“Your slightest look easily will unclose me
Though i have closed myself as fingers,
You open always petal by petal myself as spring opens
(touching skilfully, mysteriously) her first rose”—E.E. Cummings (via vintague)
Mirtala Garcia laid a hand on Sebastiao Lourenco’s chest, then pressed her ear there for a moment.
“That’s my heart,” she said. “It’s still beating for me.”
Although she had just met Mr. Lourenco, she had known his heart for a long time. It had belonged to her husband, Julio, who died from a brain hemorrhage in March 2010, at the age of 38. Mrs. Garcia donated her husband’s organs, and the family’s loss led to a second chance for Mr. Lourenco, 57.
But he was not the only one. Seven or eight other people who urgently needed transplants also received organs from Mr. Garcia, an unusually large number. (The average from organ donors is about three.) Even more unusual, his family and a group of recipients met on Wednesday in a highly emotional gathering at the Manhattan headquarters of the New York Organ Donor Network, which coordinated the transplants.
The story of the Garcias and the people whose lives were saved by one man’s donated organs provides a close look at the charged world of transplants and organ donation, where people on the transplant list know they may die waiting, and the families of brain-dead patients are asked, at perhaps the most painful time in their lives, to look beyond their own grief and allow a loved one’s organs to be removed to help strangers.
There are nowhere near enough donor organs for all the people who need transplants. Nearly 111,000 are on waiting lists in the United States, but last year, only 28,663 transplants were performed, according to the United Network for Organ Sharing, which oversees the transplant system nationwide. This year, 6,000 to 7,000 people are expected to die waiting.
Last week, Mrs. Garcia and her children, 5, 11 and 18, who all live in Stamford, Conn., met four of the recipients of her husband’s organs for the first time. A fifth recipient also attended, one of two people with renal failure, both members of the Garcias’ church, whom Mrs. Garcia chose to receive kidneys.
Mrs. Garcia addressed a room packed with recipients, families, doctors, nurses, her minister and his family and network employees. She spoke briefly through an interpreter. She said her husband had had a big heart and would be very proud “to give life after death.” No one would ever forget him, she said.
Elaine R. Berg, president of the donor network, said: “These meetings don’t happen that frequently. I’ve been here 11 years, and if it’s once a year that’s a lot. I’ve never met five recipients from one donor. It’s highly unusual.”
In many cases recipients or donor families, or both, choose to remain anonymous, Ms. Berg said. Recipients may send thank-you letters through the network, but they and donors do not often choose to meet.
“It’s pretty intimidating and pretty emotional,” Ms. Berg said. “Some people cannot bear it.”
But she said that meeting the recipients can bring solace to donor families.
Mr. Garcia was so young and strong that his corneas and six organs were healthy enough to transplant: his heart, one lung, his pancreas, both kidneys and his liver, which was divided to save two people, an adult and a child.
In photographs, Julio Garcia was handsome, with a mischievous smile. His wife said he loved to joke and laugh. But he was also deeply religious, and as a pastor at their evangelical church in Stamford he did a lot of preaching and marriage counseling. He earned his living as a carpenter. Both he and his wife, originally from Guatemala, became naturalized citizens.
For many years, he had suffered periodically from severe headaches, but he had been told they were migraines. The headaches were unusually bad during the week or so before March 17, a Wednesday. That day, his head hurting, he told his children he loved them and went to work.
He called his wife that afternoon, saying the pain was terrible and he was going numb all over. She wanted to call an ambulance, but he asked her to pick him up instead. She drove him to a hospital in Stamford. A major hemorrhage and swelling were putting pressure on his brain. Doctors tried to relieve the pressure, and then transferred Mr. Garcia to NewYork-Presbyterian/Weill Cornell hospital in Manhattan.
By the time he arrived there on Wednesday night, he was in a deep coma, needed a ventilator to breathe and had extremely low blood pressure — all signs of a large hemorrhage affecting the brain stem, according to Dr. Axel Rosengart, the director of neurocritical care. Doctors stabilized him and tried again to reduce the pressure on his brain, but scans showed extensive, irreversible damage, Dr. Rosengart said.
Dr. Rosengart said he was not certain but suspected that the bleeding was caused by an arteriovenous malformation, a blood vessel abnormality that Mr. Garcia may have had from birth.
By Thursday, Dr. Rosengart said, he began to warn the family that Mr. Garcia was heading toward brain death. Later that day, the diagnosis was made twice, by two different physicians, in accord with state law. A patient with brain death is legally dead. At that point, there were two priorities, Dr. Rosengart said: “the family and their emotional survival, and preserving the organs.”
Brain-dead patients can become medically unstable, and intensive treatment is often needed to prevent their organs from failing.
Dr. Rosengart and a social worker from the New York Organ Donor Network asked Mrs. Garcia about organ donation.
At first, Mrs. Garcia recalled, she could not accept the diagnosis of brain death. Still hoping a miracle would save her husband, she asked them to wait.
The next day, Friday, it became clear to her that her husband would not recover. Dr. Rosengart and the social worker, Michelle Aguiar, asked her to think about what Mr. Garcia would have wanted.
“More than half the time, if you offer somebody the chance to save a life when their head is clear, you know they’re going to say yes,” Ms. Aguiar said. “The timing is crucial.”
She said that 70 percent of the families she asked gave consent, which is one of the highest rates in the New York network.
Mrs. Garcia said she thought about how important it had been to her husband to help other people. She recalled a movie they had watched, “Seven Pounds,” about a man who donates organs. Mr. Garcia had said that it would be a great thing to save lives, and that if anyone ever got his heart, he hoped she would meet that person. She recalled another movie in which someone had wound up in a coma, after which Mr. Garcia said he would not want his family to see him linger that way.
She talked to relatives and her minister. Finally, Mrs. Garcia thought of her friend Milvia Palma, who needed a kidney transplant. She heard Ms. Palma’s voice in her mind, saying, “I’m sick.” And in that moment, the decision was made. Mr. Garcia had said that God would provide for Ms. Palma. Who could have known that it would be through his own death?
On Friday night, Mrs. Garcia signed the consent forms. The donor network went into action, locating patients at the top of transplant lists, looking for matches in blood type, body size and other factors.
Patients at NewYork-Presbyterian/Columbia hospital were eligible for the heart, liver and lung; a 1-year-old at Mount Sinai would also receive part of the liver, and Ms. Palma and Edward Santos, another friend and church member, would get the kidneys. The pancreas would go to a patient in Minnesota, who has chosen to remain anonymous.
The first operations were scheduled for Sunday. Thomas Ginz, 67, from Guilford, Conn., got the call at 6:30 in the morning.
“You get a slip from the hospital that you can give to the police so you can actually speed to get there if you have to, because time is of the essence,” Mr. Ginz said. (He did not have to use it.)
Mr. Ginz, who has a disease called idiopathic pulmonary fibrosis, which scars the lungs, needed oxygen all the time and was deteriorating so rapidly that even his doctor had begun to worry that a transplant might not come in time.
Now, Mr. Ginz wondered if the operation would really happen. A month earlier, lungs had become available and he was called in as a backup candidate and fully prepped for surgery. As it turned out, another patient was a better fit. Many transplant candidates go through these nerve-racking dry runs. But this time, his surgeon said, “Tom, you’re up,” and whisked him off to the operating room.
Jo Ann Laskaris, 69, from Manhattan, had also wondered if she would survive long enough to receive a transplant. She had liver cancer, caused by hepatitis C, which she had contracted from a blood transfusion when she was in her 20s. Doctors were struggling to keep the disease from spreading beyond her liver. She received the right lobe, the larger segment of Mr. Garcia’s liver.
The smaller left lobe went to Braylen Benitez, a toddler from the Bronx with a congenital liver disease, whose body had just rejected a transplant.
Mr. Lourenco, 57, who lives in Jackson Heights, Queens, had severe heart failure and was in the hospital when word of the transplant came. For two years he had needed an implanted pump to help his weakened heart, and he, like the others, saw his time running out.
Mr. Santos, 43, had kidney failure caused by diabetes, which had already damaged his sight and led to the amputation of his lower leg. Dialysis treatments left him feeling ill and weak, and as one after another patient at the clinic died, he wondered if he would share their fate.
After the operations, Ms. Laskaris and Mr. Ginz’s wife wrote Mrs. Garcia to thank her, and said they hoped to meet her some day.
Last week, the recipients and their families hugged and thanked her and her children. Several said they felt a powerful bond to her and her family. Mr. Lourenco, an artist, gave her one of his paintings. Ms. Laskaris asked if she and her family might attend Mrs. Garcia’s church.
For most, it had not been an easy year. Several had suffered from infections and frightening episodes of rejection, and all were dealing with complicated regimens of anti-rejection pills and other medicines. But all were grateful to be alive and were keenly aware that their survival had depended on someone else’s death, and the kindness of his family.
Mrs. Garcia and her children have lived with loss and sadness. And without her husband’s earnings, Mrs. Garcia, who cleans houses, struggles to pay her rent and feed the family. But she said she finds comfort, and sometimes even joy, in thinking that her husband lives on through other people, and that he would have wanted it that way.