Someone must die so another can live


At 58, Lance Cunha had traveled the world counseling organizations on strategic matters, helping solve complex development and economic problems, and advising countries on debt and capital market issues.

He was, as they say, at the top of his game. Having grown up of modest means in New York City, he was proud of how far he’d come in life. He was a first generation American, a hard worker who’d climbed the ladder to success. In just three years, he’d earned his undergraduate degree in international relations at Ithaca College, then a master’s degree in international affairs and economics from the University of Notre Dame. He’d married his college sweetheart, Mary Mackenbach, and raised two successful daughters. He looked forward to seeing his grandchildren grow up.

Then in 2003, Cunha started to feel a general malaise. He felt tired and out of breath. When he went to see a doctor, the news was bad. Cunha had an enlarged heart or, as doctors put it, hypertrophic cardiomyopathy. The risk of him suddenly dying of a heart attack was so high that doctors suggested he slow down, perhaps even retire.

Cunha was devastated.
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He considered the cost to himself, but most especially to his family. Did he have enough money and insurance to cover the unforeseen medical bills and, more importantly, did he have enough fight in him to get through the challenges and treatments ahead of him?

“I didn’t know,” he said recently at his home in Alpharetta. “Nevertheless, we bit the bullet.”

Cunha put his home in New Canaan, Conn., on the market and moved here, where one of his daughters had settled after completing law school and where he could receive treatment at Emory University Hospital, considered one of the best cardiac and transplant hospitals in the world.

A year later, in 2004, he took his doctor’s advice and retired at age 59. In 2008, he got more bad news. An X-ray showed Cunha’s heart was shot. Only about two thirds of the organ was functioning properly. Doctors installed a pacemaker and defibrillator to buy him some time.

Cunha needed a new heart.

“That concerned me more than the news a few years earlier because that meant that now somebody would have to die for me to live,” he said. “Absorbing that was difficult.”

There are 118,000 people in the U.S. awaiting organ transplants. In Georgia, more than 5,500 are waiting; 4,995 for a kidney, 376 for a liver, 21 for a lung and 74 for a heart. More than half of those patients are African-American.

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Last year, Emory performed 39 adult heart transplants, said Dr. Andrew Smith, chief of cardiology at Emory University Hospital and medical director of the advanced heart failure therapy program.

“Transplantation has had a major impact for patients who should be in the prime of their lives but are dying from organ failure,” Smith said.

Getting a heart is particularly difficult. Patients often wait several years. When they do get one, survival rates are good, said Smith.

In 2011, doctors began the process of determining Cunha’s eligibility for a transplant. By then he was 66. He had misgivings about taking a heart if the organ could go to someone younger.

Eligibility for a transplant, however, is based strictly on how sick a patient is, where he is on the list, the patient’s medical background and, of course, blood and tissue matches.

Over the next couple of years, Cunha was in and out of the doctor’s office. He struggled to walk even to his mailbox. By October 2013, he was in end stage heart failure.

Cunha had two choices: leave Emory University Hospital and most likely die or stay there on life support until a heart became available.

“I decided on the latter,” he said.

Every night, he prayed. He asked his friends of all religions to pray with him. He resolved to live. As loud as he could and as often as he could he sang his favorite song: “The Impossible Dream”

As Thanksgiving and Christmas flew by, he got weaker and weaker. He needed help just getting out of bed.

By mid-December, his heart was barely pumping, but Cunha was still alive, still singing, still dreaming “the impossible dream, fighting the unbeatable foe.”

On New Year’s Eve, a nurse arrived to tell him they might have a heart. Blood was drawn in case he needed a transfusion, and Cunha called his family members.

That evening, the cardiologist arrived to show Cunha a text he received from the organ harvest team. “Cunha’s a go,” it read.

He hugged his wife. They wept.

At 4 a.m. on New Year’s Day, Cunha was put on a stretcher and transported to the operating room. He blew kisses to his nurses as they rolled him down the hall.

I’ll see you on the other side, either in the ICU or when we meet in heaven, he told them.

He started singing his song. Cunha’s impossible dream was happening.

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Six months post-transplant, Cunha and his wife, Mary, hosted a dinner for 14 of his coronary care unit nurses.

“When God created the world, he created angels,” Cunha said. “They are called nurses.”

He wasn’t done. On Valentine’s Day 2014, Cunha reached out to his donor’s family and nearly a year later met his donor’s mother over lunch. It was one year to the day after her son’s burial.

“She held my wrist to feel her son’s pulse,” Cunha said.

The woman’s son, the oldest of eight children, had died in a car accident. He was only 20.

“There isn’t a day that goes by that I don’t wake up and think about this whole experience and wonder why God thought I should live while my donor died,” Cunha said. “There must have been a reason.”

Part of it, he believes, is to share his story and encourage others to remain resolute in the face of significant health and other challenges. And part of it is so he can remind the rest of us of the importance of being an organ donor.

“There is such a shortage,” he said. “It’s like rolling a dice between who lives and who doesn’t.”



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