Dear Lit Loves,
Wow. I just completed reading an in-depth story of two children belonging to two loving families when one passes away via a car accident and the other has a failing heart and needs a transplant. The two children eventually match as donor and transplant recipient. Additionally, this book relays a thorough history of the field of cardiothoracic surgery and transplantation. You get a moving memoir and an education regarding the heart and its ability to be repaired, and transplanted!
Initially there is Keira who is about eight years old living in England in a rather large, close family. When Keira and her mother and brother are in a dire car accident, it is apparent to a doctor at the scene of the crash that Keira quite possibly will not make it through this incident alive. The doctor appearing on the scene implements Dr. James Styner's Advanced Trauma Life Support technique whereby there is a protocol for addressing trauma patients. The technique involves knowing what can kill a patient first which is the list you go by when assessing trauma patients: A is for Airway (is it blocked) B is for Breathing (is the chest rising and falling) C is for Circulation or (is the heart beating and pumping blood) D is for Disability (check for spinal fractures and immobilize body if necessary) and E is for Exposure (has the patient been exposed to prolonged periods of cold or heat). Keira is given life sustaining measures until she can reach a children's Pediatric Intensive Care Unit.
We all know it is the precarious nature of life that causes a parent to not be able to shield a child from all the bad possibilities in life. This is particularly true for Max, son of Paul and Emma Johnson, who around the age of eight begins losing weight, sustaining low energy levels, and having shortness of breath. His parents are informed he has Dilated Cardiomyopathy - his heart is enlarged and is being attacked by a virus. Eventually Max will require a drug known as Milrinone to increase the force of his heart muscle's pumping ability. Also, Max will need a Left Ventricle Assist Device to help his heart circulate blood throughout his body.
Some interesting historical details in the book included:
1) 5 Liters of blood are pumped through the body every minute.
2) The Glasgow Coma Scale is the assessment of the level of consciousness of a trauma patient and it is measured from 3 to 15. In this story Keira scores a three meaning no brain function. 15 meaning optimal brain function.
3) Heartbeats used to define the essence of life and over time physicians learned sustainable life requires brain function thus leading to the argument of whether to keep a patient on a ventilator or to opt for withdrawal of ventilation and potentially select organ donation.
4) Children spend two and a half times longer on a transplant waiting list than adults.
5) A heart transplant is considered palliative care and not a cure. Average life span of patient receiving a transplanted heart is 14 years.
6) VAD (ventricle assist devices) help improve the force behind the heart muscle and its ability to pump blood.
7) Heart-Lung machine was invented to take over function of the heart and lungs so a surgeon can make a repair to the heart.
8) The lungs function is gas exchange or removing carbon dioxide from the blood while replenishing red blood cells with fresh oxygen.
9) May 6th, 1953: Dr. John Gibbons performs first open heart surgery with cardiopulmonary bypass machine.
10) Brain death of a potential organ donor must be confirmed by two doctors replicating the result of each other's tests.
Eventually, we see Max agonizing in a PICU for months waiting on a potential heart transplant. Keira's family decides to allow her to live on through donating her organs: heart, lungs, liver, and kidneys. We see where for children the size of the transplanted organ is critical in terms of matching a donor with a recipient along with blood and tissue typing. Keira is eventually moved to a theatre (operating room) and there is a moment of honor where all assisting in removal of organs reflect on generosity and cost to family of the donor patient. Keira's heart is removed, placed in three sealed bags, and the heart is bathed in cardioplegia to not only stop the heart but to preserve it as well. Keira's heart is then placed on ice in a cooler and a "go" team transports her heart to PICU where Max lies unconscious in an operating room awaiting the new donor heart.
There is a 25% chance Max will not even survive the transplant surgery so his parents know upon seeing him enter the operating room, they may have seen their son for the last time. The heart is the first organ to form and usually at five weeks gestation. Once Max's new heart is in place he is given a bombardment of intravenous steroids to keep his cells and body from attacking the newly transplanted heart. Some heart transplant patients suffer Hyperacute Rejection whereby a donor recipient's cells attack the newly transplanted heart with a 70% mortality rate. The author does give a history of immunosuppressants, in particular, Cyclosporine which was found through a soil sample from Norway and considerably inhibits helper T cells from attacking the newly transplanted heart.
The Organ Donation Act becomes law in the UK on May 20th, 2020 whereby instead of opting "in" for organ donation, trauma patients are assumed to be organ donors automatically unless they expressly want to opt out of organ donation. In the first year after the new law, 296 patients in England donated organs which is about one-third of all total organ donations. Each day in England over 200 children need some type of organ transplant and 50 of those are generally in need of a heart transplant.
Overall, this is one of the best, most thorough transplant memoirs I have ever read. The unimaginable loss of a child from the donor family and the overwhelming anxiety of the transplant recipient's family are never underestimated. After organs are extracted, Keira's body is returned to her family. Max excels with his newly transplanted heart. Max's story is covered widely by the media via The Mirror. Both donor and donor recipient's family eventually connect and maintain close ties. Joe and Loanna Ball, (Keira's parents) set up a charity for organ donation and also the same organization supports families who lose children and opt for organ donation. Though this story did not take place in the United States it most definitely happens each year in the United States as well. I do believe in the United States a person must opt, upon receiving a driver's license, whether to be an organ donor. What a richly moving story and a compelling history of organ transplantation. My hat's off to you Dr. Rachel Clarke! Bravo!
Till my next review,
Grace (Amy)
