Transplant Centers Rise to Hurricane Challenge

Sunday evening, August 28, as Hurricane Katrina approached the Gulf Coast, area transplant centers braced for the worst.

Tulane Medical Center

At Tulane University Medical Center, eight patients were in the transplant unit when word of Katrina came. Four were discharged before the storm but the others, including one pediatric patient, were undergoing active treatment and had to remain when the wind and rains arrived Sunday evening.

"The first thing we did was make sure we had enough staff to sit out the storm with the patients," said Dr. Hana Safah, head of the BMT unit. "Then we moved the patients and supplies away from windows."

The BMT unit is located on the sixth floor and escaped flooding, although the floor immediately above did flood because of broken windows and wind-driven rain. The hospital continued to operate with back-up electrical power until Tuesday when the floodwaters rose to the level of the generators. After that, the night-time and interior-room lighting was flashlights and candles.

With the loss of electricity came an end to the air-filtration and cooling. The BMT unit became unbearably hot, and the patients were moved to another suite. The hospital pharmacy was relocated from a lower level to temporary quarters on the fourth floor, but there were no computers to help with dispensing medications.

Finally, on Wednesday, help arrived and the patients were evacuated by military helicopter to Texas Children's Hospital in Houston, and to Southwest Medical Center in Lafayette, La.

Children's Hospital

Meanwhile, at Children's Hospital in the Uptown section of New Orleans, five patients were in the BMT unit as the hurricane approached. One was discharged, but four remained when the storm hit. Although the hospital did not experience serious flooding, it did lose electrical power early Monday and had to operate with back-up generators for several days. The BMT patients were evacuated by helicopter on Wednesday to hospitals in Baton Rouge and Houston, as well as to hospitals in Kansas and Missouri.

Memorial Medical Center

Memorial Medical Center, which sits in a low-lying area of New Orleans, was one of the hardest hit by Hurricane Katrina. More than 1,800 people were stranded at the hospital: 260 patients, 500 employees and hundreds of family members who had come to the hospital to ride out the storm.

As Monday dawned, it looked as if the hospital had survived with minimal damage. Then the levee ruptured and the water level started rising. "It was terrifying to see it rise so quickly. We didn't know where it was going to stop," said L. Rene Goux, medical center CEO. As power was lost, the plumbing in the hospital failed and temperatures rose to nearly 100 degrees. "The toilets were overflowing and the stench was overwhelming," said Goux.

"Luckily we had only two transplant patients on the ward at the time of the hurricane," said Dr. Todd Roberts, director of the Blood and Marrow Transplant Program. "One was scheduled for discharge, but was kept on the unit because of the hurricane. The second had his stem cell infusion the day after the hurricane." Both patients were evacuated to another transplant center a few days later by private helicopter.

Saving the Stem Cells

Still at risk, however, were the stem cells belonging to 200 patients, including many who planned to be transplanted at a later date. The cells are stored in special freezers that are cooled by liquid nitrogen.

When the power failed, the staff had to monitor the temperature in the freezers and manually top off the supply of liquid nitrogen so that the stem cells could be preserved, said Janet Krane, head of the Cancer Center. As the last tech in charge of the operation was evacuated from the hospital, Krane herself got a quick primer on how to keep the stem cells cool, transferring ladlefuls of liquid nitrogen to the freezers by hand with only the light of a flashlight.

"We looked at the problem as 200 people's lives in our hands," said Krane. "The stem cells had to be preserved for their transplant."

Moving Patients to Safety

Patients who were evacuated to other hospitals had a difficult time, according to Dr. Richard Champlin, director of the transplant program at MD Anderson Cancer Center in Houston.

"We received two patients from New Orleans who were evacuated to us by helicopter. They had to walk through brackish water and stop at another regional medical center before they reached us," Champlin said. "We received their medical records, but could not contact their physicians because of the lack of communication into the New Orleans area and the chaos of the evacuations. Fortunately, both patients were in fair condition on arrival and have done well."

Rita Moves In

Hurricane Rita, which rolled in on the heels of Katrina, threatened to do even more damage to hospitals along the Gulf Coast of Texas and Louisiana, but the area transplant centers were spared.

"It was very lucky for us-although not for Louisiana-that Hurricane Rita veered east at the last minute," said Dr. Helen Heslop, director of the stem cell transplant program at Baylor College of Medicine in Houston. "Our transplant units at Texas Children's Hospital and The Methodist Hospital were fine and never lost power."

Some patients at those hospitals were released from the BMT unit or transferred to out-of-town facilities in advance of the storm, but 25 patients remained. Of those, three had been evacuated from New Orleans after Hurricane Katrina.

Transplant Units To Reopen

Physicians at Tulane and Children's Hospital of New Orleans are hopeful their transplant units will reopen shortly. "I've seen the unit and it is in fine shape," said Lolie Dr. Yu, medical director of the transplant program at Children's Hospital.

Louisiana's Memorial Medical Center is still surrounded by water. It will be at least six months and possibly more before the facility reopens, said a hospital spokesperson.

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