those patients was Toni and Jason Zumbach’s daughter, 7-month-old Charli, who was born with biliary atresia, a chronic, progressive liver condition in infants that blocks the bile ducts, quickly scarring the liver cells and eventually leading to liver failure. The Zumbachs, who are from Angels Camp, California, came to Palo Alto in September when Stanford Children’s Health transplant specialists who run a liver transplant clinic at the Madera Children’s Hospital told Charli’s mother, Toni, “We need to get her to Packard Children’s now.”
“We were so happy that we had the connection to this Stanford Children’s team from Madera. This is where we wanted to be for her transplant,” said Toni Zumbach.
Zumbach said their pediatric transplant surgeon, Amy Gallo, MD, reassured them that everything would be fine when the time came for Charli’s transplantation.
“It was surreal,” Zumbach recalled, “but we trust this transplant team with our child’s life.”
“To be given the opportunity by these donors and their families to save all of these children in the past month — many whom were very, very sick — is an amazing honor for us as care providers,” said Gallo, who is also an assistant professor of abdominal transplantation surgery at the Stanford University School of Medicine.
“And little Charli . . . she is evidence of how hard these children fight to survive, at every age. It’s inspiring and a privilege to have played this role in her life.”
A national leader in solid organ transplantation
The Packard Children’s Pediatric Transplant Center is a national leader in the field of pediatric organ transplantation and a destination center for the most acute and complex cases, which require highly specialized care. October’s transplant recipients came to Packard Children’s from all over California and the western United States.
“It’s our highest-volume month ever for solid organ transplants,” said Debra Strichartz, administrative director of the Pediatric Transplant Center. She credits the increase in volume to three factors: the donor families who made the organ donations possible, the transplant center’s ability to take on the most complex cases, and a greater number of referrals from doctors who are connecting with Stanford’s transplant experts via telemedicine.
“We are broadening our ability to consult with physicians through telemedicine,” said Strichartz. “For example, we are conferencing with oncologists who have patients with rare liver tumors that require a very high level of transplant knowledge and experience.”
That breadth of knowledge and experience at Packard Children’s, along with its commitment to family-centered care, are the keys to the program’s success, according to Carlos Esquivel, MD, PhD, the Arnold and Barbara Silverman Professor of Surgery and chief of abdominal transplantation at the Stanford University School of Medicine.
“Our ability to take on cases that would be rejected for transplant elsewhere is a credit to the level of expertise, not only of our surgeons, but the entire transplant care team,” said Esquivel, who led Charli Zumbach’s transplantation with Dr. Gallo. “From caring for the youngest transplant patients, to pioneering care for patients with rare diseases who are the first with their condition to be transplanted, to performing complex multi-organ transplants — this team is the best of the best.”
That collective “transplant team” involves multiple care teams in each organ specialty, including social workers, dieticians, transplant coordinators, pharmacists, anesthesiologists and surgical subspecialists. In areas like anesthesia, a vital aspect of the transplant surgery, doctors prepare for hours to keep each patient stable during surgery, mitigate risk in cases of unexpected blood loss and respond to crucial physiological indicators throughout the 8–12 hour surgery.
Organ donation makes it all possible
The cornerstone of transplant is organ donation. For the past 2 years, the hospital has been recognized by the U.S. Department of Health and Human Services for its promotion of California’s organ donor registry and its efforts to educate and register new donors.
“We can’t ever say enough of the importance of organ donation,” said Strichartz. “There are often no words to describe its meaning for those on both ends, the family who donates and the patient who receives.”
On two separate days in October, a single donor was able to provide four organs for transplantation. Currently, there are 82 pediatric patients on the active waitlist for organs at Packard Children’s Hospital.
The only program for double-lung transplant on the West Coast
Those saved by the power of organ donation include 14-year-old, Fernanda Coronado, from San Diego, California, who received a rare double-lung transplant in early October. Packard Children’s is the only center on the West Coast that performs double-lung transplants. Fernanda has cystic fibrosis (CF), a chronic genetic disease that affects the lungs and digestive system, and CF is a top cause of lung transplantation in children. Packard Children’s Pulmonary Medicine and Cystic Fibrosis Center is a leading provider for treatment and research of new therapies for CF patients.
Fernanda moved to Palo Alto with her mother in March 2015 to await a transplant.
“When our time came for transplant, it was a mix of emotions: relief, happiness, concern and sadness for that family,” said Fernanda’s mother, Mayra Coronado. “Even after such a long wait, you’re never totally prepared when the time comes, but our team here at Packard Children’s got Fernanda as strong as she could be to go into transplant.”
The transplant surgery was led by Katsuhide Maeda, MD, surgical director of the lung and heart-lung transplant program at Lucile Packard Children’s Hospital and a clinical associate professor of cardiothoracic surgery at Stanford University School of Medicine.
“Getting a patient like Fernanda to the point of a double-lung transplant is truly a team effort,” said Maeda. “Everyone has to work together to get the patient as healthy and strong as possible so he or she can undergo the transplant surgery. It takes a special team like the one at Packard Children’s to achieve this.”
Now Coronado says that Fernanda is doing things she hasn’t done in years, just a few weeks out from her transplant. She can walk without oxygen support and is looking forward to activities like swimming, traveling, or even just climbing a flight of stairs.
“It’s truly amazing,” said Coronado.
“Fernanda has a lot of drive and determination and showed that to me the first time I met her,” said Carol Conrad, MD, director of the pediatric lung and heart-lung transplant program and Pediatric Pulmonary Function Lab. “She worked so hard to get to this point. This transplant enables Fernanda to move into adolescence with confidence and achieve her dreams and goals. She has a long list, but I am sure she will cross them off one by one! She is an inspiration to me and our other clinic patients.”
Innovative approach to intensive care following transplant
The continuum of transplant care extends well beyond the operating room into the months before and after transplant. Throughout the month of October, the hospital’s Pediatric Intensive Care Units (PICU) had up to eight transplant patients in recovery at the same time. Mihaela Damian, MD, a clinical assistant professor of critical care medicine at Stanford University School of Medicine, is the transplant physician liaison in the PICU and is working on improving outcomes after liver transplantation by continuous research and ongoing quality improvement. The newest of several clinical research studies being led by Damian will focus on reducing stress in children and their families recovering in the PICU after transplant. Her approach involves providing online education before the surgery and employing virtual reality as a means of distraction therapy as well as for ongoing education after the surgery.
“Every day and with every child, we strive to do even better and create new knowledge specific to pediatric transplantation,” said Damian. “One amazing teenager, a recipient of a lung transplant, told me, ‘All the kids need to have patience, because the day will come when their life starts anew and gratitude will wash over everything. Be present, forget the past suffering, just look forward to the new life ahead.’ I feel very honored to be part of the best transplant team in the nation.”
About Stanford Children’s Health and Lucile Packard Children’s Hospital Stanford
Stanford Children’s Health, with Lucile Packard Children’s Hospital at its core, is the Bay Area’s largest health care enterprise exclusively dedicated to children and expectant mothers. As the top-ranked children’s hospital in Northern California, and one of just 11 nationwide to be named on the 2016-17 U.S. News & World Report Best Children’s Hospitals Honor Roll, Packard Children’s Hospital is a leader in world-class, nurturing care and extraordinary outcomes in every pediatric and obstetric specialty. Stanford Children’s Health offers care ranging from the routine to rare, regardless of a family’s ability to pay. Together with Stanford Medicine physicians, nurses, and staff, Stanford Children’s Health can be accessed through partnerships, collaborations, outreach, specialty clinics and primary care practices at more than 60 locations across Northern California and 100 locations in the U.S. western region. As a non-profit, Stanford Children’s Health is committed to supporting the community – from caring for uninsured or underinsured kids, homeless teens and pregnant moms, to training the next generation of doctors and medical professionals. Celebrating the 25th anniversary of Lucile Packard Children’s Hospital in 2016, Stanford Children’s Health looks forward to the fall 2017 debut of its expanded pediatric and obstetric hospital campus. Discover more at stanfordchildrens.org and on the Healthier, Happy Lives blog. Join Stanford Children’s Health on Facebook, Twitter, LinkedIn and YouTube.