Today I saw a pediatric heart transplant. It was the first organ transplant I had ever seen, probably since I avoid long cases into the OR whenever possible and only walked into the transplant by accident, thinking it was going to be another procedure. But it was really incredible.
I came into the OR about an hour into the case, delayed by teaching rounds with my attending, so I thought that the surgeon was still doing the VSD (ventricular septal defect) repair as was originally scheduled. The patient was a young kid, chest cracked open, and the surgeon and fellow were poking around, cutting here, tying there. The kid was on bypass, tubes of blood running out of the body and into the bypass machine, where it flowed in dark and ran out cherry red, re-oxygenated and heparinized. Seeing as how I thought they were just doing a defect repair, you can imagine that I was a little surprised when, minutes later, they snipped out one last vessel and pulled the whole heart out of the gaping well in the chest. The old heart was large, flabby, clearly dilated and myopathic. It lay soggily in a specimen basin until the circulator carried it out of my view, to be labeled and sent to Pathology.
The new heart was brought in without much fanfare in a Styrofoam cooler, floating in a large plastic bag filled with water, sitting on ice. It was tiny. It was a child's heart. As the surgeon took it out and rinsed it off, it sat there in his gloved hand, so pale and still, that I couldn't believe that it was actually viable. It looked like it should be floating in a jar on the shelf of a lab somewhere, not beating in someone's chest.
But when the necessary connections were made and it was warmed back up, the donor heart literally came back to life. In fact, it beat so incredibly fast and with such vigor at first that it looked as though it were going to burst out of the confines of the chest and leap out of the OR. Gradually it slowed down a little, and the blood pressure normalized. The surgeons took the patient off the bypass machine. They no longer needed it. There was a new, healthy heart inside that body.
Like I said, it really was incredible. But the new heart was so tiny. The donor really couldn't have been more than six or seven years old. And throughout the whole procedure, I kept thinking about the parents of that donor, whose own child had died less than 24 hours ago, and who were probably planning a funeral as this whole process was going on. Their child was dead, but her heart was still beating for someone else. I wish they could have seen how amazing it all was. I wish they could know about the other child that they saved.
I hope somebody thanked them.