Organ transplant recipients are close to Jessica Borden’s heart.
Borden, a heart transplant coordinator at the Center for Advanced Heart Failure at Memorial Hermann-Texas Medical Center, was drawn to this specialty for a personal reason. Her younger brother, Jared, was fatally injured in a horseback riding accident a decade ago, when he was just 11. The family chose to donate his heart, lungs and both kidneys, saving four people’s lives. It was a decision that brought meaning to an unthinkable tragedy — and gave Borden a new calling in life.
At the time of her brother’s death, Borden had just earned her nursing degree and was working in a hospital cardiology unit in her hometown of Wichita Falls, Texas. She had hoped to one day move into labor and delivery. But when Jared died, she knew she wanted to pursue a career as a transplant nurse instead. And she did, working first with liver and kidney transplants, then moving to Houston and joining Memorial Hermann, where she started helping with hearts.
“I probably got into it sooner than I should have, and it was hard when I first started — it was only six months after my brother died,” she says. “But I wanted people to be educated about organ transplants and dispel the myths around them. I’ve been able to see how sad but how healing both sides of this can be.”
At the Center for Advanced Heart Failure, Borden is responsible for about 50 heart transplant patients, whom she monitors from the time they’re discharged through the rest of their lives. Since every patient responds differently to a heart transplant, that can mean helping them navigate a variety of different health challenges — or very few. At a minimum, transplant recipients come in twice yearly for checkups.
“We make sure they’re on the right anti-rejection medications at the right dosages; we check their levels to make sure they’re in a healthy range,” Borden says. “It’s a fine line that we have to manage: you need to be on enough immune-suppressing medication so your body doesn’t reject your heart, but not so much that you have infections and other issues. Right after the transplant, around the time they’re released, they’re at the highest risk of rejection. Over time, we can back them off of these drugs.”
Borden also helps coordinate annual follow-ups with medical specialties from dermatology to dentistry, optometry to gynecology. “We want to make sure the drugs we’re giving our patients to keep their hearts aren’t messing with other parts of the body,” she says. “These medications make them vulnerable to things you and I might not think twice about. A virus or bacteria that might give us a stomachache could put them in the hospital. That’s why each patient has their own coordinator. It’s a very specialized role: we’re not social workers, we’re trained RNs who are monitoring them throughout their lives. We send them out into the world to go live their lives, which is what we want them to do, but we also want them to be healthy and keep them safe.”
Life after a transplant isn’t all lab work and exams, of course. Borden hopes her patients will spend as little time as possible in a doctor’s office. “We have some patients for whom it’s smooth sailing. They have perfect labs, they never end up in the hospital,” she says. “But we’re still seeing them twice a year just to make sure they’re healthy, and to check the blood vessels around their heart. We worry about a narrowing of those arteries, called vasculopathy, which can ultimately affect any transplant, but for some people it can be a very long time before that happens.”
Borden’s ultimate goal is for people to take full advantage of the second chance that organ donation gave them and to lead rich, rewarding lives. “A lot of recipients deal with survivor’s guilt,” she says. “They wonder: Am I doing enough? Am I successful enough? Would that donor family be proud of me? I’m able to tell them that as a member of a donor family, I appreciate so much when people take care of their organs, and I want you to live your life to the fullest, whatever that means to you. I can tell them: I’m proud of you and I’m thankful you’re here.”
After Borden’s brother died, the family reached out to the recipients of his organs. They heard back from some but not all, and not hearing back was painful. “We really wanted to get to know them, so that was hard,” she says. “But a lot of donors don’t hear back from the recipients, and vice versa, for a lot of reasons. You don’t know what that family is going through; it may not be that they don’t want to talk to you, but it can just be too much for them. They may have had health issues and been in and out of the hospital and didn’t want us to know that. There are hard things in their lives, too.”
Sharing her perspective with transplant recipients can bring them comfort at a difficult time. It’s also been tremendously rewarding for her.
“For me to see both sides of this process is a unique gift for me,” she says. “Patients will write me cards and send me pictures of their families. A mom who got to watch her daughter get married; a young woman who was able to finish her PhD. I get to share in their after-transplant lives and tell them what a great job they’re doing. I probably won’t ever hear from my brother’s heart recipient, but I have 50 heart recipients who are doing their best and living their best lives. That’s been a huge part of healing for me.”
For more information, visit www.memorialhermann.org/services/treatments/heart-transplant.
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