‘Welcome to Your New Home:’ A Look at the Process of Transporting Hearts

Alexa Tannous, physician assistant in cardiovascular and thoracic surgery at Lurie Children's, forms a heart with Kaysen, who is now 10 years old, who had her second heart transplant at the hospital in April 2021. Alexa is among the team members who help transport hearts for surgical transplantation.

Hearts shouldn’t travel more than four hours and are packed with care in a specialized cooler to ensure the temperature stays regulated during transport to Ann & Robert H. Lurie Children’s Hospital of Chicago. When hearts arrive and are surgically placed into the chest of their young recipient, Lurie Children’s tradition is to say, ‘Welcome to your new home.’

Alexa Tannous, one of the physician assistants (PA) in the Heart Center’s cardiovascular and thoracic surgery, is often among the surgical team members who help procure hearts for heart transplants at Lurie Children’s. Below, she shares these details and more on the integral – and emotional – process of safely transporting these precious organs.

How do you get notified that a heart will be available for use in a pediatric heart patient who needs a transplant? 

The process begins when a donor is identified at a hospital anywhere in the country. Once the family decides to move forward with organ donation, the local organ procurement organization (OPO) in that state works to run a match list of patients on the United Network for Organ Sharing (UNOS) heart waitlist to this specific donor. This list is based on several factors including how sick the potential recipients are, the blood type, the size of the donor and how close geographically the recipients are to the donor. The OPO will then begin to notify transplant centers via phone call starting with the first recipient on the match list and working their way down. Each center has about an hour to decide whether to accept this organ or decline it to wait for a more appropriate offer. If the surgeons decide to accept the heart, plans are made to send a surgical team to the donor hospital for the organ recovery surgery.

How far away can a heart be for a viable pickup? Does it have to be in the region?

We typically will travel anywhere in the U.S. that is no further than four hours total travel time from Lurie Children’s. That is the longest amount of time we would want the donor heart to remain out of the body

Who goes to pick up the heart and how does it get to Lurie Children’s?

Our surgical team always flies or drives if close enough to go receive a donor heart. The people that go consist of any combination of surgeon, surgical fellow or physician assistant with our transplant coordinator. We take a medical emergency vehicle to the airport and then fly to where we are going. Once there, a vehicle or ambulance takes us to the donor hospital and then back to the airport once we are done procuring the heart. Once we arrive back in Chicago, our vehicle is waiting at the airport to take us back to Lurie Children’s Hospital with lights and sirens to get us there quickly.

Alexa Tannous, physician assistant, poses with Lurie Children’s heart surgeons (from left) Drs. Michael Mongé, David Winlaw and Osama Eltayeb.

How is the heart transported?

We place the heart in a plastic container with cold fluid to help preserve the heart function. That container is then placed in another container and then into a cooler specifically designed for transporting hearts to make sure the temperature stays just right, cold, but not too cold. It then travels back to Chicago with our surgical team.

What happens to the heart once it arrives at Lurie Children’s?  

When the heart arrives back to Lurie Children’s, the surgeons will verify that it is the correct match one last time and then will open it on a sterile table. Once the heart is fully inspected, it is quickly brought into the sterile field to start sewing into the recipient patient. We have a tradition at Lurie Children’s that we say, “Welcome to your new home” when we place the new heart into our patient.

What is necessary to determine a “match” between an available heart and a transplant recipient?

One of the biggest determinations of a match is that it is the same size. If a child is less than 1 year old, the donor and recipient blood type do not have to match. If the patient is greater than 1 year old, then the donor and recipient blood type will have to be a match. Other factors include how sick the potential recipients are and how close geographically the recipients are to the donor.

Heart transplants are bittersweet because while someone gains life, someone else has lost their life to make it possible. Do you or your team have any involvement in the emotional part of this?

We rarely meet the donor family, but you can always feel the heaviness of the emotion surrounding a procurement. There can often be delays in bringing the donor to the operating room when family members have a difficult time saying goodbye to their child. We always take a moment of silence before we start the process of procuring the heart, and I take that time to place my hand on the deceased patient’s chest as a silent ‘thank you’ to the family for what they are doing to give a Lurie Children’s patient a second chance at life. Often the donor family will send a letter into the operating room telling us about their child and what they meant to them. It sometimes includes a request to play the child’s favorite song during the process.

I usually get emotional, especially now that I have children of my own. It is difficult, if not impossible, to not let this experience affect you.

Do heart transplant recipient families ever meet with families of deceased donors? Do you or the team help arrange these meetings?

Donor families and recipients can reach out to each other at any time after transplant via transplant coordinators and organ procurement organizations where the donor was from. If the recipient family would like to initiate the process, we tell them to start with a letter, introducing themselves and explaining how the transplant has helped improve their lives -- and thanking the donor family. They can include photos or cards, too. If the donor family writes first, we call the recipient family to ask if they would like to receive the letter, but if they are not ready yet, that is perfectly fine and we can hold the letter until they are ready.

After exchanging a few letters and getting to know each other, we can help facilitate meeting if both parties agree. Some families connect right away, and some wait years until they are ready. It can be a very rewarding relationship for many families whenever it is right for them.

How does it feel to be part of this remarkable process? 

After 8 years it still makes me nervous and grateful to be a small part of this remarkable journey. I don’t think I will ever get used to the possibility that I can start my day getting out of bed in Chicago and, somewhere in between, travel across the country, and hold two different people’s hearts in my hands -- all in the span of 24 hours. I will never take that for granted.

Learn More About Our Heart Transplant Program 

 

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