Last month, 37-year-old Vincent Rankin bought his casket and began planning his funeral. The former television news assignment editor had virtually given up on receiving the heart transplant that would save his life. On April 26, less than a month after his transplant, Rankin plans to celebrate the gift of life by sharing his experience at Cedars-Sinai Medical Center's Organ Donor/Recipient Fun Run and Reunion Picnic.
Although the future today is bright for Rankin, just a few short weeks ago, it was a very different picture. Tears rolled down his cheeks on Sunday, March 30, as he and his wife watched the movie, John Q, starring Denzel Washington. As Washington's character in the movie struggled to get a heart transplant for his dying son, Rankin and his wife wept because their situation was too close to the movie for comfort. Rankin also needed a heart transplant in order to live, but the odds weren't in his favor.
Unlike some organs -- such as kidneys and livers -- which can be donated by living donors, a heart transplant means that the donor must die. And because a transplanted heart ideally comes from a donor of relatively similar size and compatible blood type, Rankin knew that at 6-feet, 6 inches tall, a suitable organ might not become available for him in time.
A year ago, Rankin thought he was in the prime of life. Although he had had a kidney removed five years earlier, he was -- he believed -- fit and healthy. His mother had passed away in 1995 from congestive heart failure, but he had no reason to believe he had inherited the disease. In fact, as some of his friends and well-known athletes were diagnosed with -- and even died from -- heart disease, he considered himself blessed that his heart was healthy. Or so he thought.
Then one day in early 2002, he woke up short of breath and coughing. The symptoms didn't go away and he went to see his doctor. After undergoing a battery of tests, Rankin was diagnosed with congestive heart failure. As his condition worsened, he was forced to quit work, simultaneously losing his health insurance. He applied for Medi-Cal, but was denied. "I couldn't get my medications for six months," he remembers. "I didn't know what to do." Although he did eventually qualify for disability, which covered his medical costs, Rankin remembers that as a frightening and very discouraging time in his life.
In October, he was referred to Cedars-Sinai where he met Lawrence Czer (pronounced Cesar), M.D., and Ann Hickey, M.D., both cardiologists. "He had class 3 to 4 heart failure, and was short of breath just from walking across the room," says Dr. Hickey. "He couldn't sleep at night because he had trouble breathing."
Rankin suffered from Idiopathic Dilated Cardiomyopathy. This disorder, which occurs in about 40 percent of heart failure patients, is caused by a virus or other undiagnosed illness rather than by coronary artery disease. Because of his large size and because of the special medications he would need due to the fact that he'd previously had a kidney removed, Rankin's medical challenges were multiple.
"In the movie John Q, some people along the way didn't care, but these doctors at Cedars-Sinai never gave up," Rankin states emphatically. "They made sure I had my medications, got me into a clinical trial and eventually found me a new heart. Dr. Czer even prayed with me at every visit. I'd never had anyone do that for me before."
Dr. Czer and Dr. Hickey told Rankin he would need a heart transplant and introduced him to Carlos Blanche, M.D., director of heart transplantation at Cedars-Sinai.
Dr. Blanche explained that for a heart to be compatible, it would need to come from a donor whose blood type and tissues matched Rankin's, and who was of a relatively similar size. Cedars-Sinai is one of the few heart transplant centers in the nation to utilize a procedure known as "under-sizing" a heart. According to Dr. Blanche, ideally a donor heart will be very close in size to the recipient heart. However, in some cases, it is actually possible to successfully transplant a smaller heart into a larger person. This can be done if the recipient's pulmonary artery pressure is normal because the heart will actually grow to accommodate the needs of the larger person.
"This means that hearts that may have been declined at other centers because of their size, can actually be used at Cedars-Sinai," said Dr. Blanche. It also means that if the donor is a woman -- women usually have smaller hearts -- and the recipient is a man, the transplant can still be successful if the other criteria are met.
This was critically important in Rankin's case, because at 6-feet, 6-inches tall and weighing more than 260 pounds, finding a donor heart from an individual of his size was very unlikely.
Despite the odds, Rankin remained hopeful. He stayed in close contact with his physicians and with Cedars-Sinai's heart transplant coordinator, Paul Nusser. "Paul would continually encourage me," he remembers. "In late 2002, he told me that as the holidays approached, sometimes more donor organs become available. So we were hoping that one would come through then." But the holidays came and went, without a heart for Rankin.
In early 2003, his condition began to deteriorate quickly. In mid-March he underwent surgery for a blood clot in his left leg. Rankin now readily admits that he had pretty much given up hope. "I had started planning my funeral," he remembers. "I bought my casket and started making arrangements because I didn't want my kids to be burdened with those things."
Then on Sunday evening, March 30, Rankin settled down to watch a movie. Suddenly, the phone rang. When he answered it, Nusser was on the line. "We have your heart," he said simply. "Can you come to the hospital?"
It seemed too good to be true, and Rankin hardly knew how to respond. Thinking that they wouldn't start a surgery so late at night, he said the first thing that popped into his mind: "I'm in the middle of watching The Marshalls, and it's at a good part," he told Nusser. "Can I finish the movie?"
Nusser laughed. "Come down here and watch it at the hospital," he said.
Reality hit, then. All the way to the hospital Rankin prayed that everything would check out -- that this would be a positive match. As he and his wife walked down the hall toward the surgery area, they saw a man standing by the door holding an orange ice chest with a white top. "It seemed surreal, like something you see in a movie," Rankin remembers now. Looking the man in the face, he asked, "Is this heart for me?"
The man nodded. All of the tests had checked out. The heart was a match. Breaking down in tears, Rankin said, "My birthday's coming up in a few days. I couldn't ask for a better gift."
Then he began to pray again, this time for his donor. "I always knew that in order for me to live, someone else would have to die -- very likely in a sudden way," he said in an emotion-choked voice. "In case that person didn't have time to pray on his or her own behalf, I wanted to say a prayer for them."
According to Dr. Blanche, Rankin's prognosis is excellent. "His old heart was badly diseased, but his new one is young, very strong and a perfect match," he said.
Rankin is scheduled to be one of the speakers later this month at Cedars-Sinai's Multi-Organ Donor & Recipient Fun Run and Reunion Picnic. Although he was not previously an organ donor -- he used to jokingly say he intended to leave this life with everything he came into it with -- he is quick to state that he is one now. He has also convinced his family members to become organ donors, and he and his twin brother plan to celebrate and honor his donor's life at the same time that they celebrate their own birthday each year.
"People need to know that hope is right here on Third Street," says Rankin, referring to Cedars-Sinai's location. "This hospital and these doctors never give up on you. It's a miracle."
By volume, Cedars-Sinai's heart transplant program is the sixth largest in the nation and the second largest in California. It has the largest published experience in the world for heart transplants in patients over 65 years of age, and the largest published experience in the world for heart-kidney transplants. Overall, Cedars-Sinai's heart transplant program enjoys a high rate of success, with a one-year survival rate greater than 98 percent and a five-year survival rate of more than 70 percent -- both of which significantly exceed industry averages as reported by the International Society of Heart and Lung Transplantation.
The Medical Center is one of the largest nonprofit academic medical centers in the Western United States. For the fifth straight two-year period, it has been named Southern California's gold standard in health care in an independent survey. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities and its broad spectrum of programs and services, as well as breakthrough in biomedical research and superlative medical education. Named one of the 100 "Most Wired" hospitals in health care in 2001, the Medical Center ranks among the top 10 non-university hospitals in the nation for its research activities.
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