Operation Transplantation

It’s been a great week for Irish medicine. There’s no doubt about that. The double transplant surgery that was announced this week shows that the technical and medical capacity of this country’s health services is up there with the very best.

Martin Malinowski, a man from Monaghan (via Poland) was the alliterative patient who was at the centre of all this medical expertise and technical know-how. Martin – who has lived in Ireland for 13 years – was diagnosed in early 2019 with cirrhosis of the liver, due to Hepatitis C.

The cirrhosis subsequently caused significant strain to his heart, and he went on to develop cardiomyopathy, which led to the chambers of his heart enlarging and being unable to pump blood efficiently around his body.

He struggled with his health for 18 months until last Summer when his condition deteriorated. Admitted to hospital with a critically low heartbeat, he had an ICD inserted to regulate his heartbeat and was put on the transplant list.

According to Dr Emer Joyce, Transplant Cardiologist at the Mater Hospital, initial assessments showed that Martin had two independently serious conditions that were also impacting on one another, causing Martin’s condition to progress more rapidly.

Although having more than one severe organ disease can result in a patient being ineligible for a transplant, due to the increased risks associated with multi-organ transplant, heart failure related to cirrhotic cardiomyopathy is one of the rare indications where combined heart and liver transplant can be considered.

Dr Joyce said: “A heart and liver transplant is a major undertaking for a transplant team, and it is an extremely rare procedure, with around 200 ever taking place in the US, and much smaller numbers worldwide. Once Martin was identified as a potential eligible candidate, our heart transplant team at the Mater worked closely with our colleagues at St Vincent’s on highly detailed planning, protocol and procedures across multiple multidisciplinary meetings to prepare for the best possible chance for a successful outcome for Martin.”

Dr Zita Galvin, Transplant Hepatologist at SVUH, discussed the complexity of the procedure: “This procedure had never before been attempted in Ireland and there is limited world-wide experience. Every aspect of Martin’s care – including the pre-transplant course, donor selection process, transplant operative details and post-operative critical care course were carefully discussed and planned”

Martin was at home in Castleblayney when he received the call, and his transplant took place at the Mater Hospital late last year. The surgery began with Mr Jonathan McGuinness and his team at the Mater Hospital performing the heart transplant, followed by Mr Justin Geoghegan of SVUH transplanting the liver from the same donor.

Multiple medical professionals, including surgical, anaesthesiology, intensivist, medical, nursing, laboratory and transplant coordinator personnel from both hospitals were involved in Martin’s care. While in recovery, teams from the Mater and SVUH took part in twice daily multidisciplinary and multisite rounds.

The operation was a huge success, and after spending a month in recovery at the Mater, Martin was discharged home. Now, he is already seeing the substantial benefits of his new heart and liver and is getting back to normal.

He said: “I am truly grateful to my transplant and medical teams at the Mater and SVUH. But especially, I want to thank my donor for giving me a second chance. Without them, I would not be here today, plain and simple. Now I can look forward to the next stage of my life.”

The teams from the Mater and SVUH are delighted at how well Martin has done and how quickly he has recovered, no small part due to his amazing determination and positive attitude.

Dr Joyce praised Martin’s courage and commitment to his intensive medical regimen both before and since the transplant. “Martin has a wonderful appreciation and methodical way of managing his condition, and he has recovered extraordinarily well from the transplant. The fact that this is a first for Ireland and that it took place during the Covid-19 pandemic really highlights how strong Ireland’s transplant teams are and the importance of cross-hospital collaboration.”

Dr Galvin agreed: “This achievement is an exciting new chapter for transplant in Ireland that was made possible because of the hard work and dedication of the multidisciplinary team across both hospitals. It is a fantastic example of teamwork and inter-hospital collaboration.”

Professor Jim Egan, Director of the HSE’s Organ Donation Transplant Ireland said, “Organ donation saves lives. Martin’s remarkable recovery and the fact that this is the first heart and liver transplant performed in Ireland is only made possible through organ donation. We would ask everyone to discuss this life saving issue with their families.”

This extraordinary success in Irish medicine has to be contrasted with abysmal failure elsewhere. There is no doubt that Ireland has the quality and training to make our health service world-class, but the failures drown out the many positive things that are being achieved – some of them quite extraordinary.

The most important thing in our system is the idea that Martin didn’t need to be a millionaire to survive. We don’t place a value on people in terms of euros or dollars. That is the great thing about our system that Americans would call ‘socialism’, but we call basic humanity.

Organ transplantation – and the voluntary gift by some of our citizens to others is at the ‘heart’ of that. We need each other, and whatever we do, we know that the commercialisation of medicine leads, inevitably, to bad medicine, bad societies and poor outcomes for the majority.

We can do more – much more – in terms of making our system better, for both patients and healthcare staff, but we badly need reform, investment and the political will to make it happen.

This operation and Martin’s recovery are wonders of science and medicine. What a pity we can’t run our health service as a whole with the same dedication, professionalism and humanity.

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