The Transplant

We cover heart and lung transplants on the cardiac anesthesia service, and I've seen one of each. It is amazing. The surgeons are called when an organ donor may have a viable heart or lungs. They go to procure the organ while I quickly meet the patient, who has often driven in from far away or waited patiently in the coronary care unit. The room is set up for a typical bypass case, and indeed, surprising as it may seem, a heart transplant is not as complicated as some of the other surgeries we do.

There is a simultaneous process where the organ is prepared as the patient is anesthetized and the chest opened. The patient is placed on bypass, the old heart stopped, the body receiving sustenance from the heart-lung machine. The new organ looks pristine. The heart is beautiful, a perfect anatomic specimen, its thin arteries and veins tracing outlines over the pearly surface. And in a process that can almost be simplified into disconnecting an old CPU from all its cables and reconnecting them to a new one, the heart is implanted. At first, it stretches, trying to feel its new surroundings, groggy and waking from its stunned silence. And then it begins to beat with vigor, and the body breathes a sigh of relief.

The lungs are similar, waking up with slow breaths, inflating with gentle pressure. There is a challenge to coaxing the lung back to work, prodding it without damaging it, giving it oxygen without toxicity (the oxygen can be damaging to the new organ). Ultimately, however, it is the course afterwards that is difficult, treading the fine line between acceptance and rejection of the new organ.

Image of a transplanted heart shown under Creative Commons Attribution Share-Alike License, from Wikipedia.