‘This is a first’: Why a 5-hour heart transplant at UCSF made history

It was only at the end of the five-hour heart transplant that attending cardiothoracic surgeon Dr. Amy Fiedler looked up from her patient and realized the significance of the moment.

There was not a man in the operating room, including the person on the operating table.

The patient, the surgeon, the cardiac anesthesiologist, the perfusionist and all the fellows and nurses were female. If the donor was a female, which is information not released, that would make nine.

“We were all done and just chatting and I said ‘Hey, this is pretty crazy, we’re all women on the team,’” Fiedler recalled in an interview in her small office at UCSF Parnassus. “We’ve never been part of anything like this before.”

Neither had anyone else, according to UCSF. 

Fiedler, Dr. Laura Scrimgeouer, Dr. Jaqueline Measer, Dr. Charlene Blake, perfusionist Ashley Risso, registered nurse Ruiza Coronel, and a contract nurse had just comprised a unique all-woman team among more than 500 heart transplants at UCSF, and possibly in any hospital anywhere.

“It’s probably a first,’’ said Fiedler, noting that surgical team assignments are random at UCSF.  “We don’t choose who we work with. You don’t handpick your team.”

According to Anne Paschke at the United Network for Organ Sharing, a nonprofit that matches transplant donors and recipients nationwide, this is likely the first confirmed all-woman heart transplant going back at least to 1988, when UNOS was founded. There have been 88,000 heart transplants since then, but it would be impossible to know if there was a prior all-woman team: Data is only collected on patients, not who performs the surgery. 

“It is fantastic to hear that it has been documented,” said Paschke, from UNOS headquarters in Richmond, Va. “I hope that we will see more and more of this as time progresses.” 

When Fiedler arrived at the operating room early on a December morning she went straight to work with full concentration, not noticing who was behind the other surgical masks. The patient and two of her team had already left the room when she figured it out. 

She corralled the remaining six with her iPhone and posted the group photo to her Twitter account with the caption,“Honestly, pretty darn cool to do a heart transplant with an all-woman team. Never thought I’d see the day. The future is bright!!!.”

The picture made its way to Facebook where Fatou Gaye happened to see it.

“I knew that was me,” Gaye, 26, said from her San Francisco home. A native of the Republic of Gambia, West Africa, she went to San Francisco General Hospital complaining of shortness of breath, loss of appetite, fatigue and swollen legs, all attributed to lingering effects of a difficult pregnancy, she said. She was referred to UCSF and diagnosed with heart failure.

During one of her post-op appointments, Gaye asked Fiedler if her transplant was the one that inspired the photo. Having it confirmed “makes me feel so happy and proud that women can and do get it all done,” she said.

When Fiedler, 40, was recruited by UCSF last summer, she became the only woman among seven heart transplant surgeons at UCSF. 

That did not surprise her. There were no heart transplant surgeons at the University of Wisconsin, where she previously worked, or at Massachusetts General Hospital where she did her residency after graduating from Harvard Medical School. She was only the second woman to graduate from her cardio-thoracic training program at Harvard. The last woman graduated 25 years earlier.

“There was never a female attending surgeon where I trained, so it could never happen,” she said. “There are very few attending surgeons in the field of thoracic surgery. Very few.”

Kaiser transplant cardiologist Dr. Dana Weisshaar, a volunteer expert with the American Heart Association, said there are no specific figures on female doctors who perform heart transplants, but she was aware of only 21 nationwide. Representation numbers are slightly better for women specializing in cardiac anesthesiology and among perfusionists who run the heart-lung machine that keeps blood circulating during heart operations. But they are still low enough that Weisshaar had never heard of an all-woman heart transplant team convening  before.

“In my 26 years of heart failure clinical practice, this is a first,” she said, from her office in Santa Clara. “It is a very unusual occurrence for everyone in that room to be a woman.”

Kaiser Santa Clara, where Dr. Weisshaar practices, handles Kaiser heart transplant patients for all of Northern California, but it assigns out all transplant cases. Bay Area-wide, she only knows of two female heart transplant surgeons, Fiedler and Dr. Maria Curie at the Stanford University Medical Center.

In recent years, the percentage of women in the surgical disciplines have jumped from 10% to 30%. 

“With all the competing schedules and the limited number of women in each department it was just a coincidence that we were all women for that surgery,” said Fiedler’s surgical fellow, Dr. Laura Scrimgeour, “but it reflects just the growing prevalence in all the fields that there was even a chance that it could be all women at the same time.”

Fiedler said her tweet generated a lot of comments, “not all of them positive,” But one positive reaction came from an all-woman orthopedic residency program at Baylor College of Medicine in Houston.

“Data has demonstrated that patients operated on by women do better,” Fiedler said, with a laugh, knowing this comment would also generate a response. One person in agreement is her patient, Fatou.

“In less than a month I was able to walk around without feeling any pain or shortness of breath,” she said. “I’m doing great and feeling strong and healthy.”

One day after her surgery, another milestone was reached when UCSF performed its 20,000th organ transplant, also a heart. The head surgeon was a man, Dr. Jason Smith, but there were six women on his team.

“There are now enough of us that by rolling the dice we all end up together,” Fiedler said.

Reach Sam Whiting: SWhiting@sfchronicle.com

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