Dr Robert Montgomery underwent a heart transplant in September 2018 after experiencing multiple cardiac arrests caused by genetic dilated cardiomyopathy.
Dr Robert Montgomery Collapsed While Hiking in Patagonia in 2010
The first time Dr Robert Montgomery died briefly, he was hiking in Patagonia near the southernmost tip of South America in 2010. He felt his racing heart as he lagged behind his son John and their guide before collapsing face down into the snow. Seconds passed before an implantable cardioverter-defibrillator (ICD) in his chest delivered a shock that restored his heartbeat.
During his visit to Argentina, Montgomery was in charge of one of the top organ transplant centres in America at Johns Hopkins Medicine. He was 50 years old and recovering quickly from the episode, but the incident made it painfully clear that his natural heart was failing.
Family History of Dilated Cardiomyopathy
Montgomery first considered becoming a doctor at age 14 when his father developed symptoms of dilated cardiomyopathy, a rare disease causing the heart’s chambers to stretch and enlarge. The condition leads to heart failure, arrhythmias, cardiac arrest, and sudden death. After experiencing brain damage from a cardiac arrest, his father’s health declined further until he eventually required a feeding tube.
His father died in 1976. Eleven years later, just as Montgomery started a surgical residency at Johns Hopkins Medicine, his 35-year-old brother Rich died suddenly of the same condition. Pathologists discovered Rich had also suffered from dilated cardiomyopathy caused by a likely genetic mutation. Medical evaluations confirmed Montgomery had the condition too.
Kidney Paired Donation Innovations at Johns Hopkins
When medication failed to keep his arrhythmia in check, Montgomery opted for an ICD to shock his heart back into normal rhythm. Unsure if he could complete his gruelling surgical training, he and his wife moved to England so he could study immunology and pursue a doctorate in case surgery did not work out.
Montgomery returned to Johns Hopkins in 1992 to specialise in transplant surgery, driven by his own diagnosis. Because so few heart transplants were performed in the early 1990s, he focused primarily on kidneys. He helped develop a minimally invasive surgical technique for retrieving kidneys from living donors, which increased donation rates. In 2001, he started a programme for swapping kidneys between incompatible donor-recipient pairs, soon expanding to domino donations where altruistic donors gave to strangers.
Multiple Cardiac Arrests and the 2018 Transplant
There, he suffered another cardiac arrest far from the nearest hospital while John performed chest compressions in a Jeep.
Montgomery emerged from a medically induced coma over a month later in New York, having to relearn walking, talking, and eating. His heart stopped again inside a Broadway theatre during a performance of School of Rock, and he experienced four cardiac arrests, one after another, at a medical conference in Italy in September 2018. That severe decline finally made him sick enough to join the official waiting list.
On September 20th, 2018, Montgomery received a heart from a donor who had died of a heroin overdose and was infected with hepatitis C. Colleagues called him crazy for accepting an organ from a clinical trial involving hepatitis C, but the virus was curable with medication.
Genetically Modified Pig Organ Trials at NYU Langone
In 2021, his team transplanted a genetically modified pig kidney into a brain-dead human patient after scientists at United Therapeutics knocked out a gene responsible for aggressive organ rejection.
The kidney functioned, produced urine, and excreted waste for the 54-hour limit set by a hospital ethics panel without triggering an acute immune rejection. Over subsequent years, his team and researchers in Maryland and Boston transplanted pig kidneys and hearts into terminally ill patients who had exhausted other options. Last year, the United States Food and Drug Administration approved clinical trials for pig organ transplants in severely ill patients lacking alternative kidney options, with Montgomery leading two of the trials.
Dr Robert Montgomery Assisted Kidney Surgeons in Ukraine
Dr Robert Montgomery assisted kidney surgeons in Ukraine following his recovery and return to clinical practice.
Dr Robert Montgomery and His Family Suffered from Dilated Cardiomyopathy
What genetic condition did Dr Robert Montgomery and his family have?
Montgomery, his late father, and his late brother Rich all suffered from dilated cardiomyopathy, a rare genetic disease that causes the heart’s chambers to stretch and enlarge, leading to heart failure and sudden cardiac arrest.
Why did Dr Montgomery accept a hepatitis C-positive heart?
Montgomery accepted the heart in September 2018 because the donor organ was available, and he believed in the safety of treating hepatitis C with modern curative medications after encouraging his own patients to consider similar trial organs.
What is xenotransplantation and how is Montgomery involved?
Montgomery led the 2021 procedure transplanting a genetically modified pig kidney into a brain-dead human and now leads US Food and Drug Administration-approved clinical trials for pig organ transplants.
The US Food and Drug Administration greenlit clinical trials for pig organ transplants in very ill patients who cannot receive human kidneys. Dr Robert Montgomery is currently leading two of these active trials to determine the long-term viability of xenotransplantation in living humans.
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