JOE JOE'S
STORY:
THREE ORGAN
TRANSPLANTS
*BEFORE AGE 18
In an extraordinarily rare case, a child had both a liver and a kidney transplant by age 9.
Ten years later, he learned, his heart was failing.
Today, 18-year-old Joseph (Joe Joe) Sanchez-Munoz loves practicing guitar, making playlists of his favorite songs and coming up with recipes — with creative input from his mom, Elena Munoz — for the café he hopes to one day own.1
But, he’s also interested in a career in medicine, and he’s more familiar with the landscape than most people his age. Joe Joe had his first organ transplant when he wasn’t yet a year old. As an infant, he was fighting liver cancer, and he received the gift of a new liver. At age 9, because of a genetic malformation that had spurred dysplastic kidney disease (underdeveloped kidneys) he received the gift of a kidney. And in the winter of 2022, he faced another enormous challenge: his heart was failing.2
Having a third organ transplant would make Joe Joe’s already exceptional case unprecedented.
He’s very resilient, bright, with lots of great support from his family. His mom is an amazing advocate. And so many team members at Lucile Packard Children’s Hospital Stanford are constantly cheering him on.
Fortunately, when it came time for this crucial, and urgent, decision to be made, he was in the care of a team of doctors, nurses, surgeons, nephrologists and other experts at Stanford Medicine Children’s Health — a nationally ranked pediatric hospital in California — who’d known him nearly his entire life.3
His most steadfast advocate, his mom, has been by his side and passionately tracking and ensuring continuity in his care from day one. In that process, she too forged constructive relationships with the staff at Stanford Children’s as close as family. 4
“Some of them became like my parents,” Elena, who was a teenager when Joe Joe was born, said of her early days working with his care team.
According to Stanford pediatric nephrologist Dr. Paul Grimm, these relationships were a strong foundation when the team was faced with a unique challenge.
“Certainly, three solid-organ transplants have been done, but so many years apart, that’s an incredibly rare situation — especially when that entire span of 17 years falls within pediatric care,” Grimm said. “This was something we really had to think long and hard about.”5
In Stanford Children’s 32 years, it has become one of the nation’s leading institutions for pediatric care and, in particular, pediatric organ transplants, ranked first for pediatric transplant volume on the West Coast and third in the nation. So, when the problem with Joe Joe’s heart arose, the team was in lockstep.
Multidisciplinary
care
Joe Joe remembers well some of the most stressful moments from the early efforts to triage his failing heart. He found comfort in the fact that trusted members of his kidney and liver teams were close at hand, including Grimm and transplant surgery physician assistant Lynn Maestretti. He also formed a close bond with his cardiac team, including pediatric cardiologists Dr. Seth Hollander, Dr. John Dykes and Division Chief of Pediatric Cardiac Surgery, Dr. Michael Ma.
Stanford Medicine Children’s Health takes on some of the most rare and complex cases in the nation.
When Joe Joe’s body struggled following an emergency heart catheterization, it became especially clear: He would indeed require his third organ transplant. At that point, Dykes recalled, time was of the essence, and there were many interrelated, complex factors to take into account.
“We knew we didn’t have a lot of time. Furthermore, we needed a lot of input to understand the complex cause-and-effect dynamics a heart operation could have on Joe Joe’s past transplanted organs,” Dykes said. This is when Stanford Children’s multidisciplinary care became a saving grace: the liver and kidney transplant teams were each immediately able to provide intel about Joe Joe’s medical history on a comprehensive, detailed and personal level.6
The team put Joe Joe on the transplant list, and with miraculous luck, a life-saving heart became available for him five days later.
in the Western United States in pediatric
organ transplant volume
in pediatric organ transplant
volume in the nation
Seamless
collaboration
Seamless
collaboration
Joe Joe’s heart transplant wasn’t an isolated decision by the cardiac team. Such an operation meant stress on the body, and this multidisciplinary team knew — and was in seamless communication about — how his two past organ transplants would be especially vulnerable to that stress.
“The thing about Joe Joe’s candidacy [for a transplant] is that a lot of other places would say, ‘No way. You are too high risk for us,’” said Ma. “All of his other transplants made his heart transplant more challenging; the operation places stress on all of the other transplanted organs. Our multidisciplinary team – hepatology, nephrology and cardiology all worked together. We met together several times a week. We’re used to collaborating to make good decisions to move these kids forward.”
Grimm and Ma agree: A good outcome from a surgery as unique as this one was possible at Stanford Children’s due to the multidisciplinary team’s effective collaboration. But it’s also a matter, Grimm said, of deep individual expertise.
After lots of education and [consideration], we thought:
if anybody can get through
this, it’s this family.
Industry-leading
expertise
“The intensive care doctors, the post-transplant coordinators, our nurse practitioners and physician assistants: They live and breathe transplant,” Grimm said. “And when you do something all the time, you get good at it. When you look at the three-year outcomes of our kidney transplant program, we have the lowest risk of kidney transplant at three years in the country, and we’re very proud of that — and it’s just a sign of the collaboration, and of how all the different pieces work together.” 8
Dr. Grimm, Dr. Wong and all the kidney doctors helped my journey so much. They came to visit a lot and check on me, and also helped advocate for me. Without them I don’t know if it would’ve been possible.
The experts, he added, are committed to their patients and to the best outcomes.
“The hospital and the team — the nurses, the pharmacists, the intensive care doctors, the anesthesiologists, of course the surgeons — we do all sorts of things here, but [transplantation] is an identified center of excellence, and an area where we want to be world leaders. There’s lots of research going on here, and there’s lots of commitment — we have people who will come in, even if they’re not on call.” 9
Beyond expertise, Maestretti points to the ability for all these different experts in care to work in unison.
“It’s the collaboration and the communication,” she said. “As a whole, we’re a close-knit group. I’m proud of how seamlessly we work together.” 10
in pediatric heart transplant volume
in the Western United States
‘Happy and proud
to be alive’
Joe Joe’s home now, happy to have more time with family and his dog, and he’s not taking a moment for granted.
“I am mostly excited and grateful about being able to leave the hospital with a third chance in life and my three organs — liver, kidney and heart — all doing good,” he said. “I’m happy and proud to be alive.” 11
His doctors say there’s still work ahead. There will be ups and downs. But the future is bright. “We'll take care of the problems as they come, alongside Joe Joe’s family, as his mom has for the last 18 years,” Dykes said.12
One thing about Joe Joe, he’s got a smile that will light up a room. He’s exceptionally sensitive and caring for others, and just a remarkable young man, and a product of the wonderful caring people he has around him.
In the meantime, Joe Joe is thinking big: “Before I got really sick I wanted to open a mobile coffee shop,” he said. He’d already picked out the name — the Unforgettable Café — and even started working on recipes with his mom. His health threw his plans into question. But now, things are back on track. When he was home and recovered from his heart transplant, he picked up where he left off.
“I was able to go back to my college program where I am able to work in a school café,” he said. He plans to open his own place and to serve his old doctors and nurses drinks.
The plans, and the inspiration seeded by the team at Stanford Children’s, don’t stop there.
“I want to one day be a nurse,” he said, “to care for other kids like me.” 13