The heart monitor in the third-floor hospital room sounds like a record skipping, its beep-beep-beeps filling the otherwise quiet intensive care unit. The brain-dead patient it is connected to has been suspended in time for hours, trapped in a loop that will only end once the transplant surgeons arrive.
Recently, a pair of physicians disconnected the patient’s ventilator to see if the brain would order the lungs to pull in air. It didn’t. They performed a test to see if blood was flowing to the brain. It wasn’t.
The incident that put this person here—patient privacy laws prevent revealing what happened, where it happened, or anything about whom it happened to—didn’t damage any of the other organs. With that ventilator, the heart beats as if the patient is oxygenating independently. The lungs fill with air then depress. The kidneys and the liver and the pancreas—those are still good, too. But the person everyone knows is gone; those tests confirmed it. And so the family decided to donate their loved one’s organs so someone else can live.
Samantha Rutledge and Anna Cervantes, coordinators with Southwest Transplant Alliance, were soon in a shaky, eight-passenger Cessna, on the way to help surgeons remove the organs. Southwest Transplant Alliance is one of 58 organ procurement organizations (or OPOs) in the United States. Think of these as middlemen in an organ transplant. They link the hospitals, charter flights for the surgeons, arrange transportation to and from the runways, and aid in the procurement. They’re the glue holding the whole thing together.
I deplane with Rutledge and Cervantes and climb into an ambulance headed to the hospital. I am following the heart, which will be transplanted into a patient at Baylor University Medical Center, back in Dallas, later in the evening. In just a few short years, Baylor’s heart transplant program has grown to be one of the busiest in the country. The volume dropped off last year, but the center still performed enough procedures to fall in the top five.
The ambulance pulls up to the hospital’s emergency room. Rutledge unbuckles herself and cranes her slim frame to open the back door. Cervantes reaches for a pair of royal-blue coolers near our feet. “Once you work with these,” she says, hoisting one onto the bench, “you’ll never buy Coleman ever again.” Part of her job is to get these iceboxes in the hospital, as well as the sterilized solution that will freeze from slush into ice and keep the organs preserved for the few hours that they’re outside a human body.
A car wreck occurred while we were in the air, and the victims were being treated in the operating room needed for the procedure. So we wait. The family lingers on their goodbyes in the ICU, a half-dozen men and women clutching each other and sobbing bedside. Down in the basement, the surgeons fill out paperwork and idly watch Monday Night Football. They swap stories, like the one about the Puerto Rican transplant surgeons who nearly came to blows in an operating room because of a disagreement about where on the patient’s body they would cut into.
Once the OR is prepped and the patient is wheeled in, the group shares in a moment of silence after a surgical assistant reads a brief paean:
To all those who are touched by what we do here today, let us not forget that it began with the gift of this one person. May this last act of charity be a testimony to his legacy.
Outside the frigid OR before the procedure began, I told Dr. Gary Schwartz, a thoracic surgeon at Baylor, that it’s surreal transitioning from a family in anguish to a group of surgeons who appear relaxed and focused.
“It’s like what I always tell medical students: don’t lose the tree from the forest,” he says. “At the end of the day, yeah, the patient’s brain-dead. But that heart is still beating. And we’re gonna stop that. You can’t take that lightly.”
One of the surgeons saws through the breastbone with an oscillating saw, emitting a foul odor into the room. Baylor procurement surgeon Raj Malyala cuts in near the patient’s trachea, allowing him to snip behind the aorta, avoiding the risk of nicking the tube that’s carrying blood to the rest of the body. Malyala grips the heart in his hand, twists it to the left and to the right and declares it healthy for transplant.
Two hours later, Malyala double-clamps the aorta, the blood flow stops, and the heart monitor, finally, hums a steady tone.
This story originally appeared in the March issue of D Magazine. To read the rest, head to this link and scroll to the second section.