June 19, 2013
When Orlando DeFelice received a new heart at Johns Hopkins in 1983, heart transplantation was in its infancy. Cyclosporine was approved that same year by the FDA. Many patients stayed in the hospital for up to three months after a heart transplant before going home. To treat a post-transplant infection, surgeons would place tubing around the heart and flush the area with a diluted form of Betadine.
There were no left ventricular assist devices (LVADs) to support a critically ill patient until a new heart became available. And only younger patients typically were considered good candidates.
In 1982, DeFelice was diagnosed with idiopathic cardiomyopathy. His condition deteriorated to the point that he lost 92 percent of his heart function.
“My cardiologist, Thomas Traill, gave me medicines to keep me alive but I became jaundiced and so weak that I could hardly get out of bed,” he remembers. “I spent four months in the hospital until my prayers were answered—a new heart became available.”
DeFelice was the second patient to undergo heart transplantation at Johns Hopkins. The operation, on August 6, 1983, was performed by chief of cardiac surgery Bruce Reitz. Cardiac surgeon William Baumgartner had just been recruited to Johns Hopkins to develop and lead the heart transplant program.
DeFelice didn’t wake up until six days after surgery but then noticed a big difference. “I felt tremendously better right away. I was able to get out of bed and walk around—even up and down steps.” While his doctors had given him only a 50 percent chance of living past five years, he is now one of the nation’s longest surviving heart transplant patients.
“There has been a great deal of progress since those early days,” says Baumgartner, who became chief of cardiac surgery at Johns Hopkins in 1992. He served in that post until 2009 and is now the vice dean for clinical affairs at the Johns Hopkins University School of Medicine.
“Back then, there was a lot of discussion about who should be eligible. Age was an important consideration since we were aware that an older recipient’s other medical issues could decrease their post-transplant survival,” says Baumgartner.
“While age is not as big a factor for eligibility today, it’s still true,” he adds, “that you have to be selective about recipients because there are still too few donor hearts. The annual number of heart transplants performed today is no different from 10 years ago.”
Cardiothoracic surgeon Ashish Shah says the profile of recipients today is much more complicated with co-morbidities. “We’ve learned how to manage higher risk patients. We’re now offering transplants to older patients—even in their 70s—as well as those who have had multiple surgeries including the placement of an LVAD. Those factors make the surgery and post-operative management more difficult. Despite this, outcomes are excellent.”
Three decades after his pioneering heart transplant, DeFelice is still working and living an active life. His only major setback was kidney failure a few years ago brought on by the same drugs that were preventing rejection. He received a kidney transplant from a living donor in 2010.
“Orlando is a remarkable man who has exceptional courage, perseverance and equanimity,” says cardiologist Edward Kasper, who has cared for DeFelice since 1993.
Looking back on what helped motivate him to recover from his heart transplant, DeFelice says it was a question from Baumgartner. “He asked me, ‘What is your short-term goal?’ I thought for a moment and answered that I wanted to dance at my sister’s wedding in two months. Sure enough, I did that.”