SEPTEMBER 2019 | CHICAGO 85
After scrubbing in, Jeevanandam’s team began prepping for the first
leg of the marathon surgery that lay ahead. On one end of the room, a
nurse neatly laid out a row of scalpels and hemostats on a metal tray and
placed a chest spreader on a separate table. Meanwhile, the perfusionist
set to his assigned task: readying the heart-lung bypass machine that
would reroute Daru’s blood during the surgery.
Two floors below, in Daru’s ICU room, his family took turns saying a
few words while Daru, already connected to IVs for the procedure, signed
three sets of consent papers, one for each organ transplant. “Y’all gonna
have to stop crying,” he said through his own tears. “Or I’m gonna have
to put you out the room.”
While the family watched Daru being wheeled away, the three SUVs
carrying the two surgical teams — one for the heart and one for the liver
and kidney — sped across the city to retrieve the donor organs. The driv-
ers — the transportation contractor tends to use retired police officers and
firefighters — could use the sirens if necessary.
One reason for separate vehicles is expediency. A heart needs to
be implanted within six hours — ideally within four hours — of being
removed from a donor. So the heart team would return to UChicago
Medicine immediately, while the liver and kidney team stayed behind
to remove those organs.
Bucio ticked down her checklist of procurement tasks, including
making sure the UChicago Medicine blood bank had an adequate sup-
ply of B-positive blood. One of the primary functions of the liver is to
produce the coagulating substances that prevent excessive bleeding.
With Daru’s liver already on the verge of a complete shutdown, there
would be much blood lost.
To time the procedure as precisely as possible, Jeevanandam did not
open Daru’s chest until the UChicago Medicine surgeon who had trav-
eled to the other hospital began removing the donor’s
heart. Once that happened, Jeevanandam stepped onto
a black spongy mat in his track shoes — which he always
wears for comfort during long procedures — and made
his first cut at 3:07 p.m.
Inserting the rib spreader, a stainless steel retractor
used to lay bare the chest cavity, Jeevanandam began to
slowly c r a n k. Da r u w a s t hen hooked up to t he hea r t-lu n g
bypass machine, the major arteries to his heart clamped
shut, leaving Daru without a functioning heart for what
would be 102 minutes, and began the removal process. The donor organ,
packed in a Tupperware pickle jar, bathed in a preservation solution, and
chilled in a medical box similar to an Igloo cooler, arrived at 5:04 p.m.
Daru’s sarcoidosis presented a complication for Jeevanandam. A
healthy person’s tissue is like supple leather, which helps it fuse when
sewn together. Much of Daru’s tissue was more like cardboard, so
Jeevanandam had to be extra careful not to rip it while sewing in the
new heart.
That accomplished, Daru was ready to be taken off the bypass machine.
I n t r a nspla nt su r ger y, it is a lw ays a tense moment when t he aor t ic cla mp
is removed. To preserve a heart for transport, doctors fill it with a solu-
tion high in potassium. If all goes well, when the clamp is released, the
whoosh of blood into the heart restores normal levels of potassium and
other electrolytes, and the heart begins to beat.
That does not always happen, though. Sometimes, the heart will start
fibrillating and need a shock. Other times, it won’t beat at all and the
surgeon has to “tickle” it to life, as Jeevanandam puts it. That was the
case with Daru.
Using forceps, Jeevanandam gently massaged
the heart until, finally, a dot began to hop up
from the long flat green line on the screen across
the room. With that, Jeevanandam stepped back,
his gloved hands raised. His part was done. It
was 7:00 p.m.
A s h is a ssist a nt s spent t he nex t hou r or so a ffi x-
ing drainage tubes and packing the area around
the heart with gauze to absorb blood, Talia Baker,
the surgeon performing the liver transplant, and
her team were already setting up.PERFORMING A LIVER TRANSPLANT IS
a lot like plumbing. There are some 180 steps,
but basically the surgeon has to plug in the four
main pipes that allow a flow into and out of the
organ: the portal vein, through which the liver
gets three-quarters of its blood; the hepatic artery,
which feeds blood to the bile duct; the bile duct
itself, which moves that digestive aid from the
liver into the small intestine; and the vena cava,
where blood flows into the liver from the lower
body and out into the heart.
Baker faced an extra challenge with Daru. A
healthy liver has the spongy consistency of a jelly-
fish, which makes it pliable. A cirrhotic, or scarred,
l iver l i ke Da r u’s is fi r m, so ma n ipu lat ing it is more
difficult, raising the risk of damage to the organ.
Just as the transplant of a heart has its moment
of truth — whether the new organ
starts beating when the clamp is
removed — so does one of a liver.
A long absence of the oxygen and
nutrients that blood supplies can
make the new organ susceptible
to severe damage once the blood
flow is restored. That damage
can even cause the heart and
lungs to collapse, resulting in
instant death. It’s rare, occurring in only 1 percent
of liver transplants, but the possibility still gives
surgeons pause when unclamping the major ves-
sels. In Daru’s case, though, the new liver handled
the blood flow as it was supposed to.
At 11:46 p.m., the second portion of his trans-
plant was complete. All that was left: the kidney.EIGHT MINUTES LATER, AS BAKER’S
assistants were finishing up with Daru, Bucio
got a page that stunned her: A young woman in
another state had been declared brain-dead. She“Pulling this off can
feel like trying to
perform a high-wire
ballet in the middle of
running a marathon.”
(Continued on page 151)