Once you get that call, everything changes.
There’s the day you’re having before you hear that your team has accepted a heart for your patient on the pediatric cardiac transplant list, and then there’s the day after.
Actually, it is more like the night after. Heart transplants almost always occur at night. Hospitals are not reimbursed for organ harvests, and as a result, these operations are placed at the end of an operating room’s elective schedule. When you add travel time for the donated heart to reach the Montefiore-Einstein Pediatric Heart Center, it’s often midnight before you start the recipient operation.
Before “the call” you might be out with your family, or at the movies with the kids, or maybe even sleeping. For me, it is hard to think about anything else but the transplant after the call. Even when I have a few hours before I need to get to the hospital, mentally I’m already there. I’m working over the details of the surgery, reviewing what our cardiologists think of the donor and the stability of the recipient. I will easily make 10 calls attempting to help coordinate the event. My wife has gotten used to it. She makes alternate plans for the evening, or for next day when I will, I hope, be catching up on rest.
Of course, this occurs not just for me, but for the dozens of people (cardiologists, nurses, anesthesiologists, surgeons, intensivists, perfusionists) on our transplant team, all working to help this one patient who happens to be the right match for the donor.
In pediatrics, the donor story is always horrible. The children most frequently succumb to trauma, terminal illness or even worse . . . child abuse. The juxtaposition of one child losing his or her life to violence from an adult and another child having more than 20 adults working to create life from that event always causes me to pause. The donor stories stay with me, unfortunately, and lately I have stopped asking our team how the child died. There was one that I cannot forget; a father ran over his own child by accident while pulling out of his driveway. My children still don’t understand why I yell out loud frantically before I back out of the garage if I hear them playing and cannot see them.
Coordination and timing of a heart transplant could become an Olympic event. It is so very difficult to organize two teams at two different hospitals with two different sets of objectives. The ischemic time for an organ (the time the organ exists without blood flow while traveling between patients) needs to be as short as possible.
Eventually, it comes together. The donor OR time is 6:45 p.m. The donor surgeon will have the heart out by 8:45 p.m. The anesthesiologists will bring our child into the OR at The Children’s Hospital at Montefiore at 10 p.m. We will begin surgery at midnight so that we are ready to implant the heart at 1:15 a.m. when the donor team arrives. The cardiologists will meet us in the OR at 4 a.m., and begin their lifelong relationship managing the patient – who has another chance at life.
Do you know someone who’s had an organ transplant? Tell us about it in the comments below.