This patient needed a heart. Here’s what life is like with a new one beating in his chest
Carlos Martinez wasn’t a drinker or smoker and wasn’t overweight. He exercised regularly and there was no history of heart disease in his family. Every annual physical had turned up nothing.
“I enjoyed for a long time a clean bill of health,” said the Colombia-born Martinez, who is married with a son and worked as a computer engineer in South Florida.
But in May 2018, he experienced shortness of breath and was not feeling well. His wife, Luz, took him to a hospital.
Martinez, 49 at the time, learned he was very, very sick. His heart had failed him. He also had cardiac amyloidosis, which occurs when amyloid deposits take the place of normal heart muscle, and affect the way electrical signals move through the heart.
After more testing, he learned he had multiple myeloma, a cancer of white blood cells in the bone marrow.
“It was really hard for my wife and my son because it was more bad news every week,” he said.
Over the next year he would undergo chemotherapy and other treatments, and he had to quit his job because of his weakened state. His doctors at the University of Miami referred him to the Miami Transplant Institute, part of Jackson Health System and UHealth, where he underwent bi-weekly tests and blood work, and he was put on the national waiting list for a heart in November 2018.
As the wait for a heart began, Luz did everything she could to help him get as strong as possible for the transplant. “For her it was never an if, it was always a when — when the heart comes,” he said. Nevertheless, as the months wore on, he began to prepare for the worst. “God had other plans.”
When the call came in November 2019, he and Luz were having lunch at home.
“I put the call on speakerphone and the person said, ‘Mr. Martinez, we have a heart for you!’ We both started to cry. It was a very emotional moment. … Once we got ourselves together, we took off to MTI.”
The transplant surgery was the next day, performed by Dr. Matthias Loebe, chief of Heart and Lung Transplant and Mechanical Support for Miami Transplant Institute.
When Martinez woke up in Jackson Memorial’s surgical ICU, his wife and son were at his bedside. “I realized it was done. I am alive and have a new heart — it was moment we will never forget, filled with feelings of gratitude, and feeling blessed and loved,” he recalled. “I put my hand on my new heart, and felt its beat.”
Martinez was discharged from the hospital in early December and is recovering at home. He is doing well, Loebe said.
“First he has to recover from the extent of the transplant surgery and after that he has to recover from how sick he was before. Because of end-stage heart failure, folks are not able to move around and exercise and they lose a lot of muscle mass and strength. It’s not easy to build that up again and gain weight,” said the doctor. He will also likely need more treatment for the amyloidosis.
At Jackson, which has been doing heart transplants for more than 30 years, Carlos Martinez’s transplant was No. 750.
Jackson’s Heart Transplant Center is the longest-running and largest in South Florida and the third largest in the state. “It is great to be part of the largest solid organ institute with access to these experts and take on these complex cases like his,” Loebe said.
Fortunately for South Florida, the region has several Heart Transplant Centers.
Cleveland Clinic Florida in Weston founded its transplant center in late 2014 and is one of the state’s fastest-growing. In September, doctors there performed the 100th transplant, and the number of transplants has now grown to 117.
Hollywood-based public health system Memorial Healthcare has performed 50 transplants since 2014 and Joe DiMaggio Children’s Hospital has performed 56 pediatric transplants since it opened in 2010.
Dr. Cedric Sheffield, director of Cleveland Clinic Florida’s Heart Transplant program, said patients are considered for a heart transplant only after their heart has been irreversibly damaged and cannot be made better.
“These patients have a very high risk of dying without a transplant — approaching 80% dying in a year without the transplant,” he said.
But even under these circumstances, the outcomes are excellent, Sheffield said. “The average patient of today, once they get through that operation, can expect to live 12 to 15 years after transplant. Many patients are living more than 20 years and I have a few patients that are 30 years out after transplant. No other therapy for those sickest patients has that kind of long-term outcome.”
Contributing to those strong outcomes is the pre-transplant preparation. Much work goes into maintaining patients in good condition while they are on the waiting list, taking advantage of technology providing essentially a mechanical heart to help them prepare for their transplant.
“Once you are on the list, the wait really depends on how sick they are. And how sick they are also determines how we prepare them. We try to make sure that the patient is best prepared by maintaining their mobility, physical stamina, lean muscle mass and nutrition and are medically optimized,” said Dr. I-Wen Wang, cardiac surgeon and chief of Adult Heart Transplant at Memorial Healthcare System.
He explained that medically optimizing patients can include giving them mechanical circulatory support that pumps the heart for them. The devices range from ECMO, which provides short-term pumping and is used on those with the highest risk of dying, to the Inpella and TandemHeart systems, in which the patient is stable and tethered to a pump, to much longer-term support on LVAD pumps that are implanted.
With those devices, “patients can’t really swing, they can’t get in the hot tub, but otherwise they can pretty much assume their normal life and even go back to work,” Wang said.
The center at Joe DiMaggio Children’s Hospital, one of two major pediatric transplant centers in the state, has performed transplants from infants all the way through young adults, said pediatric cardiologist Dr. Svetlana Shugh.
On the road to a child’s transplant, Joe DiMaggio doctors generally prescribe oral or IV medications and determine if the young patient can maintain adequate nutrition, rehabilitation and activity as doctors closely monitor the functions of other organs as well. They move to mechanical circulatory support, like Wang described, if needed, Shugh said.
“Our goal when we place these devices for patients is to get the breathing tube out of their mouth after surgery. It’s to get them tolerating a diet; it’s to get them up and moving around. If we can get them in that healthier state as best we can with the pump, then when they go for transplant they are conditioned better and they can heal from the surgery better,” she said.
All the doctors expressed the importance of a multi-disciplinary approach for better transplant outcomes. Teams include not only ICU staff, cardiologists and surgeons but also immunologists, nutritionists, respiratory, physical and occupational therapists, psychologists and social workers.
Family interactions are also important, Shugh said. “We need everybody’s input and care for these patients to help them be successful through this course and to support them for life.”
Martinez, the Jackson transplant patient, couldn’t agree more. He has high praise for all his doctors and the Jackson transplant team, and for his son, Jason, and especially his wife for being with him and helping him every step of the way.
“She saved my life.”
The importance of donors
But stories like Martinez’s and the hundreds of other heart transplant recipients in South Florida would not have happy endings without donors.
“Transplants only work if there are organ donations and we are lucky we are in a region where the public has a very positive attitude toward organ donations. Families who decide to donate organs are the real heroes of the story,” said Loebe of Jackson.
“Of course, for a transplant surgeon, we never have enough organs. We’d love to see that we wouldn’t have wait times anymore and we don’t lose any patients on the wait. Right now it is somewhere in the neighborhood of 20% who die before the organ becomes available and that is a very sad part of the story.”
Martinez’s immune system is still recovering but he hopes to be able to look for a job in a few months. He’s been taking online courses to refresh his tech skills. “Every day is a new gift for me.”
Martinez said he would like to find a way to thank and honor the donor, currently anonymous to him, who gave him life’s most precious gift. He’d like the donor’s family to know: “Your heart was received by a body and a family who will love it and always love what you have given us.”
He will be 51 in May. “This time I am throwing a party — last year I was so sick. This year everyone will be required to dance.”
How to become an organ donor in Florida
Becoming an organ donor is simple. You can register online or at a driver’s license office. If you sign up, remember to share your decision with your family and friends.
▪ Go online to register at ORGANIZE.org or the Donate Life Florida at donatelifeflorida.org OR
▪ Register at your Florida Department of Highway Safety Motor Vehicles Office when you apply for or renew a license.
