During Ms. Chen’s tour of Japan in October 2018, she was stung by a bee. Being severely allergic to bee venom, she suffered from pain and swelling around the area of the bee sting. On her return to Taiwan, Ms. Chen visited her physician, who ordered some exploratory tests. An EKG revealed some abnormal findings, and heart failure was diagnosed. On October 20, her heart stopped beating. She received CPR and when stable had an Extracorporeal Membrane Oxygenation (ECMO) device and a ventricular assist device (VAD) installed. Eventually, she was transferred to the National Taiwan University Hospital to wait for a heart transplant.
Typically, while a patient is waiting for a heart transplant, there is a high risk of acute kidney failure and diffuse bleeding. Multiple blood transfusions mean the possibility of inducing white blood cell antibodies, which add to the likelihood of the transplant failing. To increase the possibility of success for Ms. Chen’s heart transplantation, the medical team decided to use allergen immunotherapy, also called desensitization, to suppress and remove the possibility that the antibodies function to reject foreign organs. The methods adopted included the removal of B cells, immunoglobulin therapy, and plasmapheresis.
Fortunately, Ms. Chen was granted the opportunity to receive a donated heart, and the transplantation was successful. By that time she had relied on the ECMO to support her life for 50 days without her heart beating. Ms. Chen was the first patient in Taiwan whose heart had stopped beating for 50 days and despite that was able to survive. The medical team at the National Taiwan University Hospital created both a miracle and a milestone in Taiwan’s medical history through the use of the ECMO.
Dr. Chen Yee-shiang, Chief of the Cardiovascular Center at the National Taiwan University Hospital, stated that they will continue to follow up for the next six months to see if there are any signs that Ms. Chen’s body is rejecting the transplanted heart. Due to the complex nature of the procedure and its high risk in Ms. Chen’s case because of the environmental allergens induced in her body via the bee venom, medical staff opinions had been strongly polarised for or against the surgery. Ms. Chen’s husband had the will to save her life and insisted that the surgeon perform the transplantation, which finally made the miracle possible. The collaborative approach between the medical team and the patient’s family is known as shared decision making, or SDM, and in this case, proved to be a lifesaver.
Translated by Audrey Wang and edited by Helen