Highly ranked center meets challenge of two children's heart transplants in single day

Clover Carney, 3, of Murrells Inlet and another child received heart transplants at the MUSC Shawn Jenkins Children’s Hospital on the same day, a rare feat made possible by a team that has grown in size and strength over the past several years. Its accomplishments have been recognized by U.S. News & World Report, which ranks the hospital’s Cardiology and Heart Surgery program among the best in the country.

Surgeon Minoo Kavarana, M.D., who operated on Clover, explained why doing two heart transplants in a single day was such an achievement. “Heart transplantation requires tons of resources and manpower with regards to not just the surgeons, but the assistants, the operating room, nursing staff, heart and lung machine specialists, anesthesiologists, intensive care unit physicians and cardiologists,” he said.

“So you have to duplicate that within the space of 24 or 48 hours. It’s very challenging because you need to have one of each.”

 

Challenging, and thrilling for the medical team to see the results. “It's a feeling of euphoria. Walking by the intensive care unit and seeing the kids for the first time having normal blood flow and perfusion to their organs. You know, sitting up in bed and asking for something to eat and wanting to watch a movie and actually feeling normal. It's truly a gift to be able to watch this and be part of this whole process,” Kavarana said.

Clover’s parents are euphoric, too, knowing their daughter now has the chance to grow up and live a fairly normal life. She’ll have to be on medication to try to keep her body from rejecting the new heart, but it gives her a shot at going to school and playing like any other kid again.

She’s come a long way from the day she was born, when neither her parents nor her doctors had any idea at first that her tiny heart was already in trouble. Clover had heart block, which means the heart beats too slowly or abnormally, and heart failure, which means her heart couldn’t pump as much blood as it needed to. 

Her father, Tim Carney, said things moved quickly once everyone realized the seriousness of the situation. “They didn't know what to do there at the local hospital. So they flew her here to MUSC, and I think the day after, she got her first pacemaker.”

 

Clover’s mother said doctors at the MUSC Shawn Jenkins Children’s Hospital helped stabilize Clover enough with pacemakers and other treatments to eventually go home with her family. 

“She managed it well with medications and she was doing really well. She was totally normal and acted fine. She ate really well. She had good energy. I mean, you wouldn't be able to tell anything was wrong with her. So we were like, this is great,” Caroline Floyd said.

 

“And then at the beginning of this year, she started to lose her appetite. She started to show things and then echos were showing her heart failure was progressing.” Echocardiograms are tests that take pictures of the heart. 

So Clover's parents brought her back to the hospital on May 1 of this year and she hasn’t left since then. Clover was so sick that she needed a Berlin heart, a mechanical system to support her cardiac output. And she needed a heart transplant. Her family settled in, thinking she could be in the hospital for months waiting for a donor heart.

But once again, things moved quickly for Clover. A little over a month after she arrived, her mom got a phone call from Andrew Savage, M.D., director of the Pediatric Heart Failure and Transplant program in the MUSC Shawn Jenkins Children’s Hospital. 

“It was 6 o'clock on a Sunday, and I'm like, ‘Hello?’’’ Floyd said. “He said, ‘Hey, it's Dr. Savage.’ I'm like, ‘Hey, what's going on?’ I was thinking maybe something's wrong. He said, ‘I have to tell you something. We have a heart for Clover.’ I was just in shock. I'm like, ‘Is this a dream? Are you punking me?’’ she said, and laughed, recounting it later.

He wasn’t. By 1 the next morning, Clover was in surgery.

 

What the little girl had no way of knowing was that she was part of a rare event. Another donor heart became available the same day as Clover’s for a second Shawn Jenkins patient. Transplant surgeon Lloyd “Mac” Felmly, M.D., described what that set into motion.

“Now, we were trying to evaluate two donor hearts concurrently, which definitely increased the complexity of getting everything done from a standpoint of allocating resources for the recipients here. And then also allocating the resources to make sure we could get both of the donor procurements done.”

They had to make sure the two hearts were safe matches for their young patients. “A lot of factors go into finding the right donor heart for a patient. The biggest factors are heart size and function, and whether a heart's going to be a good fit from an immunologic standpoint - matching the ABO blood type,” Felmly said.

 

“Many of our patients also have blood transfusion exposure from prior surgeries, which can sensitize the immune system and affect proteins like HLA antibodies." HLA stands for human leukocyte antigen. The body uses HLAs to identify whether cells belong in the body, according to NMDP, formerly Be the Match.

“Transplant patients are all on immunosuppressant medications to prevent rejection of the new heart. And to make a heart the most compatible that we can, we take all these factors into consideration.”

That’s why a surgeon from the MUSC Shawn Jenkins Children’s Hospital travels to evaluate and transport donor hearts. The doctor who brought Clover’s donor heart to Charleston had to turn around and catch another flight to do the same with the second heart, all while the clock was ticking. Hearts are viable for only a matter of hours after donors’ deaths, according to the Donor Alliance.

The second heart made it in time, too, and Felmly was operating on the second transplant patient by 11 that morning. Like Clover, that patient is now recovering with a new lease on life.

“We're proud of the heart center,” Felmly said. “There were so many moving parts, and everyone helped out to make this happen. And then we had the teamwork in the operating room between our surgical teams, anesthesia teams and perfusion teams to take two complex patients to the operating room in a very short period of time and get great surgical outcomes.”

Kavarana said the double transplant surgery is another sign that the heart team at the MUSC Shawn Jenkins Children’s Hospital is an important resource families can rely on. 

“We're consistently very good and consistently maintaining our outcomes that are among the best in the country. So I think it's a privilege for us to be able to do that, and a privilege for the families to be able to experience that right here - and not having to travel too far for any kind of surgery related to the heart.”

Clover’s parents can attest to that. They’re amazed by how well things went – and how quickly she’s recovering. “I mean seriously. I have a picture of her playing with her Barbie makeup castle one day post-op. People couldn't believe it,” her mother said.