80 CHICAGO | SEPTEMBER 2019
cells that infiltrate and all but shut down organs — in Daru’s case, the
heart, liver, and kidneys.
That meant Daru needed all three vital organs replaced. That par-
ticular triple transplant is one of the rarest procedures in medicine, so
complex and risky that it lies beyond the capacity of all but a handful of
the nation’s elite hospitals. Only 15 had been performed.
Still unconscious, Daru continued to fight the light. Then his eyes
fluttered and opened. “Hey, man, where did you go?” Daru’s cardiologist,
Bryan Smith, said. “Thought we lost you for a second.”
In his white lab coat, his square jaw dusted with a light beard, the
36-year-old Smith could have stepped off the set of a medical soap.
Seeing Daru on rounds every day, Smith had grown fond of him, admir-
ing how hard he fought.
When he discovered that Daru had been approved for the triple trans-
plant, Smith was thrilled but worried. If the operation came off, Daru
would have a new life. But before it could even be attempted, he had to
live long enough for a donor to be found. And not just any donor: one with
three healthy organs compatible with Daru’s blood type — and sufficient
to support his 6-foot-1 frame.
Daru’s close call that day wasn’t his first. He knew the light would
be back.SARAH MCPHARLIN SAT IN A SPARE ROOM AT UCHICAGO
Medicine last November, waiting to plead for her life. She was there to
meet with the center’s transplant evaluation team.
As different as Sarah was from Daru — the daughter of a special educa-
tion teacher and an executive at Chrysler, she’d grown up in a tree-lined
suburb of Detroit, gone to college and graduate school, traveled the world;
he’d grown up as the fifth of seven children on the South Side, raised
by a mother who managed a Harold’s Chicken Shack, where he worked
until he found a better-paying job as a truck driver — they were, in more
important ways, alike.
Like Daru, Sarah was 29. A rare autoimmune disease — in her case,
an inflammatory condition called giant cell myocarditis — had attacked
her heart. Complications from years of procedures and
medications had all but destroyed her liver and kidneys.
Her only hope, too, lay in a triple transplant.
Up until age 11, she seemed like a normal, healthy
kid, smart (she was selected to give a speech at her
fifth-grade graduation) and athletic (she played soc-
cer and swam). It was while she was splashing in a
pool, in fact, that a blinding headache seized her. She
dipped her head in the water hoping it would offer
relief. Moments later, her mother, Dianne, noticed
her floating face-down. Sarah was rushed to a nearby
hospital. Her heart had stopped, and a lifetime in and
out of hospitals had begun.
Within a year, Sarah was stricken by a series of heart attacks. She had
to be jump-started back to life again and again with defibrillator paddles.
At 12, Sarah had a heart transplant, but over the years the replacement
organ also began to fail. Surgeons had to open her chest five more times
to repair ongoing problems.
By the time she and her mother traveled from their home in Grosse
Pointe Woods, Michigan, to the November 2018 meeting at UChicago
Medicine, her failing heart had led to such a buildup of fluid in her body
that her shoes no longer fit. Her liver and kidneys had been damaged
beyond repair. But the first few hospitals she approached for a tripleDARU SMITH WAS TALKING
TO HIS DOCTOR AND SISTER
ONE DAY LAST DECEMBER
WHEN HE BEGAN TO DIE.
He saw their forms grow dim, a dark curtain com-
ing down on them and himself in his fluorescent-lit
hospita l room at Universit y of Chicago Medicine.
Then the 29-year-old was above it all, looking into
a hole in the ground where a torrent of water was
swirling like a giant draining sink.
And then he was in a hallway. At the end of it
glowed a white light. He felt at peace. No more
heart palpitations, no flutters, no aches. He saw
pictures on a wall. Scenes from his life. His son
being born. Himself cutting the umbilical cord.
Changing the baby’s diaper for the first time. He
loved that child so much he’d given him his own
name and called him Junior.
It felt good, the light. Until Daru realized: This
is what happens when you die. He turned around
and began to run. Faster. The scenes spooled past
now. The light pulled him. I gotta fight.
Daru had been so sick. A few weeks earlier,
he’d gone to the emergency room with a cold he
cou ld n’t sha ke. B ut he k new it w a s more t ha n t hat.
He could barely keep up when
his son, 3 years old by then,
pedaled his bike ahead of him.
And whenever Daru stepped
from the cab of the 18-wheeler
he drove for a living, he felt the
world go sideways.
“You need to call your fam-
ily,” the ER doctor had said when
the test results came back. Daru
had a bad case of pneumonia,
but that wasn’t the worst. He
was in cardiogenic shock, a condition in which
the heart can’t pump enough blood to meet the
body’s needs. If not treated immediately, Daru
would die. What’s more, he also had something
called sarcoidosis, a rare autoimmune disease
that can cause the body to overproduce certain
There’s a macabre
math that goes into
such decisions: Does
it make sense to use
three organs on a
single long shot?