In June 2020, Raymond got “the best news”: His care team felt confident that the time was right, and they could safely add him to the transplant waiting list.
A few weeks later, on the evening of July 15, Raymond experienced severe bouts of coughing and was struggling to breathe more than usual. His mom insisted he head to the hospital, where he then started to cough up blood, a serious condition sometimes seen in patients with advanced CF lung disease.
He was immediately admitted to the ICU overnight, because “on top of everything else, Raymond now had life-threatening bleeding from his lungs,” says Dr. DiMango, who noted that his lungs were only functioning at 20 percent capacity. “We knew his time was limited.”
The next morning, “we get a phone call from the hospital saying Raymond is in really bad shape, and our hearts dropped,” recalls his sister Adrianna.
Serendipitously, on that same morning, a text chain among Raymond’s care team lit up with an urgent message: There was a possible match for Raymond.
“When I woke up in the ICU, my mom and my sister were already in the room,” recalls Raymond. “I remember someone came in and told us about the possible donor, and we all started crying.”
What happened next was a whirlwind. “I didn’t hesitate to sign the papers. I knew I was in bad condition, and this was a chance I had to take,” says Raymond.
Within three hours, word came back that the transplant was a go. “It happened so fast,” says Raymond, who was immediately wheeled into the operating room with hospital staff lining the hallways clapping. “My mother said it was a miracle.”
The triple transplant began at 6:32 p.m. with the removal of Raymond’s damaged lungs by Dr. Frank D’Ovidio, surgical director of the Lung Transplant Program at NewYork-Presbyterian/Columbia.
“His lungs were as bad as they could get,” says Dr. D’Ovidio. “He didn’t have much more time to wait.”
Like a meticulously planned relay race, the team prepared for the triple transplant so that each surgeon would have enough time to implant their respective organ within the time frame it’s viable outside of the body. When the organ procurement team arrived at the hospital with the donor organs, Dr. D’Ovidio had to be ready to implant the lungs immediately, because they can only survive for six to eight hours outside of the body. Next came the liver, which is only viable for 10 to 12 hours once removed from the donor. The final transplant surgery was the kidney, which can last for up to 36 hours before being implanted.
For the entire surgery, Raymond was supported by ECMO, an extracorporeal membrane oxygenation machine that pumps blood and oxygen through the patient’s body. “We had planned to use ECMO so that we would not stress the heart and the new lungs, which are very delicate in the early post-transplant period, throughout three big surgeries,” explains Dr. D’Ovidio.
Throughout the day, the team remained in constant contact about the progress of each transplant. “When we’re planning to do a multiorgan transplant, we’re making multiple decisions along the way of whether or not to proceed with each organ. If ever the patient’s not stable or we think that the surgery poses too much risk, we’ll cut our losses, get the patient stabilized, and reallocate the organs so that someone else could benefit,” says Dr. Ratner.
During Raymond’s triple transplant, “we were monitoring every step of the way. We were stopping in the operating room and seeing how they were doing,” says Dr. Ratner. “In this case, everything went smoothly and exactly the way we wanted it to go.”