How I led my own heart transplant | Robert Montgomery, MD, DPhil | TEDxNYU Langone Health

Key Concepts

• Cardiomyopathy
• Congestive Heart Failure
• Cardiac Arrest
• Heart Transplant
• Implantable Cardiac Defibrillator (ICD)
• Molecular Immunology
• Fight or Flight Reflex
• Organ Allocation
• Hepatitis C
• Immunosuppression
• Xenotransplant

Personal Journey and Family History of Cardiomyopathy

The speaker recounts a personal and familial history deeply impacted by cardiomyopathy. His father was diagnosed with the condition at age 52 in 1976, leading to congestive heart failure and multiple cardiac arrests, ultimately spending his last two years in the hospital. At the time, a heart transplant was considered, but his father was deemed too old, and the procedure was not yet reliable.

This genetic predisposition continued through the family. The speaker's brother, Rich, died suddenly at age 35 from cardiomyopathy while water skiing. Another brother was diagnosed with the disease and received a heart transplant at age 39. The speaker himself inherited the disease and was informed he was at high risk for sudden death, necessitating an implantable cardiac defibrillator (ICD).

The Speaker's Own Health Challenges and Career Path

The speaker was the first surgeon in the world to receive an ICD. This early model was large, requiring implantation in his abdomen with patches placed around his heart to deliver electrical shocks for abnormal rhythms. He was advised that his condition was incompatible with being a surgeon and was encouraged to pursue a different profession.

Despite this, he was determined to continue his surgical career. A mentor's support allowed him to retain his residency position while he took time off for research. He pursued a PhD in molecular immunology at Oxford.

During his time in England, an accident occurred where he had to extricate a baby from an overturned car. During this adrenaline-fueled event, his ICD activated three times, causing him significant pain and making him question his ability to be an effective surgeon with such a condition. This experience led him to retrain his mind and body to manage his fight-or-flight reflex and overcome self-doubt and fear.

Advancements in Surgery and Organ Transplantation

The speaker's surgical career progressed, witnessing significant advancements in the field. He performed thousands of transplants, transforming patients' lives and enabling them to return to near-normal lives.

However, the challenge of organ shortage persisted. He became aware that his three biological children had also inherited cardiomyopathy, extending the family's struggle with the disease across four generations.

Over the next 30 years, the speaker experienced periods of relative stability punctuated by near-death experiences, including seven cardiac arrests. Some were managed by his ICD, while others required CPR from family or bystanders. He experienced a month-long coma in Patagonia and received last rites in Italy, highlighting the severity of his condition.

Despite these critical events, he was not prioritized for a heart transplant due to the strict organ allocation system, which prioritizes based on illness severity and the limited availability of donor organs. Less than 1% of annual deaths result in organ donation, and only 3% of individuals with organ failure receive transplants.

Innovative Solutions to Organ Shortage

Facing a similar predicament to his father 42 years prior, the speaker's team initiated a new protocol to utilize organs from individuals who died from drug overdoses, a significant cause of death in the US. Many of these organs were discarded due to Hepatitis C infection.

Recognizing the availability of effective treatments for Hepatitis C, even in immunosuppressed transplant patients, the speaker volunteered to be part of a trial. He intentionally received a heart from a Hepatitis C-positive donor and underwent a two-month treatment regimen, successfully curing himself of the virus. He stated, "Leaders lead," emphasizing his commitment to the protocol he was asking his patients to consider. This also allowed him to avoid competing with his patients for a viable organ.

The Future of Organ Transplantation: Xenotransplantation

Motivated by his own experience and the ongoing organ shortage, the speaker assembled a team to address this critical issue. Three years later, they performed the world's first pig-to-human xenotransplant. This groundbreaking procedure represents a step towards creating an unlimited, renewable source of organs, aiming to eliminate deaths caused by waiting for donor organs.