Our Heart Center is pushing the envelope with techniques that make heart transplants available to more children.
Published in Connection magazine, Winter 2017
Rini Olson, now 5, was dying in a Chinese hospital when she was adopted by Andrea and Eric Olson and brought home to the United States with hopes
for a heart transplant. Dr. Erin Albers (left) and transplant nurse coordinator Pam Hopkins are part of the team that guides Rini and her parents through
the follow-up care that keeps her new heart healthy.
When Andrea and Eric Olson adopted
their daughter, Rini, from China, she
was 22 months old and needed a heart
transplant. But pediatric heart centers
across the United States told the
Olsons, who live in Salem, Ore., that
Rini was too malnourished to endure
“We got ready to say goodbye,”
Andrea Olson remembers.
Children’s called and said they would
consider Rini for a transplant. I couldn’t
stop crying — I could tell from Rini’s
eyes that she didn’t want to give up.”
Families travel from around the
world to our Heart Center because, like
the Olsons, they’ve been told their child
is too medically complicated or too
fragile to survive a transplant. We’re
using innovative approaches to expand
the boundaries of heart transplants and
give these families hope. Our survival
rates are among the nation’s best —
more than 92% of our patients live
for more than three years after
“Sometimes you have to try
something new or a child is going to
die,” says Dr. Michael McMullan, who
directs our transplant surgery program.
“Those kids deserve a chance to live,
and we believe we have the expertise
and experience to be successful even
when we’re doing something that
hasn’t been done before.”
“I could tell from Rini’s eyes that she didn’t want to give up.”
Meeting unique challenges
Seattle Children’s finds ways to give heart
transplants to children once seen as too sick
to live through the procedure. “If a child has
a legitimate shot to survive, I think it’s our
responsibility to give them a chance,” says
heart surgeon Dr. Michael McMullan.
When Dr. Yuk Law came to Seattle
Children’s 10 years ago, he was part of
the first generation of cardiologists to
specialize in caring for children with
heart failure and managing the risks
after a heart transplant.
“You have to keep patients’ original
hearts going before the transplant, so
they can stay as healthy as possible,”
says Law, who directs our cardiac
transplant and heart failure team. “After
transplant their new hearts work quite
well, but the transplant opens the door
to many potential complications.”
The immune system, for instance,
recognizes that the donor heart is
foreign and attacks it. This can cause
the body to reject the new heart. Law’s
team uses medications to suppress
these attacks, and tries to stay one
step ahead of rare infections and
other unusual complications.
“You always have to be asking:
‘What’s the next crazy thing that might
happen?’” says Law.
Because Law’s team has become so
skilled at helping children recover from
transplants, our surgeons have more
leeway to give new hearts to children
not traditionally seen as good
Some of these patients are babies
whose heart defects can’t be fixed
with surgery. Some of them are children
who have already had multiple heart
surgeries. Some of them have only one
functioning lung. Some have a blood
type different from the heart donor.
Shorter wait times
Throughout the nation, patients wait
an average of five months for a heart
to become available. But children like
Rini don’t have that much time.
After she was put on the heart
waitlist, Rini suffered two cardiac
arrests and was placed on ECMO —
a machine that supports the body
when the heart and lungs can’t function
or need rest. Most children in her
condition only survive for a few weeks.
“I was losing hope when Rini had
been on the transplant list for 19 days,”
Olson says. “Then Dr. McMullan walked
in and told me they had a heart for
her — I was stunned.”
To find hearts for patients more
quickly, our Heart Center is willing to
work with donor hearts that other
transplant centers overlook. For
example, most centers won’t accept a
heart that has been outside the body
for more than four hours because this
increases the chances it won’t function
well after transplant. Rini’s heart
exceeded that limit because it had
to travel several hours to Seattle.
“We don’t have hard and fast rules
about which hearts we accept. Instead,
we dig deep into the details about
each donor and patient, to see if the
benefits outweigh the risks,” Law says.
“Sometimes we’re way down the
priority list when a heart becomes
available, but we get it after other
centers pass on it.”
Pharmacist Christa Kirk Jefferis helped save Aaden Adams’ life by figuring out how to work with a drug that’s almost never used in children. She
remembers a day just before Aaden went home when he rode a tricycle through the hospital. “I couldn’t stop the tears — it was the best outcome
we could have ever hoped for.”
While 6-year-old Aaden Adams was on
ECMO and waiting for a transplant, his
body started resisting the main drug
used to prevent blood clots, opening
the door to fatal complications.
The Heart Center’s pharmacist,
Christa Kirk Jefferis, scrambled to
figure out how to use a different drug
that’s almost never used in children.
She quickly called colleagues
around the country to determine how
much medication Aaden needed. The
medication worked, but then Aaden’s
body developed antibodies that made
him far more likely to reject a donated
heart. Many children with these antibodies
are taken off the transplant list,
but Drs. Erin Albers and Jonathan Chen
refused to give up.
“The clock was literally ticking —
a new heart was on its way and we only
had a couple of hours to make a game
plan,” says Chen, who co-directs our
The team decided to completely
drain Aaden’s blood before surgery
and replace it with blood that didn’t
have the antibodies. After transplant,
Aaden’s blood ran through a filtering
machine to keep it antibody-free.
Just a few weeks later, Aaden was
riding a tricycle through the Cardiac Intensive Care Unit. Now he’s in second
grade in Oak Harbor.
“We’ve done so many transplants on
so many different types of children —
it gives us confidence we can put our
heads together and find a new path
for kids like Aaden,” Chen says.
“You learn lessons that can help other patients and pretty
soon … you’re expanding the boundaries of what’s possible.”
Advancing the field
Our Heart Center is one of the nation’s busiest pediatric transplant centers. Patients come from across the
country to receive care from experts like (from left) Drs. Mike McMullan, Yuk Law and Jonathan Chen.
Our Heart Center team regularly
publishes papers and makes presentations
that explain our approaches and
why they’re successful. For example,
McMullan and his colleagues are
finishing a paper that chronicles
how children like Rini can thrive
with donor hearts that stay outside
the body for longer than is typically
Today, Rini is a happy 5-year-old
who goes to preschool and loves
playing jokes on her five brothers and
sisters. Stories like hers encourage
other pediatric heart transplant centers
to embrace practices that bring
transplants to more children.
“Once you start having success with
new approaches, it builds on itself,”
Chen says. “You learn lessons that can
help other patients and pretty soon
you’re not only saving a few more kids,
you’re expanding the boundaries of
When Aaden Adams developed antibodies that made him far more likely to reject a donor heart,
our team found a way to help him beat the odds. “We’re grateful for Seattle Children’s every day,”
says his mother, Cheree Adams.
Heart transplants transform the
lives of children whose hearts are
beyond repair. But transplants
also come with serious long-term
health risks. We’re using research
to find ways to reduce those risks
and help these children lead
longer, healthier lives.
One of the biggest risks is
coronary artery disease, which
can lead to heart failure.
Law and his colleagues are
studying why many patients
who undergo transplants suffer
coronary artery disease at an
early age. Solving this mystery
could lead to ways to keep
transplanted hearts healthy.
We’re also working to find
ways to help teenagers stay on
medications that stop them from
rejecting a donated heart.
“It’s a really common risk for
these kids — sometimes they
feel healthy and think they don’t
need medications anymore, and
sometimes they stop taking
them because they’re angry or
depressed,” says Pam Hopkins,
a transplant nurse coordinator.
Chen is looking for funding to
develop a psychological protocol
that helps identify patients who
are likely to quit their medications.
“This would help us intervene
before it’s too late,” Chen says.
“It could make a difference for
all kids who get transplants,
not just here in Seattle.”
Your support makes it possible for us to provide groundbreaking care to children who need heart transplants. Contact Simon Pritikin to learn more.