Cedars-Sinai Patient Receives Rare Triple Organ Transplant

Valance Sams Sr.’s world was turned upside down 10 years ago when he was diagnosed with sarcoidosis, a rare inflammatory disease that caused a buildup of scar tissue on his heart and left him unable to work, exercise or even walk.

But today, Sams walks side by side with his son, Valance “Vee” Sams Jr. He’s exercising again, eating healthy, and focused on rebuilding his strength, thanks to a triple organ transplant at Cedars-Sinai.

“I’m feeling good, great, awesome,” he said. “It’s night and day.”

After a successful 20-hour surgery this spring, Sams is one of just 46 people in the U.S. to receive a heart, liver and kidney transplant since the United Network for Organ Sharing (UNOS), the government agency that tracks organ transplants, started tracking in 1987.

“Going through the UNOS database, I can see that prior to Mr. Sams, there were only 45 of these triple organ transplants,” said Tyler Gunn, MD, director of the Extracorporeal Membrane Oxygenation Program and Sams’ heart surgeon. “Since then, the average has been only about 1.5 of these surgeries per year in the U.S., more frequently within the last five years as providers and surgeons get more comfortable with the operations and technology.”

Sams’ journey began when the sarcoidosis diagnosis necessitated multiple visits each week to his doctors to monitor his condition, drain built-up fluids from his body, and administer dialysis treatments.

“If the heart's not working, it can cause something called congestive hepatopathy in the liver, where the liver just starts not to work very well, and can cause chronic and permanent damage of the liver, and then it can also cause stress on the kidneys as well,” said Irene Kim, MD, director of the Cedars-Sinai Comprehensive Transplant Center and the Esther and Mark Schulman Chair in Surgery and Transplantation Medicine.

In order to make it to all of his medical appointments and keep up with his health, Sams was forced to quit film school, a deeply devastating decision.

His son, Vee, then a teenager, took on the role of nurse, counting out medications and helping his father prepare meals that would keep his health on track.

“I was basically his personal nurse,” Sams Jr. said. “I made sure everything was OK, he wasn’t missing appointments. I made sure his medicines [were] OK, you know, changing his bags for dialysis at the house.”

Sams Sr. gets emotional when talking about how much of a help his son was.

“Since the beginning, he’s been like my nurse, my best friend, my brother,” Sams Sr. said.

Early this year, Sams Sr.’s health took a turn for the worse–he was hospitalized because, despite keeping up with his treatments, his heart, liver and kidneys were failing.

After a two-month hospital stay, Sams received news of a new hope–a matching heart, liver and kidney were available for transplantation.

Sams’ surgeons, Gunn, Nicholas Nissen, MD, and Justin Steggerda, MD, worked together with their teams of up to 15 other providers at a time, in a 20-hour-long operation to transplant the organs. The highly orchestrated procedure required close coordination.

“The coordination starts long before we even get to the operating room,” said Steggerda, Sams’ kidney surgeon. “It starts with our program coordinators and our respected nursing staff, who make sure that a donated organ is acceptable, identify the best time to do the procurement, and organize the logistics of getting all the teams there to get the organs and bring them back safely.”

During multi-organ transplants, surgeons operate based on allowable ischemic time–the amount of time each organ can tolerate being outside the body. Based on this, the heart transplant must happen first, followed by the liver and finally the kidney.

“The first step is the heart transplant, which is actually done in the same technical fashion that a single heart transplant is done: median sternotomy, cardiopulmonary bypass, removal of the old heart, suturing in the new donor heart, then coming off the bypass circuit,” said Gunn. “At that point, it changes. We leave the heart and the chest open, allowing the liver team to do their anastomosis [making connections] as well. And then ultimately the kidney is transplanted, followed by the closure of the chest.”

Nissen, surgical director of the Liver Transplant Program and Sams’ liver surgeon, said that multi-organ transplants like this exemplify transplant teams’ ability to work together under pressure.

“There's probably no better case in surgery or in medicine that exemplifies the concept of teamwork like a multi-organ transplant, because literally every team member has to work with every other team member for this to go right,” Nissen said. “The anesthesiologists work with the surgeons, the surgeons work with the technicians, and there are three different teams that are making this happen, so for this to be successful, it takes an absolutely coordinated effort. And it's the ultimate example of medical teamwork.”

According to transplant center Director Kim, not all medical centers in the U.S. offer organ transplants, and even among those that do, not many offer even dual organ transplants, let alone triple organ transplants.

“At Cedars-Sinai, we are one of the world’s leaders in dual organ transplants,” she said. “While no transplant center is doing triple organ transplants very routinely, our expertise in dual organ transplant management gives us an advantage when performing these complex, multi-organ procedures.”

His doctors say that, with Sams’ careful adherence to his medications and determination to rebuild strength, he should make a full recovery. He’s already back to doing some of the things he loves most–like coaching youth baseball. And much to Sams Sr.’s delight, son Vee is enrolled in film school, inspired by his father.

“The little things are so important,” Sams said. “We take advantage of a lot of little things, but now I know that those little things are where it’s at.”

Sams said he hasn’t yet met the family of the organ donor who saved his life, but if he does get the chance, he’ll tell them how grateful he is.

“I want them to know that I’m very appreciative, and that I’m going to do the best that I can to do a lot of good things,” Sams said. “His memory is still going, through me, and I’m going to do my best to honor it.”

Read more on the Cedars-Sinai Blog: 7 Myths About Organ Donation