Hearts shouldn’t travel more than four hours and are packed with care in an Igloo cooler to get to Ann & Robert H. Lurie Children’s Hospital of Chicago for use in a heart transplant. When they 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 Harris, physician assistant (PA) in 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.
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 No. 1 recipient on the match list and working their way down. Each center has one hour to decide whether to accept this organ or decline it and wait for a more appropriate offer. If the surgeons decide to accept it, plans are made to send a surgical team to the donor hospital for the organ recovery surgery.
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.
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 getting. 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 there to take us back to Lurie Children’s with lights and sirens to get us there quickly.
There is nothing sophisticated at all about travelling with an organ! We place the heart in a plastic container with cold fluid then wrap it in three bags filled with ice. Then the bags holding the container with the heart are all placed in an Igloo cooler filled with ice.
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 put the new heart into the patient.
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.
We almost never see the donor family, but you can always feel the heaviness of the emotion surrounding a procurement. There can often be delays bringing the donor to the operating room when family members have a difficult time saying goodbye to the deceased patient. 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 sends a letter with the deceased donor into the operating room to read before organ recovery. It sometimes includes a request to play the donor’s favorite song during the process.
I usually cry. It is difficult, if not impossible, to not let this process affect you.
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.
It makes me nervous, excited and honored to be part of this remarkable journey. It still seems weird to me that I can start my day getting out of bed 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.