Giving a child a new heart,an emotionally draining task

Heart transplants almost always occur at night. Because hospitals are not reimbursed for organ harvests,operations to remove the donated organ are typically placed at the end of an operating rooms elective schedule,late in the day. The donated organ,which may be hundreds of miles away,must be brought to our medical centre. We usually dont get to start the implant of the donor heart till sometime after midnight.

Coordination and timing of a heart transplant could become an Olympic event,involving at least two teams at two hospitals a harvest team and a donor team each with a different set of objectives.

The donor story is always horrible. The children frequently succumb to trauma,terminal illness or,perhaps most tragic of all,child abuse. The donor stories stay with me,and lately I have stopped asking how the child died. I cannot forget the father who,backing out of his driveway,accidentally ran over his child. My children still dont understand why,whenever they are playing basketball in our driveway,I make them stop and line up where I can see them before I pull my car out.

The schedule for the transplant operation itself is made,adjusted,then readjusted. We all know that its only a guideline and that delays are the rule.

The heart is placed in a cooler. The donor surgeon takes it to the airport. He tells me that they are on their way and that the retrieval went fine. No issues, he says. I always reply the same way,though Im not sure why: Safe travels, and Bring me back a winner.

We need to have our patient completely ready to implant the heart as soon as it arrives. The family hugs the child on his way to surgery,with kisses and tears all around. The patient is partly sedated already and remains the calmest of everyone.

We will make the first incision just before midnight so that we are ready to implant the heart when the donor team arrives. They arrive five minutes later than expected,at 1 am. They join us just as we are removing the recipients heart.

Once the diseased heart is out,we can see that it is three times the size of the new heart. For technical reasons,this is good. The new heart will fit easily in the chest.

The implantation proceeds without incident. There are certainly more difficult procedures in congenital cardiac surgery to perform than a heart transplant,but few freighted with more anticipation. After all,the heart that we are asking to sustain our patient started off this morning in another child.

After the heart is sewn in and we allow it to be perfused with blood,it starts to beat. Within 30 minutes,it is beating strongly enough that the patient can come off the heart-lung machine. The boy is on his own.

Another cardiologist,an expert in echocardiography,has joined us and tells us that the new heart is working well. The patients cardiac function is the best it has been in over a year. We can begin to close.

The next conversation I have will be with the family. The sun is starting to come up,and it is a new day.