Profiles | Matt Kamasz

By Kayley Mendenhall, Bend Bulletin

A team of anesthesiologists ventilated the new lung and it flexed, blooming with the steady rhythm of life.

At 34, thanks to modern technology, skilled surgical hands and a precious gift from a stranger, Matt had been given his second chance.

In a hospital waiting room, six stories above the operating room where her husband's life lay in the balance, Sarah Kamasz, 32, took a quiet moment to cry to herself. The stress of the day, the exhaustion and the worry caught up to her at once and she allowed herself to think about another family's decision to save Matt's life.

"I had a lot of time to think about the other end of this," Sarah, a fourth-grade teacher at Lava Ridge Elementary, said. "Who's giving him life? That gets your mind going. Who they were. What they went through. It's the ultimate gift."

Less than 24 hours earlier Sarah and Matt had dinner at his sister's home in San Jose. They went to bed anticipating nothing more than another day of waiting for a phone call that might not arrive in time.

A rare lung disease physicians still aren't certain of a diagnosis had been slowly causing the alveoli, or cells within the air sacks, in Matt's lungs to turn to scar tissue for at least seven years. His lung capacity was at less than 30 percent. He needed oxygen 24 hours a day just to walk from one room to the next.

Without a lung transplant, Matt had less than a year to live.

The Bend couple's health insurance company sent them to the University of California-San Francisco Medical Center.

There, they were entrusted to Dr. Jeffrey A. Golden, a pulmonologist and medical director of lung transplantation, and Dr. Charles W. Hoopes, a cardiothoracic surgeon specializing in heart and lung transplants.

"He came to us with something called idiopathic pulmonary fibrosis. That's not what this is," Golden said. "It does not change the issue of the transplant."

Instead, Golden said he believes Matt has an autoimmune disorder known as scleroderma. According to the Mayo Clinic, scleroderma affects about 150,000 Americans and physicians do not know what causes the disease.

With new lungs, Golden said, it is highly unlikely scleroderma would return and damage them.

Other than the scarring of his lungs and a severe acid reflux problem, Matt, a former Deschutes County Sheriff's deputy on long-term disability, is in excellent health, making him a good candidate for transplantation. He was officially placed on the transplant list June 22. At the time, there were about 50 people waiting for lung transplants at UCSF alone.

"The best thing is that he was somebody who was very young," Golden said. "He has a perfect social situation, meaning support. He has good nutrition, good muscle mass. He was healthy. He had exclusively lung disease."

The Younger the Better

Wheeling a green Coleman cooler with a diagram of lungs plastered to the top behind him, Dr. Preben Brandenhoff entered operating room No. 9 in Moffitt Hospital, part of UCSF Medical Center, at 5 p.m. Wednesday.

The cardiothoracic surgeon, originally from Denmark, flew to inspect the donor lungs to determine their health earlier in the day. He liked what he saw and brought the organs back, flushed of fluid, inflated with oxygenated air and packed in ice.

"They are perfect. Good lungs. Very healthy," Brandenhoff said. "We are very satisfied with them."

On a small table, draped with blue, sterile cloths, Brandenhoff prepared the donor lungs to enter Matt's body.

Simultaneously, on a much larger table nearby, Hoopes and his team worked to remove Matt's diseased left lung. The cavity containing his lungs and heart was already exposed from an incision running horizontally from one armpit to the other. The smell of burning flesh filled the room as they cauterized small vessels to control the bleeding.

"We always open before the lungs arrive. We don't take the lungs out until the donor lungs are in the room," Hoopes said. "God forbid if the plane were to crash, or if the guy grabs the wrong container on the tarmac and comes in with a kidney. It happens."

Using tweezers and scissors, Brandenhoff trimmed the openings of blood vessels and separated the bronchial tubes at the junction with the trachea so the donor lungs could be deflated and transplanted one at a time. He placed each lung in a rectangular, plastic container and marked them with handwritten tags for "right," and "left."

The lungs, he said, came from a young, healthy donor.

"This set of lungs is very good, about as good as they get," Brandenhoff said. "It's a young donor, the lungs are going into a young recipient. We would expect he should live a long time."

All other information about the donor is kept strictly confidential, Hoopes said. If Sarah and Matt ever learn the identity of the donor, it will be because the donor's family chooses to contact them.

Donor organs used at UCSF typically come from the region between Bakersfield and the Northern California border, said Janet Basu, a spokeswoman for the hospital. That region can expand as far east as Reno, she said, and donors have been flown in from farther away in rare cases.

Matt "desperately wants to know where they are coming from," Sarah said.

The Fear and the Hope

When Hoopes, the surgeon, learned about the possible donor lungs early Wednesday morning, he said, four patients on the UCSF transplant list were immediately in the running. The transplant recipient is chosen based on a variety of factors, but blood type and size of the chest cavity are most important.

Matt was not the first person on that short list.

"The first patient was incompatible," Hoopes said. "Four patients were up for these lungs. We go down the list and Matt was the next person we decided to do."

Hoopes called Matt's cell phone to tell him the news at about 3:50 a.m. After months of working to be put on the list and after weeks of waiting for that all-important call, Sarah said the ringing phone didn't immediately register in her sleeping mind as a life-changing moment.

Matt, too, said it took a minute for the news to sink in.

"At 10 til four in the morning the phone rang," Matt said, in his hospital room before surgery. "Dr. Hoopes, the surgeon, said pretty much get here as fast as we can. Adrenaline kicked in at that point.

"Now, sitting in here," he said, "there is anxiety a lot of anxiety."

Nearly 12 hours after answering that phone call, Matt was wheeled into a pre-operation prep room for a series of questions by nurses and physicians and for the beginning of his anesthesia. He had an epidural to numb much of his body, not for pain management during the surgery, but to help control the pain in the days following the operation.

"If you don't have it, it hurts so much to breathe, you won't want to," said Dr. Susan Wetstone, a member of the anesthesiology team. "It's really important that you take big, deep breaths."

As physicians struggled to place the long epidural needle in Matt's spine, other tranquilizing drugs began to take hold and the often quiet deputy began giving instructions to his wife. Call his brother-in-law, he said, his mom and a friend from the sheriff's office in Bend.

"He remembered today is the day his dad died last year," Sarah said. "I wasn't thinking of that. I knew it was around this time, but I'm not a date person and I didn't remember it was the same date."

When Hoopes came by after finishing a heart valve replacement to discuss the transplant, the doctor, wearing a suit jacket over the top of his scrubs, rubbed at a tired eye and asked Matt how he was doing.

"I'm scared to death," Matt said.

"You should be," Hoopes replied. "It's scary."

As Hoopes walked away, Matt turned to Sarah with tears running down his normally stoic face. She held him and cried.

"It broke my heart to see how scared he was," Sarah said.

Thinking back to those moments just before Matt was wheeled away for the six-hour operation, Sarah said later her message to her husband was one of hope.

"I kept focusing on the positive and the future," she said. "We didn't exchange too many words, but I was telling him how great the future is going to be."

A Long Road to Recovery

Seventeen hours after surgeons transplanted the second lung, closed Matt's chest and sent him to the intensive care unit, he sipped a vanilla milkshake, in too much pain to speak more than a few words.

ICU nurse Eimer Maguire, touched a stethoscope to Matt's back and prompted him to breathe deeply. An expression of pain flashed across his pale face as his iodine-coated chest heaved in and out.

"You sound a little coarse right now," Maguire said. "You haven't coughed."

Hugging a pillow tightly to his chest, Matt tried to cough and clear some of the fluid from his new, life-giving lungs. Maguire said he was only clearing his throat and must try again.

Matt concentrated, grasped the pillow and coughed enough to satisfy his nurse and inspire a cheer from his wife.

"Matt can't take a deep breath without feeling pain. He's taking shallow breaths," Sarah said. "At one point he stopped breathing and the nurse was like, Breathe.' That snapped him back into it. He does what she says."

For the next days, weeks and months, Matt's life will be focused on healing and adjusting to his new lungs. He'll be moved from the intensive care unit by early next week into a regular hospital room.

In 10 days to two weeks, the UCSF staff will release him to an apartment nearby the hospital. He'll return to the hospital at least four times a week, Sarah said, for tests until his physicians are confident he's well enough to move back to Bend.

Until then, Matt and Sarah will pay to rent an apartment while still making their mortgage payments on their Bend home. The cost of the transplant alone, Sarah said, will be about $250,000 not including his hospital stay, post-surgery care, transportation and lodging costs.

Matt will be required to have regular blood tests and will take immunosuppressant drugs to keep his body from rejecting his new lungs for the rest of his life.

"Even after 20 years of doing this, the lung still likes to reject," Dr. Golden said. "The five-year survival rate for lung transplants is only 50 percent."

Of all the body's organs, Golden said, lungs interact with the environment most constantly. They are exposed to foreign materials through the air and can respond to that exposure through what's known as "chronic" rejection. For lung transplant patients, avoiding infection is a constant battle.

"We (the medical community) haven't done much to improve chronic rejection," Golden said.

Another concern in Matt's case is his problems with acid reflux, Hoopes said. It's possible that within a week or so, Matt will undergo a second surgery to wrap his esophagus to prevent him from aspirating food into his new lungs.

"The operation went fine," Hoopes said. "His lungs are working fine."

At about 3 p.m. Friday, just 41 hours after the end of his operation, Matt took the first steps of his new life. He walked the length of the ICU corridor and back to his bed, Sarah said, stopping frequently to have his vital signs checked.

"He's not a man of many words," Sarah said with a laugh, when trying to explain how Matt felt about the walk. "He was a man on a mission."

Story first published in The Bend Bulletin, July 31, 2005. Reprinted with permission.