Rex Parton was 71 when he faced end-stage organ failure for his heart and kidneys.
That’s beyond the age that most transplant centers are willing to consider for such a complex procedure. Parton asked the team at Vanderbilt University Medical Center to look past his clinical age, however, and focus on him as an individual.
In April 2016, Parton became the medical center’s oldest patient to undergo a combined heart/kidney transplant.
“We can never thank them enough for pressing forward. They gave me my life back,” Parton said. “I’m working out in the yard, trimming bushes, mowing the grass. If the doctors came down to watch me, they wouldn’t believe it!”
Nancy Parton echoes her husband’s sentiments.
“We have quality of life again and I feel like we have a future together again,” she said. “He is the love of my life and they gave him back to me.”
Advances in transplantation procedures, improved survival rates and the aging population have prompted more doctors to reconsider transplant eligibility for patients 65 and older.
Vanderbilt Heart and Vascular Institute (VHVI) offers ventricular assist devices (VADs) as a treatment for patients who are not candidates for heart transplantation, and as stepping stone to transplant for those patients who hope to eventually receive a donor heart.
Parton had a left ventricular assistance device (LVAD) implanted because he had ongoing heart problems, including congestive heart failure. Soon afterward, though, his kidneys failed and he started dialysis. The combination was tough on his body, and by February 2016 he was very ill.
But there was something different about Parton, said Ashish Shah, M.D., professor of Cardiac Surgery and surgical director of Heart Transplant and Mechanical Circulatory Support.
“He was such a good patient as far as his compliance, his ability to successfully follow a complex medical regime, his high health care literacy and his self-advocacy,” Shah said. “Age and renal failure made him not a good candidate on paper, but because of our collective experience, we set aside conventional wisdom and utilized our instinct.”
Parton was put on the transplant waiting list. Four weeks, donor organs were available.
“I cannot explain the feeling when we got that phone call,” Parton said.
The Partons drove nearly three hours from Athens, Tenn., to Vanderbilt.
“That drive was a quiet one,” recalled Parton. “I was calming my mind, talking to the good Lord and getting prepared for surgery while Nancy drove.”
Parton’s heart transplant was on April 12. Surgeons implanted his new kidney on April 13. He spent nearly a month in Nashville before heading home.
“Right before the LVAD, I couldn’t walk 60 feet before I had to stop to get my breath,” Parton said, several months after his surgeries. “But now, I am enjoying life. When I come out of rehab I feel so, so good. I’m up to four and a half miles a day. I am amazed myself!”
The Vanderbilt transplant team is pleased, too.
“We were able to restore both life expectancy and longevity,” Shah said. “Most importantly, we were able to give him back his quality of life. By simply having functioning kidneys, a functioning heart, no battery, no dialysis, no power cords — his life dramatically improved.
“But that is really small compared to what [Parton] has given our program,” he said. “No. 1, it’s an affirmation that this is a program where we tackle complicated cases, and No. 2, it has expanded our horizons and our mindset about what candidacy for advanced therapies looks like.”
According to United Network for Organ Sharing (UNOS) data from 2012 (the most recent statistics available), there were fewer than five combined heart-kidney transplants performed in the country in patients older than 70.
“Mr. Parton’s case showed us that age is not an absolute,” said JoAnn Lindenfeld, M.D., professor of Medicine and director of the Heart Failure and Transplant Section at VHVI.
“He really showed a lot of gumption in his recovery,” she said. “We really are all about patient-centered care and listening to our patients and families. Their input and feelings are important in the way that we run our program.”