Low-key tissue transplants revive lives
BARBARA TURNBULL | Healthzone.ca
Finally, on Feb. 1, came the solution: a transplant of cartilage from an anonymous deceased donor.
We don’t hear much about the 2,000 tissue grafts performed in Ontario each year, even though they outnumber organ transplants nearly three to one. These procedures may not be live-saving, but, according to the Trillium Gift of Life Network, one donor can enhance up to 75 lives with gifts such as corneas, skin, heart valves and bone.
Koslik hadn’t heard of tissue transplants before meeting Dr. Allan Gross of Mt. Sinai Hospital’s orthopedics department. Her referral to him last March ended what was quickly becoming an excruciating knee problem.
Unlike organ transplants, tissue grafts rarely offer dramatic life-and-death stories that hold the public’s attention. One exception occurred this past January, when Toronto Police Sgt. Ryan Russell died on duty after being hit by a snowplow. His widow, Christine, donated his eyes for transplant.
Koslik, 47, talks about Christine Russell’s gift to anyone who asks about her situation. “It’s amazing what an educational process it became,” she says, now recovering at home in Niagara-on-the-Lake from the surgery that replaced cartilage in her knee and realigned her bone with a tibial osteotomy. “People don’t realize that these kinds of transplants happen.”
As with organs, tissue supply comes nowhere close to meeting demand. Ontario meets just 8 per cent of its tissue needs, purchasing the rest from other provinces (mostly Quebec) and the U.S. to help reduce waiting lists. While registered organ donation rates in this country and province, at 17 per cent, are among the lowest of any jurisdiction that performs transplants, GTA rates of 13 per cent are even lower. In the U.S., 35 per cent of citizens are registered on state databases.
Gross performed the world’s first knee transplant like Koslik’s in 1972, and now does 20 to 25 a year. Most recipients wait six months for a match (criteria include body height and weight, sex and size-matching).
“Almost always they’re caused by trauma: motor vehicle accidents, athletic injuries,” Gross says. “When only part of the knee is damaged and it’s in young patients, then they get a transplant.”
A knee replacement would only be a temporary fix; the cartilage transplant is permanent, he notes.
Koslik’s troubles began just after she and her husband, Peter, had just moved to Niagara-on-the-Lake with their daughter, Alexandra (Ali), after purchasing a bed and breakfast.
The couple married 11 years ago, blending her three kids with his two, but by then all were older and off on their own except Ali, then 12. In 2008 they sold their Newcastle, Ont., paint and decor store, bought the B&B, overhauled it, and named it Cape House Bed & Breakfast after the home’s style and the couple’s love of Cape Cod and sailing on their 29-foot boat the Bonaventure. It has three guest bedrooms that have proven to be in demand every night from July to October’s end. No wonder Koslik was enthusiastic about this new venture in a new town.
But just as they were getting settled, her knee began buckling regularly (she injured the same knee in a skiing accident when she was 18, which ended her days on the hill but still allowed an active life). Pain quickly set in, intensified, and didn’t let up. Within two months she had two magnetic resonance imaging scans and a devastating diagnosis from an orthopedic surgeon.
“His exact words: ‘I think it might be cancer,’ ” she says, recounting her ordeal. “If you can imagine, I’m in more and more pain every day, my knee is giving out constantly, and psychologically I’m a mess because I’ve just been told it might be cancer.”
By the end of 2008 she needed heavy pain medication to get through each day. Out of desperation, she took her MRI results to Mt. Sinai’s emergency ward in early 2009.
Within days an orthopedic oncologist ruled out cancer, finding a specific damaged area in her knee, most likely stemming from her teenaged skiing accident. Another referral to an orthopedic surgeon led to microfracturing surgery in March 2009, in an attempt to stimulate cartilage regrowth. Nine months after the surgery, there was still pain and little progress. Finally she was referred to Gross.
“Basically, the last three years I’ve been living in pain,” Koslik says, adding, “It’s a scary thing when you actually get used to the pain.”
Everything has been impacted. The family has had to close the B&B on many occasions, straining finances. Peter has had to perform double, sometimes triple duty. There’s been no driving Ali to her musical theatre classes or taking the family’s golden retriever, Nauset, for walks. Koslik went from working 12-hour days at the paint store to unrelenting fatigue from being unable to get respite from pain, even in sleep. “This injury, it weighs on you,” she says.
Tears come easily when she talks about this journey, how she hasn’t been able to visit her 91-year-old father in Quebec since her mother died last year, the doubts and fears that have plagued her. But her most emotional moments come when talking about the selflessness of donors. “Organ transplants mean life or death. I (was) waiting basically for someone to die ... for something that’s for quality of life,” she says. “But this is going to help me and this is going to help my family. I want to live pain-free and be able to do things with my family.”
The challenge has been extraordinarily difficult, Peter says. “There’s nothing worse than seeing the woman I love in pain all the time.”
Ali, now 15, agrees. “Right now it doesn’t feel like I have my mom around much, just my stepdad, because she can’t do anything. (But) it’s been really hard watching my mom be in pain.”
Koslik’s recovery and rehab will take up to six months. She works at it on her own every day, and three times a week at the Hotel Dieu Shaver Health and Rehabilitation Centre. For now there is still great pain, but everything she has heard about this transplant suggests a pretty good summer is in store — and a great one next year.
“I don’t know why and I don’t know how it all came together at this point in time,” she says, “but I’m just so grateful that it did.”