Transplant doctor finds himself on receiving end of procedure

By Clem Fiortentino

Staff Writer

December 24, 2007

Transplant surgeon Dr. David Laskow needed a new heart himself after suffering cardiac arrest Robert Wood Johnson University Hospital

As a transplant surgeon, Dr. David Laskow has presided over thousands of miracles. But two years ago, at this time of year, he needed a miracle of his own.

Laskow, director of kidney and pancreas transplant surgery at UMDNJ-Robert Wood Johnson Medical School in New Brunswick, had just turned 50, had always been in good health (a self-described "fairly athletic guy") and was getting ready to go to Atlantic City with his neighbor Alan Potechin for a bit of a celebration. Little did he know he was about to have a life-altering experience.

It was Saturday morning, Dec. 10, 2005. His wife, Mary, a medical librarian at Bristol-Myers Squibb in Lawrenceville, was working. So he was alone at his home in the Skillman section of Montgomery.

"I got out of the shower and starting having chest pains," he said. "They started getting worse. I broke out in a sweat. I started getting dizzy. I called my wife. I called my neighbor. I never called 911, because they found me on the floor."

Luckily for Laskow, Potechin knew the combination to Laskow's front door and was able to get into the house, find Laskow and call for help.

When Laskow awoke, he found himself in bed, unable to move. He had been intubated for almost two weeks and was sick with a bad infection. He was told that, after the heart attack, his blood pressure was low and he had suffered renal, respiratory and liver failure.

He was first treated at Somerset Medical Center in Somerville, where he suffered an allergic reaction to heparin. The drug, prescribed to thin the blood, had instead caused his blot to clot. After the insertion of a balloon pump and a "whole host of medications," he was transferred to New Brunswick.

"It was touch-and-go," Laskow recalled. "They got me to Robert Wood and put me on a mechanical heart. I did better, but over the next 10 days, I started clotting off the mechanical heart. We were worried about a stroke."

The diagnosis had been confirmed. His family had "put the word out from Day One." The transplant surgeon needed a heart transplant.

Put on the list

He had been placed on the list for a transplant with the New Jersey Organ and Tissue Sharing Network in Springfield. As his condition deteriorated and when no appropriate donors were found in New Jersey, the network broadened the search from just New Jersey to the Northeast region. In less then 24 hours, a match was found Dec. 20.

Laskow was taken to the operating room and given the heart of a 51-year-old Delaware woman.

"I think she died in a car accident," Laskow said. "She was an organ donor who had spent her life helping the handicapped. She had a generous heart and a tremendous family."

Still, Laskow's saga continued.

"On Christmas Day, I became infected with a drug-resistant bacteria," Laskow said. "One drug did work, but it was toxic to the kidneys. Between that and the anti-rejection drug (which is hard on the kidneys), I had to have my medications adjusted just to get through the day."

Two weeks later, he was able to breathe on his own. In January, the infection was under control, his blood thinned and he regained liver and kidney function.

"I had come in at 190 pounds, and now I was down to 135," he said. "I had no strength. I couldn't move my hands and couldn't move much."

In February, he started rehab, but after a week, signed himself out.

"I thought I could do more at home," he said. "I could work six hours a day at home."

Laskow was back to work six months after the event, "probably too soon," he acknowledged. "It's a real miracle that I didn't lose anything mentally."

Luck and commitment

Laskow, who with Dr. Diane James had started the liver, kidney and pancreas transplant unit at Robert Wood in 1998, was lucky. He knows that. And now, he's committed -- more than ever -- to helping other transplant patients.

"The act of donating one organ has an exponential effect," he said. "What a powerful event. It winds up affecting thousands of lives. I touch a lot of people's lives. You go back to what you do. You interact with the world."

More than 4,200 people in New Jersey and close to 100,000 nationwide are on the waiting list for transplants. Of those 100,000, 70,000 are waiting for kidneys, according to the New Jersey Organ and Tissue Sharing Network, a nonprofit, federally certified, state-approved organ-procurement organization. It is estimated that a name is added to the waiting list every 20 minutes and that 3,000 people die each year while waiting for transplants.

"Bottom line, there is not enough to go around," said Joe Roth, chief executive officer of the network. "Organ donation should be on everybody's list. People should consider it from a positive standpoint."

Roth blames the organ shortage on misinformation and misperceptions.

"No major religions object anymore," Roth said. "And sometimes, people think that if doctors know they are registered, they won't treat them aggressively. This is certainly not true."

There are two easy ways to become an organ donor, Roth said.

First, let your interest be known to your family. Sometimes, families don't know their loved one's wishes.

And secondly, put it on your driver's license. This will ensure your consent.

"It's a righteous thing to do," Roth said. "This (transplantation) is not an experimental procedure. It can save lives."

Organs are computer-matched according to compatibility of donor and recipient tissue, determined by various tests, waiting time and the medical need of the recipient.

It is based on factors such as acuity, how sick the patient is, whether he or she is intubated, kidney function and if the patient is being supported mechanically.

"Every hospital in the United States is required -- when death is imminent -- to call a group like the Sharing Network," said Bill Reitsma, the network's clinical director. "We do an initial exam to see if they're suitable. We dispatch a team and work with the hospital collaboratively."

The donation process

When the call comes, Reitsma first sends a transplant coordinator, who is skilled in assessing patients and the physical nature of the injuries, and a family-support person, generally from pastoral care or a social worker -- "someone who is very, very gifted at sitting with the family," Reitsma said. "First we want to understand the gravity of the situation and then offer the family the option to save someone's life."

Typically, the potential donor has been the victim of a catastrophic injury and has been placed on a ventilator.

"This is not a coma," Reitsma emphasized. "This is death."

The Sharing Network has up to 12 professionals on call 24 hours a day, seven days a week.

Once consent is given, doctors from the network are sent to recover the organs. Doctors from the hospital also are part of the process.

"We have to allocate organs via the national system," Reitsma said. "We put the specifics (e.g. height, weight, blood type) into the computer. The computer tells you in order of priority, who we must offer it to."

It's all electronic, Reitsma said. And rarely is there a perfect match.

"We're looking for a match that is compatible and safe," Reitsma said.

Also, Reitsma said, doctors take into account the concept of "risk-benefit."

In Laskow's case, Reitsma said, "David Laskow was so sick, he wouldn't have survived 24 hours. He was in cardiogenic shock. Under ideal circumstances, we would have waited for a bigger patient. We thought that maybe a smaller heart would work, and it's worked great. It's a matter of what's going to help a patient live."

Reitsma has the utmost respect for Laskow.

"He's quality in every respect," he said. "He's been on both sides of the miracle. This is a rare gift that he has received. He understands on such a personal level what the gifts of the donors mean. He does all he can to respect that gift."

Roth echoed those sentiments.

"It got down to the last few hours of his life," Roth said. "Dr. Laskow is a real gentleman, dedicated to his profession and an excellent practitioner. He is one of the people we work with very closely as a transplant doctor and on our board of trustees. He is living proof of the benefits of organ transplant, that you can still be productive. And it goes to show you that this can happen to anyone."

More than 4,200 people in New Jersey and close to 100,000 nationwide are on the waiting list for transplants. Of those 100,000, 70,000 are waiting for kidneys.

Separate and specific equitable allocation of each organ has been determined by experts and approved by the Organ Procurement and Transplantation Network. Social or financial data are not part of the computer database and are not factors in the determination of who receives an organ.

In the absence of a donor designation or if an individual is younger than 18, the family is responsible for making all decisions regarding donation.

In 2006, 533 organ transplants were performed in New Jersey at the state's six transplant centers. These included 385 kidney, 78 liver, 46 heart, four pancreas and 20 kidney/pancreas transplantations.

In 2006 at Robert Wood Johnson University Hospital, there were 97 kidney transplants, seven pancreas transplants and nine heart transplants.

In 2007 (through Nov. 30), there have been 105 kidney transplants, six pancreas transplants and six heart transplants.

Robert Wood Johnson University Hospital offers:

• Kidney transplants for both adults and children.
• A paired kidney exchange program, which is a national program that matches a patient in need of a transplant who has a willing but incompatible donor with another patient/donor pair in the same situation.

In addition to Robert Wood Johnson, transplant centers in New Jersey include Newark Beth Israel Medical Center, Hackensack University Medical Center, University Hospital in Newark, Saint Barnabas Medical Center in Livingston and Our Lady of Lourdes Medical Center in Camden.

For more information, call the NJ Sharing Network at (800) 742-7365 or visit www.sharenj.org.

To contact the transplant centers at Robert Wood Johnson University Hospital, call (732) 235-8695 for information on kidney and pancreas transplants and (732) 235-8264 for heart-transplant information.

Sources: New Jersey Organ and Tissue Sharing Network and Robert Wood Johnson University Hospital

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This article posted February 15, 2008.