In a remote site, a young man was in a fatal car accident. Although his heart continued to beat, brain death was confirmed by standard maneuvers including an electroencephalogram showing absence of brain activity, an apnea test demonstrating the inability of the patient to breath on his own, and a neurologic exam which confirmed the absence of brain-stem reflexes. The patient was pronounced brain-dead; he had no chance of recovery. Representatives of the organ sharing network approached the next of kin to ask if they would allow the patient to become an organ donor. After receiving consent for organ donation, further tests were performed to confirm eligibility, such as blood tests for communicable diseases and other tests specific to each organ that is to be harvested, to make sure that it is healthy. Commonly harvested organs include the lungs, the heart, the kidneys, the liver and the pancreas. Serologic studies are performed to identify immunologically compatible recipients. In this case a child on the heart transplant waiting list at New York Presbyterian Hospital was identified and the procurement team was mobilized.
The transplant is a meticulously orchestrated event and is arranged by a team of transplant coordinators who are responsible for making sure that all the many pieces of the puzzle come together. The many different members of the team keep in close contact, with the goal of having the donor heart arrive in the operating room just after the recipient's heart has been explanted in order to minimize ischemic time (i.e. the amount of time the heart is in transport and not being perfused with blood). Different organs have different limits of ischemia; the heart can tolerate roughly six hours of preservation using current methods.
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