Hard Cases: Tennessee’s First Heart-Lung Transplant (Linked In)

LINKED IN | One month after Christmas, in 1987, my surgical team and I prepared for Tennessee’s first heart-lung transplant. A determined mother, desperate to live, was flying to Tennessee to receive the heart and lungs from a young woman in Nashville whose own life had ended too soon.

It was a bold step for our patient, the surgical team, and the brand new Multi-Organ Transplant Center at Vanderbilt University.

I had just left Stanford to move home to Nashville and start the Multi-Organ Transplant Center at Vanderbilt University Medical Center (VUMC), with the goal of creating a world-class transplant program. At that time, heart-lung transplants were still quite rare; fewer than 100 had been performed worldwide. It was a challenging operation that would give even the most experienced surgeon pause. Remove all the organs between the neck and the diaphragm, leaving the chest cavity bare. Transplant a donor heart and lungs. Put everything back together. The long-term prognosis of transplanted lungs was unknown.

It was a nascent field. The procedure was still considered experimental in 1987, and most insurers would not cover it. So before we could take on a heart-lung patient, several things needed to happen. First, I needed a guarantee to finance the operation. The cost of transplantation, which often totaled $100,000 or more, was one of the big social and ethical issues confronting the field at that time. We didn’t want this life-saving treatment to be available only to the very wealthy, but without insurance covering the procedure hospital systems struggled with how to absorb the hefty cost.

I had already left one program at Massachusetts General when they decided (mistakenly and shortsightedly I believed) in 1980 not to pursue heart transplantation because of the price tag. In starting the multi-organ transplant center, Vanderbilt agreed to open its doors to the patients in greatest need, not just those who could afford to pay. Eventually our center would need to pay its own way, but during those early years when insurers failed to cover the procedure – we would.

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