May 30, 2001 -- These days, Timothy Heidler spends a good deal of time speaking in public. He talks to Lions Clubs, women's clubs -- just about any group who wants to hear his story. His story is remarkable because for nearly two decades Heidler couldn't speak at all without using a battery-powered, vibratory device called an electrolarnyx that produces what he calls a "flat, robot sound."
Heidler had the first and only successful voice box, or laryngeal, transplant in January 1998 and was speaking almost normally in just over a year.
During a 12-hour operation, surgeon Marshall Strome, MD, and colleagues at the Cleveland Clinic removed Heidler's larynx, his thyroid gland, part of his windpipe, and surrounding throat tissue and replaced them with that of an unidentified donor.
Now, more than three years later, the 43-year-old from Duncansville, Va., says he would have the operation again in a minute.
"I never dreamed of even talking again, and now I speak in front of large groups of people," he tells WebMD. "I am getting used to it, but for the first year or so, just picking up the phone and saying 'hello' was unbelievable. People couldn't get over the fact that it was my voice on the other end."
Strome and colleagues reported on Heidler's progress in the May 31 issue of The New England Journal of Medicine. They have not yet done a second laryngeal transplant, but Strome says he is searching for just the right patient.
"We are definitely looking for our next candidate," Strome tells WebMD. "We have had maybe 15 serious inquiries, but none of them fit the bill. We are not going to rush. I want the next transplant to be as successful as this one was."
Tremendous advances over the past few years in antirejection drugs that keep the body from rejecting the transplant have opened the door for transplants like Heidler's -- those aimed at improving the quality of a person's life rather than prolonging it. Such transplants are still controversial, however.
Take, for example, the world's first hand transplant: Less than three years ago, French doctors received worldwide attention after attaching a hand from a corpse to a man who had lost his hand in an accident. Last February, doctors in London had to amputate that hand transplant.
The original transplant team now acknowledges the patient, Clint Hallam of New Zealand, was a poor candidate for the transplant. He lied to them about his background, disappeared soon after the surgery, and did not take his antirejection medication regularly.
Strome, who practiced laryngeal transplantation in rats for more than a decade before attempting the procedure in a human, says he suspected Heidler was the right candidate the day he met him, but he put him through a rigorous selection process, which included extensive psychological evaluation. After Heidler was selected, he and the transplant team waited another six months for a donor that matched his blood and tissue type.
"Each step of the way, we have been very conservative, so that if ... things had not gone well, we would have been able to live with it," Strome says.
Heidler's larynx was crushed and his esophagus severed in a 1978 motorcycle accident that left him hospitalized for two years. He says a serious infection acquired in the hospital put him into a coma at one point and he was told his legs might have to be amputated.
"I didn't eat for a year after the accident," Heidler says. "They had to totally reconstruct me so that I could eat. And I ended up with an electrolarnyx that I used for more than 19 years. I never got used to it, though. You sound like a robot; and for people to understand you, they almost have to read your lips. But most people end up just trying to figure out how [on earth] you are talking."
He says the transplant was "like a vacation" compared with the time spent in the hospital following his accident. Three days after surgery, he said his first word -- "hello." His sense of taste and smell, which was lost due to the accident, also returned.
Unlike Heidler, who lost his voice due to an accident, most people with permanent voice loss have had their voice box removed, a procedure called a laryngectomy, because of illnesses like cancer. Although many of these patients would not be good candidates for a laryngeal transplant, Strome says others might be. He is considering patients who have had laryngectomies due to benign tumors and those treated for cancer who remain disease-free after five years.
Harvard Medical School physician Anthony P. Monaco, MD, who had his voice box removed due to cancer seven years ago, says he would consider having a transplant if he were younger. Monaco, 69, does not use an electrolarynx, but instead has learned to speak by taking air into his esophagus and projecting it out like it is coming from the lungs. The esophageal voice is very difficult to learn, and many laryngectomy patients either can't master it or do not try.
"To say I am amazed at this transplant is an understatement," Monaco tells WebMD. "I really want to hear this guy talk."
In an editorial accompanying Strome's report, Monaco writes that the continued improvement of antirejection drugs will make possible more transplantations once thought to be too risky for the patient.
Considering all the advances in transplant medicine, "If I were 40 years old, I would probably consider undergoing the operation myself," he writes.