Inside a Pediatric Heart Transplant

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.

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Samuel Weinstein, M.D.

Samuel Weinstein, M.D.

Samuel Weinstein, M.D. is associate professor of clinical cardiovascular and thoracic surgery, Department of Cardiovascular and Thoracic Surgery at Albert Einstein College of Medicine. He is also director, pediatric cardiothoracic surgery and director, adult congenital cardiac surgery at Montefiore Medical Center

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  • Christina June 7, 2012, 6:13 PM

    My son is currently waiting for a new heart. He is 6 years old and has been listed for 3 months. It’s interesting to read it from the medical professional point of view. We’re waiting for the call….

    Reply
  • Lisa Fields June 13, 2012, 10:30 AM

    Christina,

    I promise I’ll keep you and your family in the LIght as you wait for the call. I can’t image how hard this must be.

    Sincerely,

    Lisa Fields

    Reply
  • Kevin Strickler November 19, 2012, 2:15 AM

    Our son was born HLHS and we elected for 3 stage repair. After a 12 year battle with PLE, about a year ago we learned he was in heart failure. He went on the heart transplant list in early December 2011. Sixty-five days later, (February 2012) we received ‘the call’. His surgery began at 12:30 am and finished about 2 pm. He was hospitalized about 4 weeks. Now at 10 months post-transplant, we have had no rejection and continue to wean medications.

    Reply
  • The Doctor's Tablet Editors

    The Doctor's Tablet Editors November 19, 2012, 9:41 PM

    Kevin, thanks for sharing the story of your son’s “call” with all of us.

    Reply
  • Christy Cates January 10, 2013, 9:20 PM

    Thank you, Kevin for your story. It gives me so much hope for my daughter who also has HLHS and is in heart failure. She is not on the list yet, but I’ve been told it could be a year or two before she’s ready for a new heart. You are giving us hope though. Thank you so much. I hope and pray your son continues to do well.

    Reply
  • pedro j. rodriguez January 16, 2013, 1:40 PM

    hola, nosotros somos de cantabria españa, hemos visitado esta pagina y tan solo queriamos dar nuestro apoyo a todas esas familias que tienen a su hijo esperando un trasplante. nuestro hijo esta trasplantado de corazon en el año 2001 cuando tenia 13 meses de edad y ahora despues de 11 años sigue con una calidad de vida increible llegando a ser campeon del mundo en la world transplant games, solo esperamos que continue asi de bien durante muchos años.
    desde aqui os mandamos mucha fuerza y un fuerte abrazo para todos.

    Reply
  • Pamela May 11, 2013, 1:10 AM

    Hi!
    My husband received a donor heart on June 26, 2012. You are so right about the call. It’s surreal. As soon as we got the call, we quickly went from shock to excitement, to sadness in realizing what had to happen for that heart to be available to him.

    He is doing great, excited about hitting that one-year mark. We still pray, as do our family and friends, for the donor and family.

    Reply
  • Zipper club October 1, 2013, 10:33 PM

    My youngest of 4 received a heart at 6 months of age. He’s now a robust 3 year old!
    There isn’t a single day that I don’t sit in awe…of his tenacity and will to live, of the
    Technology and staff that sustained and ultimately fixed him, and of course our donor
    Family who returned him to us. Medical advances are amazing, but the compassion
    Of humanity blows my mind every single day…

    Reply

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