Getting the Go-ahead
When a heart from a deceased donor is available, Lifecenter Northwest, the organ procurement organization in the Pacific Northwest region, will call your transplant nurse coordinator.
Both a nurse coordinator and a transplant surgeon are on call 24 hours a day. The coordinator will call the transplant surgeon to discuss the history and condition of the donor to determine if this donor organ would be best match for your child.
If the organ is a good match, the transplant nurse coordinator will contact you to see if your child is able to undergo the transplantation operation. The coordinator must make sure that your child does not have any new health problems that require delaying transplantation.
Current UNOS policy requires that the transplant center (Lifecenter Northwest) make a decision to accept or turn down the organ within ONE HOUR.
We will make every effort to contact you. We will first call your home number. Then we will page you. You must answer all pages that come, even if you do not recognize the number. The number may be the coordinator’s home or cell-phone number.
We must also have a list of contacts (e.g., family, friends, work, school, etc.) to call. We may call the local police to help find you.
When we contact you, the coordinator will discuss:
- If your child is well enough for surgery
- How you will get to the hospital
- How long it will take you to arrive
- When to have your child stop eating and drinking to prepare for surgery
- Where to park and check in at the hospital when you arrive
If we are unable to contact you within that hour, a very important opportunity for transplant will be missed. The heart will be offered to the next person on the list, and your child will remain on the waiting list.
Preparing for Surgery
At the hospital, your child will have blood tests and a chest X-ray to make sure her condition is stable enough for surgery.
We will start an intravenous (IV) line to give medicines and fluids. An IV is a small needle inserted into your child’s arm so that we can easily inject medicines and fluids into a vein.
The time of your child’s operation is planned to match the heart’s arrival at Children’s. The heart cannot live long outside a body, so the heart must be removed from the donor, transported to Children’s and then transplanted into your child within a few hours.
You may stay with your child until the anesthesiologist has put her to sleep. Then your child will be taken to the operating room.
At that time, you can check in at the Cardiac Intensive Care Unit (CICU) front desk. There, you will be given a pager, so that operating room staff can let you know how your child is doing during the surgery.
There are many places for you to wait at the hospital during your child’s surgery, including the hospital cafeteria, the chapel, the Family Resource Center and family waiting rooms in the CICU and near the operating room.
Heart Transplantation Surgery
Once your child is asleep under anesthesia, she will be put on cardiopulmonary bypass (heart-lung machine) in order to maintain circulation throughout the body while the damaged heart is removed and the new, healthy heart is connected.
For children with complex congenital heart disease, especially those who have had prior heart surgeries, the operation can be more involved.
The operating room staff will let you know how your child is doing during the surgery. They will contact you through the pager you picked up from the CICU.
After the Surgery
After surgery, your child will go to the CICU. You will be able to be with your child there.
Here are some of the things you may see attached to your child in the CICU:
Sticky patches or leads on your child’s chest that will be connected to a monitor that checks heart rate and respiration.
Breathing tube and ventilator
After your child is put to sleep in the operating room, a breathing tube will be placed in her airway to help her breathe. The ventilator pumps air into the breathing tube. We will remove the tube as soon as the doctors feel your child is OK to breathe on her own.
Several IV lines
Your child will initially have a central line in her neck with three “ports.” We will use one port to monitor the pressure in her blood vessels, one to give medicines and one to draw blood for lab work. Your child will also have an IV line in an artery in one arm to monitor overall blood pressure.
A catheter (flexible tube)
Used to drain urine from the bladder. It allows nurses to accurately measure urine output. It will remain in your child’s bladder for up to three days. While this catheter is in place, your child may feel the urge to urinate, a normal sensation.
A chest tube
Placed in your child’s chest cavity to drain out any fluid that may have accumulated during surgery. This will remain in place for a day or two, depending on how much drainage your child has.
A nasal cannula
Soft plastic tubing that fits under your child’s nose, for extra oxygen. Once the breathing tube is removed, your child will most likely require extra oxygen for a short period of time. Your child will most likely have the cannula on for at least 24 hours in order to maintain an adequate oxygen level.