When you think about someone getting their heart cut out, you probably think about horror movies. Or done-me-wrong love songs. But snipping out a person’s heart doesn’t necessarily make you mean spirited or low-down.
As a cardiovascular and thoracic surgeon, Moses deGraft-Johnson, MD, “procures” hearts—and lungs— with the best of intentions. With the University of Minnesota Medical Center as his home base, he travels the country, hopping off planes and into waiting ambulances that take off with their lights flashing and sirens blaring. They rush towards a local hospital, where an individual who has been declared brain dead, but who has been kept on life support, awaits.
DeGraft-Johnson goes in, changes into surgical scrubs and performs a brief, yet complicated procedure on the body, before returning to the ambulance, this time with a cooler by his side. Then he’s raced back to the airport with a special delivery for a sick patient whose days previously had been numbered.
“Oh boy! Nothing compares,” the doctor says of this role that places him squarely in the breach between life and death. “As one family cries for a lost loved one, another cries tears of joy for a family member who’s been saved.”
Today, more than 100,000 people are waiting for trans- plant surgeries, according to the official U.S. government website for organ and tissue donation. Nearly 28,000 transplant operations were performed in 2008. Each day, about 74 people receive an organ transplant, and about 17 people die waiting for one. The procedure is considered to be a last resort for patients in the final stages of illness, and only one in four people who need an organ is expected to get a transplant in time for it to save their lives.
As a medical student a decade or so back, deGraft- Johnson embarked on his current path during an anatomy class. He performed so well that he became the teacher’s assistant in the very course that he himself was taking. As he continued his studies, he began to see that while all doctors eventually fix floundering boats, surgeons patch torn sails instantly.
“With chronic illnesses, such as high blood pressure, you don’t really change a patient’s situation in that moment. You prescribe medication, they take it, and then you start to see a change,” he explains. “But if I’ve got someone who’s had multiple gunshot wounds, I do surgery on them, and the next day they’re talking to me, then I’ve saved their life.”
He experienced one of those stark turnarounds during the last year of a cardiothoracic fellowship, when he served on the trauma unit of a Queens, NY, hospital. That day he recalls that a patient with multiple gunshot wounds was left on the steps of the emergency room.
Working with the team, he helped to save the life of a young man who would go on to become a popular rapper. After the incident, deGraft-Johnson’s friends heard about his surgery on someone with an “inexpensive” name. His buddies laughed about the unusual name. “They were—who? What? A quarter? Twenty cents?” But it wasn’t long before the object of their humor—and deGraft Johnson’s emergency procedure—went on to fame and glory, with a huge dose of “street cred” for toughing out that blaze of bullets.
The now famous performer pulled through, but many others facing major health crises do not. Those who elect to become donors, as indicated on a drivers’ license, or whose families contribute a loved one’s organs, set the process in motion. Recently, within a three day period, two high-profile organ donation cases made headlines: Actress Natasha Richardson, 45, died after what seemed a minor fall, and her family quietly donated her organs. Then the father of one of four Oak- land police officers, tragically gunned down after a rou- tine traffic stop, is reported to have kept his 41-year-old son, already declared brain dead, on life support until his organs could be harvested.
A liver, kidney and heart from slain cop John Hege is reported to have saved four men, and his donated tissue is expected to enhance the lives of up to 50 more, the California Transplant Donor Network reported.
While there’s no word on who received Richardson’s organs, a family friend told People magazine that the gesture “is very Natasha… At least by donating her organs something good could come out of [the tragedy].”
Organ donor advocate Andy Tookey says such high profile cases help the cause: “Celebrities and role models could dramatically increase the number of people who are prepared to be donors by their promotion of organ donation.”
Richardson and Hege became donors on opposite coasts, while deGraft-Johnson’s neck of the woods in recent years has been the Dakotas, Nebraska, Iowa, Wisconsin and Minnesota. They are part of the United Network for Organ Sharing (UNOS), a nonprofit organization that oversees a national database of potential recipients and their medical details to assign them a place on the registry. Where one lands on the list is based on degree of need, length of time on the list, type of transplant required, nearest transplant center and more.
When an organ becomes available, UNOS sends an alert message to all transplant centers within their network.
That’s when his team logs onto their Intranet, accesses the deceased patients’ info, and makes the initial evaluation of the organs. They review the donor and recipient’s blood and tissue types, immune status, physical distance between donor and recipient, and so on.
If there isn’t a match for deGraft-Johnson’s team, or the patient is not immediately available, perhaps because they’re on vacation, UNOS keeps calling down the recipient list, until a match is made.
When his team decides to take an organ, “I leave Minnesota and go to wherever the organ is,” the surgeon says. “Once there, I go through all the paperwork and make sure my partner didn’t miss anything [in the initial assessment]. I go alone, or sometimes take a profusionist, who helps with organ preservation for transport.”
They want to know the donor’s medical history, the present illness, information on how they died, and what killed them, deGraft-Johnson says. Then there’s the physical inspection: “We do an echocardiogram, check the valves, do a heart catheterization, a cardiac angiogram, we check the blood vessels…”
If everything pans out, the heart must be stopped, or as he puts it “arrested,” so it can be procured. That’s when he puts a cross-clamp—a kinder, gentler type of wrench—over the aorta until it stops pumping out fluids. That way they can pour in a solution to cause “cardioplegia,” or temporary paralysis. With the heart stilled, the surgeon can cut it out of the body, store it in a cooler, and take it on to a new home.
Once the heart is sewn into a recipient, in a procedure called anastomosis, the cross-clamp is removed and the heart can get back to work.
“I’ve done tons of transplants,” deGraft-Johnson says, “but every time I see a heart start to beat again, it’s like the first time.”
“Every surgeon is not perfect, but when it comes to this level of skill there’s no room for error,” the doctor explains. “You’re not just cutting out a heart. There’s calculation that goes into it, there’s a certain technique that you have to perform. If you miss one of those steps, you can cause a heart to fail, and then it’s no good. Every single step that goes into the calculation must be precise. He notes that it costs a lot of money for a medical center to charter flights and coordinate all the moves.
“It’s a big production. You cannot be the reason the production didn’t take place. It’s like everything is set and ready to go, and the main actor loses his voice… In a $100 million dollar production, somebody’s going to be very upset.” It’s not cheap for the patient—or their insurer—either. He estimates the tab for getting a new heart at about $658,000.
Harvesting a good heart takes 20 minutes, and then they put in another 10 minutes to package it for travel. While his team must later be meticulous in placing this donor heart, precision is far less critical in getting rid of the heart it will replace: “You usually just whack it out,” he says. “You don’t have to be very fine about it. It takes about 10 minutes.”
DeGraft-Johnson’s team is understandably picky about the organs they procure, and take great care to ensure that a transplant will be successful. Aside from per- forming the exhaustive battery of tests, they have to make sure that an organ recipient is fit enough for major surgery. They also suggest that a patient stick close to home to avoid being out of network and getting passed over if the call comes that an organ is suddenly available.
Sometimes the surgeon must offer his patient an organ with a disclaimer, such as the recent case of a 21-year- old donor who had a history of drug use and who ultimately took his own life. “I had to tell my patient that the person who had the organ engaged in high-risk behavior,” deGraft-Johnson admits.
Lingering doubt cast a shadow over the young donor’s organs, and when deGraft-Johnson offered his patient one of them, which to be fair had been tested and cleared by the network, the patient declined. “The knowledge of the risky behavior didn’t sit well with him. It was like moving into offices overlooking the water, and they give you a little cubicle with no view,” deGraft-Johnson says. “The history of the organ took away all joy he should have felt in receiving it.”
When a potential recipient, who may in fact be very near death, asks deGraft-Johnson’s advice about an organ with a checkered past, he tells them, “If it was my brother or family member, I wouldn’t take it.” He says that it’s not enough to give people the facts, he also has to help them interpret them.
When an organ donation is a go, the team operates on short notice. “We’re expected to perform under any circumstances, and fly under any circumstances.” Timing affects every aspect of the job. “The six hour window during which an organ leaves one body and is sewn into the next is called ischemic time,” the surgeon says, and then adds: “If those hours elapse, and the organ hasn’t been transplanted, it’s no longer of any use.”
A transplant is calculated from the second he takes off from Minnesota. If he is going to Michigan, for instance, he reviews the paperwork once he arrives, and then calls the team back in Minnesota, so they can bring the recipient into the holding room and get them ready for the operation. “The next time I call is when I make the incision in Michigan and inspect the heart. When I’m satisfied with it, I talk to the abdominal transplant team, the liver-pancreas team, and the kidney team.
“It’s like a bunch of vultures,” he says in jest. “I’m the cardiac vulture, there’s the liver vulture, the lung vulture, the pancreas vulture. There may be someone there to take the heart, while I take the lungs, or vice versa. It all depends.”
WATCHING THE CLOCK
“I coordinate with the abdominal transplant surgeons and ask, ‘How much time do you guys need?’ If they tell me two hours, I call back home and tell them I’m going to cross-clamp the heart and cut it out two hours from whatever time I’m calling them. They know that as soon as I cross-clamp, that two hours from that point, they should have the recipient ready. I calculate the time it took me to fly from Minnesota to Michigan, which was two hours, the drive to the hospital from the airport, which was maybe 20 min- utes, with maybe five minutes to change. Now I add the two hours the other doctors will need and the two hours and 25 minutes before I get back to the airport in Minnesota.
With the heart out of circulation for two-plus hours already when he gets back to the airport in Minnesota, he has fewer than four hours to transplant it. “When I get in the ambulance in Minnesota, I call them and tell them I’m 10 minutes away. An ambulance picks me up on the tarmac, and I zoom all the way to the university hospital, where the team is waiting in the operating room, and the patient’s chest is already open. They don’t take the heart out until they know I’ve landed.”
That’s because doctors have accidents, too. DeGraft- Johnson remembers the time a transplant team was killed on the job: “The plane went down in Lake Michi- gan about two years ago. Several people died trying to save one.” This part of his work doesn’t sit well with his wife, Latifa, he says. She’s a doctor, too, but practices family medicine with both feet on the ground.
“When I fly, I call my wife a lot to give her peace of mind,” deGraft-Johnson says, “because when this Michigan team crashed, (newscasters) said a ‘U of M transplant team crashed,’ and she thought University of Minnesota, not University of Michigan. I can’t tell you the stress that brought into my family.”
It shook him up as well, and for the next few flights he was on edge. The father of three young boys, he worried about crashing and not being there for his family. In time the anxieties eased, but to be safe, he says, “Ipray when I get on a plane, and I pray when I get off.”
DeGraft-Johnson with Dr. Denton Cooley, pioneering heart surgeon. (Bottom) Clay DuVal and family; DuVal received a lung transplant from deGraft-Johnson a little over a year ago.
Though he stays in constant contact with his crew, miscommunications happen. More than once, he’s returned to the airport in Minnesota and found no ambulance waiting to take him back to the medical center. One time he had no choice but to call 911. “A Minnesota state trooper responded. He picked me up from the tarmac and rushed me to the hospital. That was my first time riding in a police car, and I hope my last.”
In some ways being a cardiovascular surgeon seems oh- so Bond, James Bond: the chartered flights, the people to chauffeur you around, the women—and men—who sit by the phone, waiting for your call. But in other ways, it’s a hard-knock life.
“When it’s time to do a transplant, you’re operating nonstop,” says deGraft-Johnson. “You’re doing great things, but your body doesn’t like you at that point. Your sleeping patterns become irregular because the whole process is unpredictable. There are no bathroom breaks, no nothing.
“It’s a whole process of training your body, like running a marathon or doing the Tour de France. You’re expect- ed to function, [even if you] haven’t slept in two days. If somebody needs a transplant in the middle of night, or they come into the ER with multiple gunshots, I don’t clock out and go home.”
Although it’s difficult to predict when deGraft-Johnson will pull out his old kit bag and head off on another mission, he finds that summer, when people play full out in the heat, and winter, when they play full out in the cold, translate to his field’s high seasons. “Winter puts [people] in snowmobiles or in other sports, which poses risks,” the doctor said only weeks before Natasha Richardson’s fateful fall.
ROOTS OF A DREAM
DeGraft-Johnson and his older brother, John, who is also a cardiovascular and thoracic surgeon, grew up in Ghana, West Africa. As children, the younger sibling recalls that people frequently died of preventable illnesses. “You know there’s a big problem when our ex president [Hilla Limann] dies on the way to the hospital in the back of a pick up truck because he couldn’t get proper care. Can you imagine President Clinton dying in the back of a pick up truck?” deGraft-Johnson asks.
The desperation and urgency around the need for good health care in his homeland created in him “a spark, something in me that wanted to pursue a career in medicine and make a difference.” He dreams of returning to his home country to improve the state of medical care.
The name deGraft-Johnson, the doctor says, started with a Dutch man named deGraft, who married an Englishwoman named Johnson. The story goes that they immigrated to Ghana during slavery, where white and black roots mingled. Akin to America’s Kennedy clan, he says, his ancestors include J.C. deGraft-Johnson, PhD, who wrote the book, The Glory of Africa, and Joseph W.S. deGraft-Johnson, PhD, a former vice president of Ghana.
In the late 70s, however, with political tensions rising within the country, deGraft-Johnson’s father immigrated to Houston, TX. Five or six years later he sent for his wife and middle-school age children. Son, John, later joined the Navy, which paid for his medical schooling. He became a surgeon and served in Iraq during Desert Storm, before returning to the US to train in cardiac and thoracic surgery at the University of Pittsburgh. He now practices in California’s Bay Area.
Son, Moses, completed his undergraduate work at Texas A&M and Prairieview University. He went on to Ross University School of Medicine in the West Indies, and a general surgery residency at Long Island’s Jewish Med- ical Center, followed by a Cardiothoracic Surgery Fellowship at the University of Minnesota. He also spent time, of course, at Jamaica Hospital in Queens, NY, where he performed emergency surgery on 50 Cent.
Both deGraft-Johnson brothers graduated as cardiovascular thoracic surgeons around the same time. Not a small amount of ego goes into their work: “I was look- ing at how high on the surgical chain I could go,” the younger brother admits about the ambition that drives him. “Being a heart surgeon is like being on the varsity team. Everybody else is on the junior varsity team.”
It takes nearly a decade of education and training after medical school to become a surgeon who is licensed to operate on the chest area. “You can’t be a heart surgeon without being a general surgeon first,” deGraft-Johnson says. “You go through college for four years, four years of medical school, general surgery is five to seven years, after that its cardiothoracic training for another three years.” Now in his mid-30s, he’s performed between 50 and 60 successful transplants.
He still remembers his first time. He was alert, but not afraid. Though he admits, with a laugh, that his sphincter muscles were unusually tight. He’d watched his older brother do the procedure, and as he followed in his sibling’s footsteps, he thought, What a gift God has given me to allow me to perform this miracle. He saw the target area on the patient, went in and pulled off the job without a hitch. “I was so ecstatic,’ he says of the feeling afterwards. “I called my mom, and then I called my brother, and he said, ‘Yeah, yeah, whatever’—probably because he’s the older brother, and I’m the little brother. But now he calls and asks me for advice.”
As the father of three, Michael, 6; Matthew, 4; and Gabriel, 10 months, the surgeon is especially sensitive to cases involving children. Recently he traveled to Chicago to procure a heart from a 16-year-old girl who was murdered.
“I get to the hospital to procure (the heart) and I’m told that police officers are guarding the patient, because they fear who ever shot the girl doesn’t know she’s dead, and may come to the hospital to finish her off.
“I thought to myself, What kind of world do we live in, and what kind of life did this young girl have that some- one would want to shoot her in the head, and then risk being caught by coming to a hospital?”
Another teen he operated on recently died in a snow mobile accident. “I looked at the body on the table, cov- ered with tattoos and piercings,” he recalls. “Based on [the patient] history, she’d had some issues. And I thought, Wow, what problems could she have had? Another young man was arguing [with his father] while they were traveling in the car, and the kid jumped out at 45 to 50 miles per hour.” Organ donors all.
“But the more hopeful news is that their deaths actually saved other people’s lives.”
In what can be a suprisingly small divide between death and life, deGraft-Johnson finds that people often explore their spirituality. Though he is a religious man, he does- n’t talk about it unless a patient brings it up first: “It’s a defining moment in their life. They could die on the table, and if they want to talk about God, I’m wide open.”
FOUR SEASONS CARE
Although deGraft-Johnson and his family are in the process of moving from the Midwest to St. Thomas, US Virgin Islands, he’s proud of the University of Minnesota’s reputation for groundbreaking advances in heart surgery. The late pioneer Norman Shumway, MD, completed his residency and was awarded his surgical doctorate at U of M. He went on to perform this nation’s first heart transplant operation in 1968. When other doctors abandoned heart transplants because of challenges and dangers related to organ rejection, he stayed with it. Ultimately he moved on to Stanford University, where he advanced the field. Today, one of his children, Sara Shumway, MD, is director of heart and lung transplantation at the University of Minnesota’s Medical Center.
Aside from the renown father and daughter surgeons, deGraft-Johnson has high regard for U of M alums C. Walton Lillehei, MD, the pioneer of open-heart surgery who died in 1999, and Earl Bakken, inventor of the pacemaker and founder of the company Medtronic.
DeGraft-Johnson intends to continue the university’s tradition of excellence in his new home. He says he aims to give his patients what he calls ‘Four Seasons’ care: “When you go to the Four Seasons Hotel, they make sure you get the care that you need. They want
you to walk out of there saying, ‘That’s the best hotel I’ve ever stayed at, and next time I’m staying at the Four Seasons…’ I want to project that into my practice. I want patients who come to see me to leave saying, ‘That was the best doctor I’ve ever gone to.’ ”
DeGraft-Johnson befriended a recent patient named Clay DuVal, a graphic artist who just celebrated one year with a transplanted lung. He had a type of non- smoker’s emphysema.
“I met Dr. deGraft-Johnson the day after the trans- plant. He had flown to get the organ, and to see it go into me, a live human being, it’s got to be very rewarding for him.”
Before he got his new lung, DuVal recalls: “I was very sick, with shortness of breath. I was on oxygen. I’d lost a lot of weight. But after I had the procedure, I was walking the dog the next day, and riding my bike two weeks later. I’m doing stuff with my kids, who are now 5 and almost 8, that I only dreamed of doing.”
But a few months later, he was at death’s door again. Late last year he caught pneumonia, owing to drugs that helped his body accept his new lung, but lowered his resistance. He remained in the hospital for two months, where the outlook appeared bleak. On occasion, deGraft-Johnson went to ICU and sat with DuVal’s wife, Rachael, to offer his support and address their fears. Ultimately, DuVal pulled through, and he and deGraft-Johnson sometimes grab a coffee and catch up.
Now everyone can take a deep breath again, especially DuVal, with his new lung.
by Pamela K. Johnson