Pediatric INSIGHTS - Fall 12Children's Hospital of Pittsburgh of UPMC

After Transport, Darrin Gets a Transplant

Darrin shortly after his transplant in 2010, and in 2012

As Darrin Hall ended his high school sophomore year, life was good: he had a new driver’s license, enjoyed motocross competitions on local dirt tracks, and pitched in with chores on his family’s 42-acre cattle farm in Reedy, W.Va.

By the time he began junior year 10 weeks later, he had been transported by medical air transport to Children’s Hospital of Pittsburgh of UPMC, attached to a ventricular assist device, given a heart transplant, and returned to his home. His remarkable recovery was, most definitely, an out-of-the-ordinary summer vacation.

When Darrin’s mother Angela noticed her son’s coughing and fatigue the first week in June 2010, she suspected nothing more than a sinus infection. Darrin had been able to run five miles at a stretch; he’d had only one episode of croup in his younger years. After a few doses of over-the-counter medicine, he seemed to improve. But as the weekend approached, a blood test showed some abnormalities. By Saturday, he was doubled over with stomach cramps, pleading to go to the hospital.

“His liver was shutting down. He was in severe pain,” Angela recalls. After a transfer from a small community hospital to a larger medical center, he was given a diagnosis of cardiomyopathy. His heart was failing rapidly, affecting other organs. Recognized that his case required tertiary care, the team immediately contacted Children’s Hospital to dispatch a helicopter; Children’s long experience in transporting patients in heart failure is a unique complement to its expertise in cardiac care. As a thunderstorm raged, Darrin was lifted aboard a midnight flight to Pittsburgh.

Five days later, Peter Wearden, MD, PhD, director of Children’s Mechanical Cardiopulmonary Support Program, stabilized Darrin’s condition by surgically attaching his heart to a ventricular assist device, or VAD.  The VAD would pump Darrin’s blood mechanically, allowing his heart to rest and heal. In about a third of pediatric VAD cases, patients recover without the need for a transplant.

“For kids in sudden heart failure, it’s a big shock to their families,” Dr. Wearden says. “Adults in heart failure go downhill over months or years. A child can be perfectly fine one day, and the next day, they’re in big trouble.”  The cause of the infection that attacked Darrin’s heart remains a mystery. “We suspect a virus, but we don’t know,” says Dr. Wearden.

With a national reputation for both VAD use and transplantation, Children’s was well equipped to help Darrin. And his size — nearly 6’3” and 155 pounds — qualified him for a Thoratec VAD approved by the Food and Drug Administration for use in adults. Dr. Wearden’s team has also achieved remarkable results with smaller experimental VADS for smaller children.

Over the next 10 days, Darrin and his family coped with pain and uncertainty. “I was pretty sore. I could hardly do anything. I could get up and walk, but four or five people had to carry all the stuff. I could hear the thumping sound — the VAD pumping blood. I’d cover it up with a pillow, but it was hard to sleep.” When Dr. Wearden determined that Darrin’s heart wasn’t healing on its own, he was listed as a candidate for a heart transplant.  

Remarkably, a heart was found almost immediately. On June 26, the surgeons came to talk to Darrin and his parents. “If five of seven different things matched up” between the donor heart and Darrin’s system, his mother remembers, “they could do the transplant the next day. We were up all night, worrying.”

After a successful transplantation on Sunday, Darrin was sitting up on Monday.

While the progress of his case was unusually fast, the outcome was routine. Since performing the first pediatric heart transplant in 1982, Children’s has completed more than 200 more. More than 85 to 90 percent of its young patients survive at least three years following surgery, a rate significantly higher than the 80 percent national average. Children’s is one of only two high-volume pediatric cardiovascular programs in the country with a surgical mortality rate of less than 1 percent, according to 2008–2009 data compiled by the Society for Thoracic Surgery. Nationally, the average mortality rate for high-volume pediatric cardiovascular programs was 3.4 percent.

Less than two years after surgery, Darrin continues his antirejection medicines and has regained his strength, returning to his regular chores. “The only difference is, he can’t put up hay, because of the mold,” says his mother. “He gets lucky!” As he prepares for graduation in June, Darrin continues to visit Children’s for follow up, but less and less frequently. He says simply,” I can do everything now.”