Stanford Medicine Newsletter Updates For the Local Community


Domino effect

Two patients benefit from rare transplant procedure

Tammy Griffin (left) donated her heart to Linda Karr and received a new heart and lungs from a deceased donor in an unusual "domino" procedure.


The first thing Linda Karr asked her doctor after her heart transplant surgery at Stanford Health Care was, “How is my heart donor doing?”

That question is as exceptionally rare as the surgery that made it possible. On Feb. 1, as part of a “domino” procedure, Karr received the heart of Tammy Griffin, who received a new heart and lungs from a deceased donor.

A little more than six weeks later, on March 17, the two women met for the first time. Griffin listened to her old heart beat in Karr’s chest as their families and Stanford Medicine doctors looked on. “I feel as though a world of possibilities opens up now for my future — kind of a second chance in life,” Karr told Griffin.

“Me too. I feel the same way,” Griffin said.

Karr, 53, promised Griffin, 51, that she’d take good care of her new heart, adding, “Even though we were strangers before today, you’ll always be part of me.”

Exchanging organs

Organs available for transplant are in short supply. Heart-lung combinations are even rarer because a set of heart and lungs is usually split up so that the organs can benefit two people instead of just one. Domino transplantation of a heart-lung and heart does, however, benefit two people. A highly unusual procedure, it has been performed at Stanford Medicine only eight times, the last one in 1994.

Griffin’s lungs had been critically affected by cystic fibrosis. Her lung capacity had diminished so much that she was on oxygen full time, unable to do much at all. She had so little energy that she couldn’t get through a shower without sitting down to rest. Her heart, however, was still functioning well.

“Her heart was an innocent bystander pushed out of its normal position in the middle of the lungs as her right lung shrank and the left one expanded,” said Joseph Woo, MD, a cardiothoracic surgeon at Stanford Health Care who oversaw and coordinated the surgical teams that conducted the domino procedure. That displacement made a heart-lung transplant the only viable option for Griffin, said Woo, who is also professor and chair of cardiothoracic surgery at Stanford School of Medicine.

Karr was diagnosed almost 20 years ago with right ventricular dysplasia, a genetic disease that causes a dangerously abnormal heart rhythm. Over time, it became difficult for her to walk down a hall at work without having to stop and rest. Even so, she wasn’t very high on the transplant waiting list.

“My doctor told me I’d have to be hospitalized to move up — and if my deterioration was rapid, I might not get a heart in time,” she said. Now she’s making good progress toward recovery, hoping to run a 10K again, ride a mountain bike or even just jog. “When I think about my future,” she said, “I am optimistic.”

A brighter future

Griffin is progressing in her recovery, too. “Now I can walk and talk at the same time,” she said. For the first time in more than two years, she said, she was able to walk with her husband on a beach.

Knowing that she was able to help someone else gives Griffin great joy. “I didn’t want my heart thrown away,” she said, “and I thought, I’ll be able to meet the person who has my heart! How many people can say that?”

“We hope this story will raise awareness of how scarce organs are,” said Woo. “People are waiting and dying on those transplant lists. We would like to see that change.” Stanford Medicine surgeon Jack Boyd, MD, said he would remember one particular moment from the domino procedure: Once Griffin’s heart was sutured into Karr’s chest, blood flow through the aorta was restored. “Sometimes hearts don’t start up on their own,” Boyd said, “but in Karr’s case, Griffin’s heart started right up—and in a pretty normal rhythm,” he said. “It was truly awesome.”

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