Organ hunter, life saver Transplant surgeon: Dr. John Conte aggressively seeks organs -- sometimes rejected by other doctors -- that will save lives

March 24, 1996|By Patricia Meisol | Patricia Meisol,SUN STAFF

Just before rush hour on a gray Monday in November, transplant surgeon John V. Conte Jr. runs out of the University of Maryland, jumps into a waiting Jeep with a makeshift siren and heads down Interstate 95 toward Alexandria General Hospital in Virginia. He's after a set of lungs.

At 36, Dr. Conte is one of six surgeons at Maryland working to build one of the country's top transplant programs. Like his colleagues, he's young, willing to take risks to help patients and able to survive on very little sleep.

If Dr. Conte finds the donor in Virginia acceptable, he will perform his third transplant in less than 24 hours. He learned of her by accident when a Washington organ retrieval group called Maryland to rescind an offer for her heart. "What about the lungs?" he had asked.

No good, he's told. The patient has been on a ventilator for two days. He asks them to repeat the X-ray. It's not perfect, but it's OK. Oxygen is getting to her blood. No bacteria in her blood or urine. She's a smoker, but she's 29 so she hasn't been smoking that long. She's also a cocaine user. Not a perfect donor by any means. But neither is the recipient.

Dr. Conte decides to look for himself.

As his volunteer driver blares the siren and traffic falls to the side, he opens the file of his patient, Margaret Spring, who is packing her bags for Baltimore.

Dr. Conte considers Mrs. Spring, 43, a respiratory cripple. Without a transplant, the Hagerstown woman may live a year, maybe two. Severe emphysema keeps her hooked to an oxygen tank; she gets short of breath when she does the dishes or plays with the 5-year-old granddaughter she and her husband are raising.

A tiny lady, weighing 75 pounds, she has a long smoking history and several surgeries from a childhood burn that will make a transplant more risky. Like many people with end-stage lung disease, she also is taking steroids, making wound healing difficult.

Dr. Conte knows she won't be easy to transplant. But he's willing to try.

"I owe it to everybody to give them a shot," Dr. Conte says. "Even if I can keep them alive for a year, to see a grandchild graduate, it's well worth it."

But he's also tells his lung patients flat-out that their chance of survival in five years is 50 percent, and that they are at high risk for infection the rest of their lives.

A skilled surgeon

This is his first job after 10 years of training under the world-renowned Norman Shumway, the father of heart transplants, and Bruce A. Reitz, Stanford University's transplant chief, formerly chief at Johns Hopkins. It was at Stanford, the country's most prestigious heart-lung program, that Dr. Conte learned how to perform transplants on risky patients and how to evaluate lungs in person instead of on paper. Dr. Reitz describes him as a "real charming guy and a dedicated surgeon. He also has the real loyalty and work ethic of Baltimore."

After performing hundreds of transplants at Stanford, Dr. Conte did his first here in August. The week of Nov. 12 proves to be his busiest so far.

It begins on Sunday when Dr. Conte transplants a single lung and assists in a heart transplant, working from 6 a.m. to 10 p.m. On Monday, he arrives at the office at 5: 45 a.m. for a heart bypass, makes the trip to Alexandria at midday and doesn't get home until 10 p.m. He sleeps a few hours before being awakened at 1: 30 a.m. to look at another pair of lungs, this time at Suburban Hospital in Bethesda. On Tuesday, he's still at work past 9 p.m. when a third organ run, this time downstairs to the Maryland Shock Trauma Center, finally turns up something for Mrs. Spring. He sleeps a few hours before the 7 a.m. transplant on Wednesday and gets home for the first time in two days just in time to close on a new house.

Because organs are so scarce, Dr. Conte always goes out to inspect a border-line heart or lung: "I find a reason why I can use it."

The donor he is about to see in Alexandria arrived at the hospital eight days earlier with a severe headache after snorting cocaine. She was operated on for an aneurysm and never recovered. Her mother maintained a bedside vigil, praying from her Bible for her daughter's recovery. After the third day, she left and a sister gave permission to use the organs.

A machine has kept her heart beating. Now, in the intensive-care unit, Dr. Conte looks at the donor's charts, then the X-ray. Not good.

Fragile lungs

Nationally, only 10 percent of people who die are even eligible to donate organs. Of these, 25 percent are ruled out for lungs.

Among organs, the lung is least able to survive outside the body, so Dr. Conte is the first in a line of doctors waiting to retrieve organs in the operating room. He uses a tube to look inside the lung for pneumonia or cancer. The donor's face is calm, her blond hair pushed back, her skin slightly tallow and taut. Two out of three times Dr. Conte goes out to inspect marginal organs, he is able to use them. But not this time.

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