In Death, There Can Be Life -- For Families Of Donors As Well As Recipients, A Heart Transplant Is Intensely Personal

(SECOND OF TWO PARTS) HEART TRANSPLANTS are an exercise in intensity. No one experiences the intensity more than the donor's family and those receiving a transplanted organ. Here are two stories of such experiences.

It was the last thing anyone dreamed would happen to Jeremy Montoya, a young man so confident, so full of optimism in his new college career. He was planning to be a doctor, planning to use his bright, inquiring mind to help others.

Montoya was returning from lunch to his weekend Naval Reserve unit in New Mexico when a car turned directly in front of his motorcycle.

The bike hit the car broadside, sending Montoya, 20, into the air. His head smashed into the top of the sedan.

In the end, after days of dissolving hopes, Montoya did help others in a most significant way. He donated his heart, liver, kidneys, corneas, bone and other tissue for transplantation.

"My life is so much closer to normal now," the 30-year-old recipient of one kidney recently wrote to Montoya's parents, Denise and Mushroom Montoya, of Renton. "I say thank you to Jeremy and his family every day."

Jeremy Montoya was an exceptionally bright young man. He was a member of MENSA, the national organization for those with high IQs. He loved classical music, played the violin, read a lot. He also was a high-school wrestler - largely, his parents said, because he didn't want to be considered a nerd.

When he graduated, he decided college should wait while he served two years as a Navy medic, working mostly with the Marine Corps. He loved the medical work and set a goal of becoming a neurologist.

He was doing well as a sophomore at the University of New Mexico when the devastating accident occurred in Albuquerque on Saturday, Oct. 17, 1992. It was hard to predict at first the long-term effects of his head injury.

When Denise and Mushroom Montoya arrived late that night at the University of New Mexico Medical Center, they found their son unconscious, with a probe through his skull to measure the pressure from his swollen brain. By Monday, doctors suspected brain damage, but there was still some hope.

"They said that it didn't look good, but that anything could happen," Mushroom Montoya painfully remembered. "Then each day it got more dismal."

Early Tuesday, Jeremy's brain pressure increased and one of his eye pupils widely dilated, indicating serious brain damage and little chance of recovery. Doctors broached the subject of withdrawing life supports.

The Montoyas already had imagined that might be a possibility. They wanted to do what was best for Jeremy. Unlike most families, they already knew exactly what Jeremy would want.

Through the years, both had given blood often and discussed organ donation with their children. The subject also surfaced when four relatives died in a single year, and when it appeared Jeremy might serve in the Gulf War.

At the hospital, they even checked their son's California and New Mexico driver's licenses to confirm their memories of Jeremy's wishes to be an organ donor.

"We knew that Jeremy wouldn't have wanted his death not to have a positive outcome," said Denise Montoya, a computer program analyst.

Through the next two days, their son's condition further deteriorated, and by Friday, after another rapid decline, doctors said his only chance for survival would be in a permanent vegetative state. The Montoyas told hospital officials they wanted their son's organs donated so others could live.

During the weeklong ordeal, Mushroom Montoya, an architect and a Jicarilla Apache who has studied with Native American medicine men, had noticed a white rose outside their friends' home. Each day it lost a few more petals. Each day it became a more powerful symbol of his son's decline.

"I had wanted to go on a healing journey with him, but I stopped," said Montoya. "By Friday, all the petals had fallen. I knew my task was not to heal him but to help him cross over."

Doctors declared Jeremy Montoya brain dead at 11:30 p.m. Friday. On Saturday morning, his organs were removed for transplantation.

Today, the Montoyas take solace in Jeremy's contribution. They speak often to hospital medical staffs and others on the value of organ donation. They want others to know.

Lovingly, they show the recent letter from the kidney recipient.

"I can't imagine your heartache at having lost (Jeremy) when he was young," she said, "but I can understand your pride in him that is so rightly deserved."

Heart transplant `was meant to be'

Vada Moss smiles broadly when she talks about the timing of her heart transplant.

It was the University of Washington's 91st - on Aug. 19, 1991. And it happened just 2 1/2 days after she went on the waiting list.

"It was meant to be. It tells you something, huh?" said Moss, a friendly, upbeat Tacoma office worker.

Moss is a confident, take charge kind of person. She takes care of what she can, she said, and leaves the rest to God and her doctors. Psychologically, she was an excellent heart transplant candidate.

In addition, her heart donor, a 22-year-old Alaska woman, was a perfect biological match. She is one of the most successful patients ever in the UW's 10-year-old transplant program.

"I just have no problem doing anything now," said Moss, nearly four years after her transplant. "I'm 53 and probably feel like I'm 35."

Her return to health was a long time coming. Nearly a decade of heart problems preceded her transplant.

As with many heart transplant patients, the trouble began with a common virus, causing flulike symptoms.

The virus inexplicably traveled to her heart, inflamed the sac surrounding the organ and caused a disease of the heart muscle called cardiomyopathy.

At one point during an eight-day stay at Good Samaritan Hospital in Puyallup, her heartbeat raced to a dangerous 280 beats a minute. Doctors prescribed a long-term drug to control the heart rhythm.

The drug held the problem at bay until a sunny summer day in 1985 when, as Moss puts it, "I dropped dead at work, right in front of Bud," her husband. Her heart muscle had gone into an erratic quivering called ventricular fibrillation.

Bud and the medics revived Moss. But after several weeks of hospitalization, it was apparent she needed additional support for her diseased heart. Physicians at the University of Washington Medical Center implanted a battery-powered defibrillator in her chest cavity to shock the organ back to life if it went haywire again.

Moss had no further problems for 3 1/2 years.

Then one night in January 1989, as she watched television with Bud, her heartbeat raced to 200 and the defibrillator went off. It knocked her down but saved her life.

Over the next year-and-a-half, she had three more such incidents. Her heart was becoming weaker, she was down to 95 pounds, she could barely go to work. In summer, 1991, her doctors sent her to the UW for evaluation for a transplant.

Medically, the need was unquestionable. Her insurance would cover the procedure. A network of family and friends were there for moral support.

Doctors were impressed with her mental outlook. She was a prime candidate. She didn't worry.

"You can't worry about something you can't control. . . . We've learned that with all the things we've been through," said Moss. "I just put my faith in God and the doctors and didn't think much about it."

The organ recovery and transplant went smoothly. A tailwind helped speed the small jet carrying the donor heart from Anchorage to Seattle.

The tissue match was so good, transplant surgeon Margaret Allen and her assistants were "really excited . . . and it took a lot of the fear away," said Moss.

Moss was amazed at the change she felt with her new heart. As she sat on the edge of her hospital bed just a day after her surgery, she felt as if she were vibrating.

"I said: `Bud, it's like getting a new Corvette engine,' " Moss recalled. "At that point, I knew it was going to be great."

In five months, Moss was back at work. She has well tolerated the drugs to prevent her body from rejecting the new heart. She walks three to four miles a day.

Moss is grateful for her second chance at life. Nearly four years later, she is still a little awed by how young she feels.

"I was very fortunate," she said. "Thank God, there was that kind of family that was willing to donate."