Contributor: Syed Hussain, MD, Department of Thoracic & Cardiovascular Surgery
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The heart. Its beat is the music of life. Have you ever wondered how this amazing organ can be transplanted from one person to another?
So much depends on timing — and every step must be flawlessly executed by a highly skilled medical team.
The clock begins to tick
It all begins when a new heart is matched to a person with an urgent need. A member of our Cardiac Transplant Program gets a call. This happens through the United Network for Organ Sharing (UNOS) national organ list.
We jump into a van and drive if we can get to the heart within a one-hour drive. Our transplant team includes a cardiac surgeon, physician assistant, and a nurse. However, in all, more than 50 people are involved in a typical heart transplant.
If it’s further away, we take a jet plane. We go almost anywhere at any time — but we only have three hours in flight time back to Cleveland to safely perform a heart transplant.
How we recover a human heart
Depending on the number of organs being recovered, multiple transplant teams from all over the country arrive at the donor hospital at the same time.
We come together in the operating room to recover these organs.
Before a donor heart is even considered, doctors refer to a detailed medical history of the donor and review imaging tests. However, the final decision about the health of the heart requires a visual evaluation of the donor heart in the operating room. Until that time, is it not “a go.”
If cleared, we call back to the hospital and let them know that the “heart is good.” At that time, the team in Cleveland is able to make an incision on the recipient.
When it’s time to proceed with removing the donor heart, we stop its beat with a special solution called cardioplegia. It stops the heart and keeps it safe for up to four and one-half hours.
It might surprise you that packing a heart for safe travel happens in the same sort of plastic cooler you might find at Target®.
First, we place the heart in cold saline in a plastic bag. This bag is placed in a plastic ice-filled container, which is then packed inside the cooler with more ice.
Once secured, the heart generally travels by ambulance, with lights and siren, from the donor hospital to the airport. We board the plane, keeping the cooler with us in the airplane cabin.
While all this is going on, the patient who will receive a new heart is prepared for surgery. It is timed precisely so he or she can receive this precious gift the moment we arrive back in the operating room in Cleveland.
When our plane lands, a police officer meets us at the airport and rushes us to the operating room, where the recipient is already undergoing surgery.
In the operating room
Once the new heart arrives, the team knows they can safely remove the failing heart from the live patient. They wait to remove the damaged heart as a safety precaution.
Over the course of a four- to eight-hour surgery, the new heart is placed in the recipient’s chest.
People sometimes wonder if we have to warm a dormant cold heart. Actually, we don’t. When we take off the clamp, the blood starts flowing in the heart and warms the heart. Then, we may shock it with a defibrillator or use inotropic medications to help it get started.
As it begins to beat again, life is shared.