History at the heart: Dr. Anne Dipchand’s career has grown alongside SickKids’ heart transplant program

Dipchand, who first joined SickKids as a resident, has seen the hospital’s heart transplant program grow alongside her own career. She is the medical director of SickKids’ heart transplant program, and as SickKids reflects on 150 years of milestones, she points to changes in the field over the course of her career, including innovative research and care pioneered at SickKids, that give her hope for the future of heart transplantation.  

“I’m still here because I love SickKids,” she says. “I love what it has allowed me to do for patients and families and for my own career, and also for many different organizations internationally that help move the field forward.”   

Dipchand’s path to pursuing heart transplant 

Dipchand decided early on that SickKids was where she wanted to be. She’d become interested in medicine during her undergraduate degree at Dalhousie University. Classes and experience at a hospital in Nova Scotia solidified her interest in paediatrics.  

Drawn to SickKids’ positive reputation, when it came time to apply for medical school, Dipchand focused on the University of Toronto’s faculty of medicine. After medical school, she was accepted into the university’s four-year paediatric residency program, receiving training at SickKids. 

Dipchand was the Chief Paediatric Resident at SickKids in her final year of residency in 1996. In this role, she mentored junior residents and got to connect with hospital leadership. She also helped develop and publish two editions of the SickKids Handbook of Paediatrics, which she calls “a tremendously significant accomplishment, because it’s used and referenced everywhere.”

In her second year, Dipchand remembers looking over a folder with a table of contents listing subspecialties, putting checkmarks next to the ones she thought she’d want to pursue in the future, and scratching out the ones she didn’t. She was left with three: cardiology, intensive care and neonatal intensive care. 

“It became very clear to me that I liked acute care medicine,” she says. 

She chose cardiology because it offered the chance to follow patients over time, in some cases from birth up until adolescence. Throughout her residency, heart transplant also stood out: she saw the impact transplants had on patients, and the medical challenges in the field.  

“You’re dealing with the sickest of all the cardiology patients, without any other cardiac options whether surgical, interventional or medical,” she says. “But you had this potential other option for them, which would give them an excellent survival and quality of life if they had the fortune of being able to get a donor heart.” 

After residency, Dipchand went on to complete a three-year paediatric cardiology fellowship. She was excited to finally be exposed to the depth and breadth of the field at SickKids and beyond. With her emerging interest in transplant, SickKids’ Division of Cardiology sent her to Denver, Colorado for six months of additional training at a cutting-edge infant heart transplant program. 

“It’s a very busy and demanding fellowship, so it was definitely something that I threw myself into — it was a huge, but very rewarding, learning curve,” she says. 

SickKids team’s pioneering innovations ‘unbelievably gratifying’  

Today, as medical director of SickKids’ heart transplant program, Dipchand runs the inpatient and outpatient services and regular clinics, with the program supporting all patients currently on the transplant wait list. She leads a multidisciplinary clinical team, conducts clinical research and teaches trainees. 

She has also held leadership positions with the Paediatric Heart Transplant Study and the International Society of Heart and Lung Transplantation Registry. Another "phenomenal” experience stands out: in the early 2000s, she helped organize for a team of SickKids patients to attend the World Transplant Games in Thailand and Australia. It was an opportunity for the patients to meet other children and youth who had received organ transplants, as well as for parents to connect, feeling safer to travel internationally because it was facilitated by the clinical team. Patients and parents were motivated by knowing their clinical teams believed in them, as they trained for months, and this built their confidence not only in physical activities post-transplant but also believing in themselves. Dipchand recalls many patients who attended still stay in touch today.

Did you know?

In 1996, a SickKids team performed the world’s first blood-type incompatible heart transplant — a pioneering milestone that showed infant heart transplants from any blood type are safe and effective. Owing to its early start, SickKids has completed the most blood-tyle incompatible heart transplants of any hospital in the world, with more than 80 to date. Check out more SickKids firsts here as we reflect on 150 years of milestones! 

In her day-to-day work at SickKids, when a transplant comes up, she and the team "drop everything else." She describes feeling a “mix of emotions — excitement that the patient will get the opportunity, but also apprehension about unknowns, like how the new heart will work or how long the patient will be in the intensive care unit (ICU).  

“It is very much a roller coaster and waiting to see how things go, and if you’re going to be able to give that child and family a second chance,” she says. 

Dipchand is part of some families’ journeys for 18 years until their child transitions out of care at SickKids. She keeps in touch with patients as they grow up, cheering them on through milestones like starting university, launching their careers and building families of their own. She credits seeing patients grow up post-transplant with helping to balance the more difficult emotions — like when a patient is getting sicker on the waitlist and there is uncertainty around when a heart might become available. 

But Dipchand is hopeful for the future, because the hospital’s heart transplant program already offers more innovative treatments to patients than it did when she started her career. 

One big change was a milestone when Dipchand was a fellow, in 1996, when a SickKids team performed the world’s first heart transplant where the donor’s blood type did not match the recipient. Between 1996 and 2000, SickKids performed a total of 10 blood-type incompatible heart transplants. In 2001, the team published a paper in the New England Journal of Medicine that brought broader global awareness to the fact that these transplants were safe and effective.   

This meant more hearts were available to patients on the waitlist, since they didn’t need to wait for a heart that was a blood-type match. Following this milestone, the hospital’s heart transplant waitlist mortality dropped from 58 to 7 per cent, the team wrote in a 2001 New England Journal of Medicine article.

“It’s unbelievably gratifying because our team has been able to help a whole population of children that perhaps now have a new lease on life that may not have been given the opportunity without this type of transplant.” 

Today’s challenges and opportunities  

It has also been gratifying, Dipchand says, to watch other centres start to perform blood-type incompatible heart transplants — with SickKids playing a role in that expansion after proving it was possible. In 2008, the hospital created a transplant and heart failure subspecialty fellowship, something that didn’t exist when Dipchand was training. It has welcomed fellows from all over the world, and a number who have gone on to other centres in Canada.  

Fifteen to 20 years ago, Dipchand travelled to other provinces to take care of patients — but now, “colleagues who’ve now gone on to work as staff cardiologists in those areas have been able to take over.” Those SickKids-trained fellows have created “a nice little network in Canada” that allows for collaboration, continued relationships and local support for patients.

Dipchand also points to the adoption of mechanical support (like Ventricular Assist Devices) to support patients waiting for transplants. “We didn’t have access to anything like that when I first started 30 years ago, but nowadays it’s completely standard of care. It’s absolutely revolutionized the ability to have patients be well and develop while they wait for a transplant,” she says.

Today, SickKids also offers transplants for patients whose bodies are more likely to react negatively to donor organs, known as “highly sensitized” transplants. Early success with this approach led to SickKids becoming the only Canadian Centre to participate in an international trial and the team has continued to offer these transplants.  

Other changes include an at-home milrinone program for patients who need to be on an IV and would otherwise be staying in hospital; innovations to tailor approaches to each patient and how they might respond to transplant; and a program to improve patients’ transitions from SickKids to adult centres. 

The biggest challenge in the field of paediatric heart transplant, Dipchand says, is a lack of donors. So she’s encouraged by potential opportunities to expand the availability of donor organs, such as a paediatric profusion device to allow a donor heart to maintain its viability so teams can travel farther with the heart to the hospital where the recipient will get surgery. 

As for what excites her? It’s not only future innovations — it's what is already happening at SickKids today. 

“The opportunity to offer transplantation always excites me,” Dipchand says.