82 CHICAGO | SEPTEMBER 2019
PHOTOGRAPHY: (TOP RIGHT) COURTESY OF SARAH MCPHARLIN; (ALL OTHERS) COURTESY OF UCHICAGO MEDICINEtransplant turned her down. It was too risky,
they said. One predicted that she would die on
the operating table.
Even the surgeon who had performed her
first heart transplant declined. His medical
center just wasn’t up to the much more compli-
cated procedure. He offered to provide palliative
care — end-of-life comfort that would ease her pain
in her final months.
Sarah discussed it with her family. She wasn’t
ready to give up. In that case, the surgeon told her,
there was one last place she could try.
JUST OUTSIDE THE ROOM WHERE HE
was to meet Sarah McPharlin, Nir Uriel paused. As
the UChicago Medicine heart specialist scanned
her file, peering through his glasses at her history
of surgeries and hospitalizations, he understood
why she’d been turned down repeatedly.
Even without a tricky patient, triple transplants
are difficult enough. They require a precisely
timed orchestration of five surgeons — two taking
out the donor organs at one hospital, three putting
them in at another — each working with a team of
nurses, anesthesiologists, and assistants.
T he Un iver sit y of P it t sbu r g h’s T homa s St a r zl,
regarded as the father of modern transplants,
oversaw the first heart-liver-kidney procedure
in December 1989. The patient, Cindy Martin,
didn’t make it to April. “They did everything
they could,” her husband, John, told the New York
Times. “They tried to make her life better. But she
suffered for four months in the hospital and noth-
ing was really accomplished.” Starzl, for all his
towering accomplishments, was skeptical it could
ever be done successfully.
It could, of course, but it would take 10 more
years. It wasn’t until 1999 that UChicago Medicine
performed the first successful heart-liver-kidney
transplant — success here being defined by the
patient living for at least a year. By the time Daru
and Sarah were under consideration, UChicago
Medicine had performed four of the 15 triple trans-
plants of this kind ever undertaken.
It seemed unlikely that Sarah would be the
16th. The degree of difficulty of a heart transplant
doubles with each previous cardiac operation.
Sarah had undergone six: the initial transplant and
five reparative surgeries. Those procedures had
left her heart buried in scar tissue. This “hostile”
chest, as surgeons call it, makes it harder for them
to locate the arteries and veins they will need to
HOW THE BACK-TO-BACK
TRIPLE TRANSPLANTS UNFOLDED
Daru SmithSarah McPharlinDECEMBER 18, 2018DECEMBER 20Call comes in: Organs are available.
Transplant team gives final OK.
Daru is told the procedure is a go.Teams leave to retrieve the organs.
Surgery begins.
Donor heart arrives.Heart transplant begins.
Heart transplant finishes.Liver and kidney arrive.
Liver transplant begins.
Liver transplant finishes.Kidney transplant begins.Kidney transplant finishes.
Surgery is completed.3:15 P.M.
5:09 P.M.
5:30 P.M.12:30 P.M.3:07 P.M.
5:04 P.M.5:26 P.M.
7:00 P.M.7:20 P.M.
8:31 P.M.
11:46 P.M.4:01 A.M.5:38 A.M.
8:18 A.M.11:54 P.M.2:40 A.M.
3:20 A.M.4:05 P.M.
6:04 P.M.11:43 P.M.
11:53 P. M.1:42 A.M.2:30 A.M.
2:40 A.M.
6:56 A.M.10:26 A.M.
11:34 A.M.2:27 P.M.Call comes in: Organs are available.Transplant team gives final OK.
Sarah is told the procedure is a go.Teams leave to retrieve the organs.
Surgery begins.Donor heart arrives.
Heart transplant begins.Heart transplant finishes.
Liver and kidney arrive.Liver transplant begins.
Liver transplant finishes.Kidney transplant begins.
Kidney transplant finishes.
Surgery is completed.DECEMBER 19DECEMBER 21