OK, we need to shock the heart.
OK, charge.
50 years after the UK's first heart transplant...
..a world-leading hospital, Newcastle's Freeman,
has opened its doors to reveal what this extraordinary surgery
is like today.
Still beating.
But they're in the middle of a crisis.
I'm really sorry.
It's not good news, Joseph.
There simply aren't enough hearts for those who need them.
She won't survive
unless she has a transplant.
My heart's broken and I just...
It's just really hard.
One in six don't survive the wait for a donor.
It is a lottery.
You just feel useless, really, sometimes.
SHE SOBS
Over the course of a year,
we follow seven patients on the waiting list...
I've got a ten-month-old little boy.
He doesn't quite understand what's going on.
..the surgeons with one chance to save them...
I think there's no other answer.
It's, "Yes, I will take it, I'll take the risk."
..and the ground-breaking technology
set to change everything.
It's THE most exciting area in the transplant community.
This is the story of Heart Transplant...
I'm ready for the heart now.
..and the challenge of turning death into life.
Thank you, people out there.
Thank you.
Every day, I've got that nervous feeling.
Say, if you were going to go skydiving.
I get that nervous sensation
just in case it comes.
Like, "Will it happen? Is it the day?"
It's April and there's 200 people on the waiting list for a new heart.
Of all donor organs, these are the hardest to come by.
Not only does blood group and tissue type need to match,
nearly 80% of the hearts donated are too diseased to use.
Newcastle's Freeman Hospital take on some of the most complex cases.
Richard was born with a back-to-front heart.
Years of strain have damaged it.
Now 38, he'll die without a new one.
It's obviously a waiting game. It could be very lucky
and I could find one within a day
or it could be up to a year.
It could be two years.
They will not put the heart into me unless it fits me perfectly.
You do think about the future
and what's going to happen because it's the unknown, isn't it?
It's the unknown.
Claire was born with half a heart.
She's had numerous operations to improve its function.
But after 34 years,
it's now wearing out.
It's frustrating because I'm such an independent person.
Obviously spending weeks on one single ward
can be quite disheartening.
I'm ready for... I'm ready to fight now
so I hope it's soon.
The teacher dives out the way. HE GIGGLES
Max was healthy until his ninth birthday
when he contracted a virus that attacked his heart
causing it to enlarge and begin to fail.
INTERVIEWER: How long can you wait for a new heart?
How much longer?
Well, I hope it's going to be around two weeks...
..but I'm just going to keep on waiting until it comes.
The problem is, before you can get a heart transplant,
someone else has to die.
Donor hearts can come from hundreds of miles away.
Following a head trauma,
a young man has just died
at an intensive care unit.
A specialist nurse in organ donation,
one of 260 in the country,
has been called in.
Previously fit and well.
He sustained injury really incompatible with survival.
He's been GCS 3
with fixed dilated pupils since the outset.
He's had formal brain death testing
just now, which confirms that he has died.
We've all met the family,
so I said that we'd like to give them some information
about something they're not expecting
and that we would ask their permission to be a donor.
And if at any point, I can see that the family need a break,
I'll stop it there and just see... Yeah.
..do they need a break, and give them a little bit of time
to adjust to the situation and then go back in.
They're both, as you can imagine, absolutely devastated
But dad is particularly struggling with the situation.
He is, yeah, absolutely. Really, really struggling.
I'll wait here for you.
The man wasn't registered for organ donation
so the family will have to make a decision on his behalf.
We don't try and coerce anyone
but I would rather these organs went to help save someone's life
rather than they were buried or burnt.
It's an animal response to protect the body
of someone we love after they've died
and overcoming that is incredibly difficult.
We have a belief, though,
that many people say no and regret it
and the evidence is strong that
about three or four times as many people regret saying no
as they do saying yes.
Unless it's been discussed,
relatives don't always know what their loved ones would have wanted.
INTERVIEWER: What did the family say?
Er, so, the family said no to organ donation on this occasion.
They understood the situation and...
..felt that it just wasn't the right thing for them
and, you know, we respect that.
You know, it's not something they'd ever talked about
and so that's the decision they've come to.
Fewer families agree to donate organs in the UK
than almost anywhere in the world.
In some ways, he typifies the perfect donor.
Good heart, lungs, kidney, liver, small bowel, pancreas.
You know, he was looking at eight people, potentially.
Eight people whose...
..lives could have been saved or transformed in the next 24 hours
who are going to continue to wait.
On average, it takes more than 1,200 days to find a healthy donor heart.
Do it carefully.
No, she...
We've been here nearly five months.
I think the wait has probably been a bit of a surprise for everyone
but you just don't know with these things, do you?
You know, it'll come when it comes.
Yeah, obviously something tragic has got to happen to another family...
..for Max to have a chance...
..of a good quality of life.
INTERVIEWER: What worries you most, Harry?
Erm... I'm getting my walls painted.
I don't really want to say it in front of Max.
Yeah, you have to, though.
Go on. Whisper in the microphone.
Er, I don't want...
Max doesn't...
Block your ears, Max.
I can't say it if Max is listening.
I'm fine. Look.
Harry, you've got to say it.
I can't.
I don't want Max to hear.
If he hears, then...
Have you got the rings?
Brilliant. Right, I'll ask you for them, all right? OK?
This mutual friend introduced us.
At the time, Claire was with somebody,
but what did you say?
I'll be with you one day.
In the ward next door, Claire's been told her heart
may not hold out much longer.
So she's decided to get married to her partner of eight years, Kelly.
She can read me like a book.
But then again, I'm the same with you. Yeah.
Soul mates. Soul mates, yeah.
I call upon these persons here present
to witness that I, Claire...
Do take thee, Kelly Louise Taylor, to be my lawful wedded wife.
I wanted us to have that happy time
and I wanted to have it in hospital so we had a positive memory
of hospital instead of all the negatives. Yeah.
When life is easy... When life is easy...
..and when it is hard... And when it is hard...
..I'll be faithful to you... ..I'll be faithful to you...
..for always and eternity. ..for always and eternity.
CHEERING AND APPLAUSE
I'm not going to stop fighting now.
There's nothing going to get in my way.
Nothing.
She's a warrior.
One, two, three!
CHEERING
Hello. I'm just ringing to let you know that we've accepted the heart.
I don't know if you've already heard.
I'm just going to get it now
and slowly make our way round to the anaesthetic room.
Hello. I have some news.
We're going to take you to theatre.
All right?
Oh, God, it's happening.
It's happening. It's happening. It's happening.
Oh, it's cold on this level.
A healthy donor heart has just been found for Claire.
I'm thinking about if I'll come out of it.
All the statistics are rattling through my head.
I'm literally being cut open,
like, chest exposed and everything.
It's just scary.
I wouldn't wish it on anyone.
Upstairs in theatre, the on-call transplant team
prepare for Claire's arrival.
Her operation could take 12 hours.
One, two, three, four, five.
She's ready and raring.
I'm going to make you exercise this morning.
INDISTINCT
My mum noticed that there was something wrong with me
when I was quite young.
Like, I'd get blue lips and I wouldn't be taking my bottles,
and then there was a particular night where...
..my heart was beating out my chest
and she took me to the doctor's
and the doctor said, "That's not normal,"
and they fought to save me and I lasted...
Well, I've lasted 34 years so far, so they did something right.
Will you be really nice to me
and not put it where there's a bone, please?
That one's a good one where they've been taking blood from.
I'll be able to run around and play with my nieces and nephews.
I've never been able to do that before.
Go swimming. Go running up a hill.
Just having a happy life.
This is good stuff. Is it?
It's going to make you feel much more relaxed.
I've planned my own funeral, though.
I've got everything down in black and white
just in case the worst happens
so people know what I want
and...stuff like that,
which was quite heartbreaking at the time,
but you've got to be practical.
There, that's you going off to sleep.
Think nice thoughts now, OK, Claire?
For patients born with half a heart,
the odds of surviving this operation
are particularly bleak.
In Claire's case, the mortality
is about 30%,
which means every third patient dies.
So, if I tell you that you have a one in three chance
that you do not...
..make it, will you take that chance or not?
Otherwise, you've got a few months, maybe,
but you'll be bedridden and in poor condition.
Would you take this or not?
I think there's...
..no other answer.
It's, "Yes, I will take it, I'll take the risk."
And the same, I, as a surgeon, will take the risk.
Mohamed needs to work out how best to open Claire's ribcage.
Imagine doing a surgery on a patient
who had two, three, four or five surgeries before.
If you imagine the scar that is in front of the chest,
there is also a scar inside the chest.
The heart is effectively two pumps.
The right side sends blood through the pulmonary artery,
around the lungs, to be oxygenated
and the left then sends this, via the aorta,
to the rest of the body.
In Claire's case, the left side didn't develop
so, when she was born,
surgeons had to re-plumb to make the right side do both jobs.
But this surgery created scar tissue
which has now fused her heart to the back of her sternum,
the very bone they now need to cut through.
So, we look into the proximity of the heart to the bone
to give us an idea of how difficult it will be to get inside the chest.
See here, this is the right atrium and this is the bone,
and you can see how proximal it is to the bone.
So going through the bone with the saw,
we have to make sure that we do not hit the heart.
So, we try to lift...
..the bone and try to work under these
to free the heart from the bone first
before we cut through it.
Asif Hasan is the country's leading
congenital heart transplant surgeon.
Mohamed. Yeah. We won't be able to look at it. It's too far out.
He's come in to help Mohamed.
We have taken on more and more difficult patients
because, if you jump over a bar,
people start sending you patients who are a bit more difficult.
So, we're constantly trying to jump higher and higher.
This will be his 400th transplant.
Transplantation, for Claire, is perhaps one of the most challenging
and complex transplantations
you can undertake at this point in time.
Surgeons, by and large, are optimistic.
That's why we are in this game.
But everything depends on luck.
In life, you have to be lucky.
This is the first time Asif has let anyone film this operation.
Give me a knife, a retractor.
Everyone happy to start?
My light, please. Thanks.
Yeah, go.
Their first job is to make an incision
through the fat and muscle of the chest with an electric diathermy...
..which cauterises bleeds as it cuts.
What is the diathermy on?
Diathermy's on 50.
50. That's fine. OK.
This exposes the sternum,
the bone that holds the ribcage together.
The main objective here
is to open the chest without...
..producing any catastrophic bleeding.
Mohamed will cut through this in stages.
First, using the diathermy,
he edges along the underside of the bone, inch by inch,
to free the heart.
That's good. That's nice.
VOICEOVER: Over the years, we have learned from lots of mistakes
and what we try to do is
do it very slowly and very cautiously,
taking time,
try separating the heart from the sternum.
Suck the smoke there without getting in Mohamed's way.
May I use scissors?
Here.
Right, OK.
You cannot really see anything.
And you have to take it slowly and carefully...
..and use your experience and your knowledge of anatomy
to know where to cut.
New scissors.
Mohamed works his way up the sternum.
If you cut into the heart,
you get bleeding everywhere,
quickly the blood pressure drops,
and then you might lose the patient.
They've now reached the thickest part of the bone
and there's only one tool capable of cutting through the rest.
Give me the saw. Yeah.
The sternal saw
which requires absolute precision.
SAW WHIRS
Right, OK.
We have achieved the main objective here,
to open the chest without producing any catastrophic bleeding.
For the first time, everyone gets a clear look at Claire's heart.
A pump which could stop at any time.
Heart failure can affect anyone
and sometimes without warning.
Joe is 56.
A few years ago, he caught a viral lung infection
which then spread to his heart.
Inside, yeah, I'm very confused and very...
..desperate for a solution
and a way to get back to normal health.
I've always been quite a healthy, fit person.
Never smoked.
I'm not that old, I'm only mid-50s.
I've still got two kids
who, hopefully, will have children of their own.
I want to see grandchildren. I want to...
I think I've still got quite a few years in me yet to enjoy.
Joie's 54.
He's got an autoimmune disease
which is attacking his heart.
It's heart failure.
Only 25% is working.
I'm short of breath, can't walk, can't sleep, can't eat...
..getting dizziness, no life...
INDISTINCT
Saraya is eight months old.
Doctors don't know why her heart is failing.
She won't survive unless she has a transplant.
That's the only thing that can help her right now.
My heart's broken and I just...
It's just really hard.
It's really, really hard but I have to stay strong for Saraya.
A kid's got to lose their life
for my daughter to get a chance in life
and just the thought of that alone is quite horrible.
But...
But she's my little girl and, at the same time, I want the best for her.
Of the 200 people in the UK waiting for a heart transplant,
80 are listed here.
But some wait longer than others.
There's two different ways of listing a patient for transplant.
So, there's an urgent list and a routine.
So, the urgent list's the sickest patients in the country.
Organs get offered to them first.
The routinely-listed patients are sick enough to warrant
needing a transplant but they're well enough to go home and wait.
But they do wait a lot longer.
David has a back-to-front heart
but isn't yet sick enough to be listed as urgent.
I've got a ten-month-old little boy.
He doesn't quite understand what's going on.
I'm trying to keep things as normal as possible for him.
The call might not come for months,
it might not even come for years,
and then the reality kicks in
that this is really difficult
and nobody has the answer to this.
It's really a lucky draw, it's a lottery,
and it's in the lap of the gods, really,
whether they're going to get transplanted or not.
Are you on oxygen at the minute?
How many litres are you on?
Right, right.
Kirstie runs a team of transplant coordinators.
Every day, they search the country for potential donor organs.
The weight and height is 177
and 80kg, and he is a male.
To find them, they have live access to a database of donors
who have just died.
I can see every donor in the country.
The youngest that I can see on there at the moment is 25
and the oldest today is 76 -
and they're in the north, the east, the west, the south.
You know, it can save lives all over the country.
When a donor heart is added to the system,
the coordinators try and match it against their own waiting list.
When you get an offer,
you're looking at the blood group first of all
and then the size of the donor.
So, we look at our list and you work your way
through all of these different aspects.
To be honest, it's a matter of luck.
You could be transplanted within hours.
It could be months and months, and months.
One size doesn't fit all.
One blood group doesn't fit all.
So, it goes to the person it suits,
not the person at the top of the list.
A new donor heart has just appeared on the system.
It's a match to Joe
but the heart also matches another patient
in a different transplant centre.
This is the worst bit - the waiting.
Within different centres,
of course there's competition.
There always will be.
You really want to do the best
for your patients on your list.
But we also have to recognise that this is a national project, really.
Hi, it's Kirstie.
So, what's happening?
Oh.
Right.
Papworth are taking it, are they?
They are - definitely, definitely?
Right. Oh, I'll stand our heart people down, then.
Thank you, bye-bye.
SHE SIGHS
Despite the match being the same,
the other patient was considered more critical than Joe.
He's been waiting in hospital for months, literally, on a ward.
He's not allowed to leave the hospital, so he's very restricted.
He's becoming really down,
and there's just no light at the end of the tunnel.
We don't know when that next call's coming,
but we keep encouraging him.
Oh, I'll go and let him know.
It's the fifth time Joe's been this close.
I'm really sorry.
It's not good news, Joseph.
Right. Um, the other centre who was ahead of us,
has accepted it for their patient.
Right. So that means you won't get your transplant today.
Right, OK. I'm really sorry.
Disappointing. Very disappointing for you.
You're just so near.
Yeah. There was just one person ahead of you.
You try and not get your hopes up too much
when something happens,
but you do...
..so...
Tomorrow's another day.
You keep your chin up.
I will. All right. Thank you.
Cheers. I'm sorry. It's all right.
It is a waiting game, it is a lottery.
Um, and, yeah, you just feel useless, really, sometimes.
SHE SOBS
Claire's surgeons have removed her old heart...
..a process that's taken two-and-a-half hours.
They're now ready to sew in the new one.
OK, go.
To do this, they're keeping Claire alive
with a heart and lung bypass machine.
This connects, via pipes, to the main vessels
which transport blood around her body.
Her entire circulation is now going through the machine
instead of through her heart.
So, we have a pump here...
..which is taking over the function of the heart,
and we've got what's called an oxygenator
in the circuit to oxygenate the blood.
Blood cells change colour when oxygen binds to them.
They turn from blue to pink.
You can actually see the difference...
..quite clearly, so you can see the blue blood
that comes out of the body,
and we can see the pink blood going back into the body.
Steroids.
This is a heart from somebody else, from a foreign body.
And as soon as you have somebody else's heart,
it tries to reject it, it tries to push it out.
And to stop that response,
you have to give a massive dose of steroids.
This drug will completely shut down Claire's immune system,
so it can't attack the new heart.
It's like a hydrogen bomb, sort of, it kills all.
With the heart almost connected,
Asif allows some oxygenated blood
to flow into it from the bypass machine...
..giving the cells vital nutrition.
When the heart starts to warm up, the electrolytes become more active.
The myofibrils, inside the muscle strands, start to interdigitate.
The electrical impulses in the heart start to move around,
and make the magic happen.
It's nice.
Though it's beating, the heart isn't actually pumping Claire's blood.
That's still being done mechanically.
It's like running the car in neutral, you know,
sort of letting it just recover a bit, yeah.
You can only relax once you're
completely off the heart-lung machine
and the heart takes over the load,
because that's where the proof of the pump is.
Is it able to pump the blood around?
All right, then, I think we can try coming off.
OK, we're coming off.
Very slowly, now.
Yes.
Three-quarters.
Half. You watch these veins, yeah.
OK, off now.
So, we are off the bypass now, and the heart is on its own.
The heart function looks very good.
Not just OK.
We need to be satisfied that this is a sustainable situation.
It looks like it, but I never take my eye off
first ten, 15 minutes.
It's completely unpredictable.
Before they can close her chest,
they need to stop all the bleeding caused by the surgery.
Let me know when you're giving protamine, yeah.
So, with the bypass machine,
you have to make sure that the blood doesn't clot.
So you give anti-coagulation, you give heparin.
But when you come off the bypass
and the surgeons want to close the wound,
obviously, you can't have any bleeding at all,
so you give a medication called protamine...
Protamine's going in.
..and it neutralises the heparin.
With Claire's blood getting thicker,
the bleeding should come to a stop.
Can you keep an eye on the pressure?
58.
That's not good.
Lift up, please, don't let it drop.
But something is wrong with Claire's new heart.
I want pressure of 80 and not go down below.
INDISTINCT
I know, chief, I can see it here.
There's nothing you can tell me which I don't know here.
All right.
Claire's blood pressure is plummeting
because her lungs are restricting the flow of oxygenated blood
back to her heart.
Cannula, please, thanks.
The right side of the heart,
the one that supplies the lungs,
is very vulnerable.
So, if you give the protamine and it causes a reaction in the lungs,
then you may face a right ventricle failure.
The heart has now stopped working.
Without blood coming back from the lungs,
it has nothing to pump to the body.
We'll have to go back on bypass. Quickly.
OK, pass string to me, please, thanks.
Cut that, please, thanks.
OK, give heparin, please, thanks.
Cannula, please, thanks.
Scissors to me, please, thanks.
Scissors to me. Forceps to me, please, thanks.
OK, snag it down, please, thanks.
OK, snag it down.
Go back on bypass, release the clamp, please, thanks.
Go on bypass!
Go on, quickly.
The blood pressure's too high.
Yes, well, we need to do it immediately.
Asif decides to leave Claire for a few hours
in the hope her lungs improve,
allowing her heart to work again.
This new organ is her only chance of survival.
Sometimes, you feel you're helpless,
you just squeeze your brains thinking of an answer,
"What can I do more to help this heart get better?"
But, at the end...
Ah. Well, there are limits to what we can do,
we are not magicians.
Several hours later, Claire's condition is unchanged.
She's being taken to intensive care
on a portable form of bypass called Ecmo.
Hiya.
Morning.
The operation went well...
..and then we nearly lost her.
You know, she's got to try and keep fighting.
I wish I was there, not her.
I wish it was me.
She's my soul mate.
The surgeons will keep Claire alive like this for as long as possible
until they come up with a plan.
She'll not let the heart go to waste.
She'll fight with everything that she's got.
It's not in her nature.
On the heart ward, the coordinators continue to search for donors.
The longer the wait, the harder it becomes for the patients.
Some days, I feel sick.
Some days, I feel like, "I want to go for a run!"
But I can't...
..because of my stupid heart.
It's the kids that I worry about more than myself.
It's family, friends.
I can't have a happy life.
Loneliness.
INTERVIEWER: You feel lonely?
Yeah.
Our patients are very, very sick
and we want to obviously give them the best chance.
We have a good psychologist here,
we've got great social workers here.
And that's our job
is to keep them going so they don't give up.
Baby Saraya has started to deteriorate.
Surgeons have had to fit a Berlin Heart,
a device that pumps blood on her behalf.
But it comes with a risk of stroke.
She's just been started on heparin and she's also on warfarin as well.
We're just looking for any deposits,
so, like, little clots or anything like that.
It's just very important to look every hour
because, obviously, it could go back into her system.
We check hourly, 24/7.
Richard is also in trouble.
His back-to-front heart is now so weak,
his other organs are starting to fail -
so the surgeons are having to intervene.
Start the pump now.
They are going to try and implant a new internal pump,
called a ventricular assist device, or Vad.
The ventricular assist devices were based on milking machines.
These were cows' milk being sucked.
That gave the idea to develop these machines.
The Vad sucks blood directly out of the heart
and pushes it through a pipe which is sewn into the aorta.
This will take pressure off the organ
and keep blood pumping around his body.
His right ventricle has failed
and what we are trying to do is to bring him to transplantation
and this device we are going to put in today,
he will be, I think, our 13th or 14th patient on which we have done.
But it's a risky procedure.
The pump has to be implanted into the wall of the heart.
So, the first step is to sew the ring onto the surface of the heart
and it contains a mechanism to lock
the ventricular assist device in place.
The second step is then to make a hole into the ventricle.
Push it through. That's it. OK, that's fine.
A boring tool is used to cut a hole through the heart wall.
The device, please.
That hole is large enough to accommodate the device...
..and the device is placed into the ventricle through the sewing ring...
..and then it's locked into place.
It's like a flat pack Ikea.
The machine just goes through the sewing ring
and then you screw it tight.
We actually screw it in.
That's fine.
The pump then connects through the skin to an external power pack.
Essentially, Richard will be running off the mains.
The ventricular assist device is working beautifully.
With this pump, Richard's other organs
should start to recover,
buying him time to wait for a donor.
Hi, it's Alison.
Yeah, we're definitely going to use it.
We're just moving him to theatre now.
Max, can I ask you a question?
Yes. How do you feel about the family at the other end
who have donated the heart?
I feel sad for them and thankful...
..for them. Very thankful.
Thank you, people out there.
Thank you.
A child has just passed away
and the heart is a perfect match to Max.
Right, we'll see you soon.
His family have been waiting for this moment for 196 days.
Max came to us and he was...
He was a sick boy.
He was a very sick boy.
Max was in imminent danger of death.
He had a dilated cardiomyopathy,
a viral infection, which had damaged his heart.
We thought his heart would stop at any time.
Max only survived this long
because the surgeons fitted him with a Vad,
just like they did with Richard.
But this now presents them with a challenge -
removing a heart with a pump attached.
MAX SHOUTS
Say that a bit louder, please, I can't quite hear you.
MAX SHOUTS
That's better. Now I can hear you.
What will you do with your new heart?
Annoy my brother.
Erm...
Prank my granny and grandpa.
I'm going to have to say bye soon.
We will see you...
I love you, Mum. We love you too. We love you too.
We love you so much.
Give him a kiss, Daddy.
All right. It's OK. Don't be scared. Just relax.
Asif and Fabrizio have opened Max's chest
and immediately hit a problem.
The heart is just completely stuck everywhere
and there is no anatomical demarcation.
We can't see anything.
Since the operation to implant the pump,
Max's body has created a thick layer of scar tissue as it's healed.
It's like a cement.
Basically, you're trying to peel off the cement
and trying to get in to see the heart underneath
without damaging the structure of the heart or the device itself.
That's the challenge.
This is the driveline...
..of the Vad. It's completely embedded into the tissue.
It's the power cable, basically,
and is the only part of the device that is externalised to the body,
from a separate wound that I'm pointing out now,
and is the one that is connected to the console.
Max's Vad is still plugged in and keeping him alive,
so Fabrizio cuts very cautiously.
There's a bit of touch and feel, you know.
You can feel pressure or something pulsing, something not.
That's nice. That's good.
Are we making good progress?
Can we ask Alison to...
..call the retrieval team and cross clamp the heart, please?
Fabrizio has just given the instruction to take the donor heart.
Hundreds of miles away in another hospital,
a retrieval team will now begin to remove Max's new heart
from the donor.
This instruction has been left until the last minute
because, once you remove an organ from a body,
it begins to deteriorate.
We are meticulous about timing,
we take it out of the donor at the last possible minute.
We bring it by aircraft or by ambulance with a blue light.
We go to enormous lengths to manipulate the time,
so that everything is ready
the moment that heart comes into the operating theatre.
Thanks, bye. Cross clamp on, 18:10.
When we say cross clamp can go on,
that's when circulation's stopped in the donor.
From then, that's when the clock starts ticking down.
As soon as it's removed from the donor,
Max's new heart will be packed and flown across the country.
But this means the pressure's on for Asif and Fabrizio,
to get the old heart out so they are ready for the new one
the moment it arrives.
Vad on 50, please, now just temporarily.
Forceps for me, heavy one, please.
Now they can see where the pump is,
they can start to look for the major blood vessels
that attach the heart to the body.
These will all need to be identified
and severed in order for the heart to be removed.
But they, too, are buried in the mass of scar tissue.
Asif and Fabrizio are now working blind.
Essentially, what we're trying to do is find areas of the heart
we can recognise without damaging the heart.
It's archaeology, digging.
Your senses are heightened
and all your senses get tuned in.
The sense you don't want to use is your hearing
because, if you get audible bleeding,
then you are really in trouble.
The structures are becoming a little bit clearer now.
It's like, you know, the morning mist is slowly lifting
and you can just start to see.
We're just seeing the aorta now,
just, basically, at this point in time.
Just go around the aorta, if you can.
Around there.
Uh-oh!
Give me forceps.
Give me a swab, please.
Asif has torn the pulmonary artery.
Give me a swab. This sits right next to the aorta.
If they don't stem the flow quickly enough, Max will bleed to death.
When real crisis occurs, everything goes...silent.
Everything becomes slow motion.
Give me the suture now.
Asif fights to stop the flow of blood with his finger
whilst trying to get a stitch in with his other hand.
Time can be of the essence...
..and can make a difference to life and death.
Come on, come on, come on.
The worst possible emotion would be, you know,
thinking that what you are doing is not going to work.
He gets one stitch through
and goes in to try and get another.
With two threads in place,
they run a tiny square patch of material
down to the surface of the artery
to try and block the hole.
OK.
I made a hole in the pulmonary artery,
which we've just controlled.
That's where the structures are
so adherent to each other, it's like cement.
Of course, the brickwork doesn't bleed or anything like that,
it's just the damn thing bleeds quite a bit
and then you lose control.
Hazard of the job.
The bleed has stopped,
yet they've still got to find all the vessels
before they can remove Max's old heart.
And the new one is now on its way to Newcastle.
While the surgeons are working on Max,
the retrieval team are transporting his donor heart across the country
as fast as they can.
So, all organs need oxygen
and oxygen's usually delivered through blood.
When you lift an organ out of the body,
it's no longer got that lovely environment
and the organ starts to deteriorate.
The organ doesn't last forever,
so we only have a certain amount of time...
..to get the heart from A to B once it's out the body.
Because the longer that it is out of the body, the less usable it is.
This process of decay is called ischaemia.
To combat it, they've transported Max's new heart in a box of ice.
It's been done this way since transplant was first pioneered.
Hi. I'll take it up, you're all right.
OK.
But this doesn't stop the dying process,
it only slows it down,
so they need to implant the heart right away.
Just concentrate on one place, please, no moving around.
Go, go, go.
INDISTINCT
That's it.
Asif and Fabrizio have managed to get Max on bypass
but they're struggling to cut his old heart free.
Put the sucker inside, please, be proactive now.
You need to concentrate on what you are doing,
you need to maintain your focus,
you need to maintain your concentration.
Break loose from the heart.
Divide all that. Divide all that cleanly.
Just go one point through. Just straight through.
Divide it cleanly, please.
Ooh.
Just go.
All right. The heart's here.
We're not ready for the heart yet.
Go. Now. That's fine.
With every minute that passes,
the risk of damage to Max's new heart increases.
From front to back, just go from here, please, that's it.
Yeah. Keep on going.
Cells start suffering and, when they suffer,
the function of the heart goes down.
So, it's like taking a failing heart
and putting another failing heart in.
Cut onto the metal. Cut on the metal. Keep on going.
Just be careful that you don't hit the lung.
When you come to this stage, you need to have
the instincts of a cage fighter.
Cut on the metal here. Yeah, that's it.
Keep on cutting on the metal.
It's like a battle.
Yeah. Keep on cutting on the metal.
Then, after a half-hour battle,
Max's nine-year-old heart is freed from his body.
Yes. Come nearer. The heart is going to come out now.
Along with the pump that's been keeping him alive.
So, this is it.
You can see, from the inside here,
this is the heart and this is the device.
And we have taken it out all in one.
Throw it in the bin.
Max's survival now depends entirely on the new heart working.
And at this stage, it's still unclear
what effect the delay has had on the organ.
Can you grab a hold of that? Yes.
OK, just hold on a second.
Forceps to me, please.
They now need to connect the cold donor heart
to Max's warm blood supply
as fast as they can.
Go straight through.
When the heart was cut from the donor,
the surgeons left extra vessel
so Asif can now trim it
to make the perfect fit.
Just cut through, please. Thanks. Go, go, go.
That's it. Good job they didn't tie that.
There'll plenty of room today.
Just drop it all inside.
OK, suture, please.
OK. We are sewing the new heart in,
starting from the deepest part of the heart, coming superficially.
So, sewing first what is called the left atrium,
the receiving part on the left side.
Don't worry about the names, it's just that these are the veins
and the arteries from the body which are coming into the heart.
It takes 40 minutes for the surgeons to plumb all the vessels together,
making sure each connection is watertight.
A leak could be life-threatening.
Max's new heart can now be given a dose of oxygenated blood
from the bypass machine, which is still keeping him alive.
OK, from now, please.
OK.
Thank you. We are just...
..giving the heart a drink and...
..we think it helps the heart in recovery.
When the walls of the heart receive oxygen,
small electric currents are able to pass through the cells
causing the heart muscle to contract.
If enough of these cells come back to life, so should the heart.
So, the heart is beginning to beat now. It's beating.
After three hours and ten minutes in a box of ice,
the donor heart is starting to respond to Max's warm blood.
It's woken up too early, we haven't finished yet.
They successfully get Max off bypass.
His new heart is keeping him alive,
all on its own.
He's, kind of, in and out, a little bit, of consciousness,
and when he comes round
a little bit, he's quite feisty!
He's using gestures rather than...
He can't speak at the moment cos of tubes but...
..he's able to point and...
..shoo people away if he wants to,
so that's encouraging cos it shows his spirit is intact
and it's Max, definitely Max.
The short shelf life of hearts,
or their ischaemic window,
means transporting them has always been a race against time.
We know, from experience, that,
when you approximately reach four hours of ischaemic time,
the function of the heart afterwards might be compromised.
This means patients can only receive a donor heart
that can get to them and be implanted within four hours -
hugely limiting the pool of available donors.
But in labs just down the road,
the surgeons have been working with Newcastle University
to find ways to give all types of donor organs a longer shelf life.
I'm going to start ventilation right now.
Respiration rate of 12.
By pumping oxygenated blood through these pig lungs,
they're able to keep them alive,
replicating what happens inside the body.
They call it ex vivo perfusion.
We are at the dawn of a new era,
where organ perfusion is the new frontier of science in transplant.
With this technology,
we can buy extra time,
which means we're not losing good quality organs
for logistical reasons.
Donor organs can survive longer like this than they can in ice,
so they can be sourced from much further afield.
But this also creates time to repair them,
which means doctors could consider using diseased organs
they currently turn down.
We could give different medications to the organ during perfusion.
We could silence specific genes.
We can give cell-based therapies.
We believe we could be doubling or tripling the number of transplants
that happen in the country.
A hugely exciting prospect.
The Freeman Hospital have already started using ex vivo perfusion
on human lungs, livers and kidneys for critically ill patients.
But the one organ they haven't tackled is the heart.
Until now.
Let's go up to the perfusion room.
Upstairs in theatres, an expensive piece of kit
has arrived from America.
It's a hi-tech bit of machinery
but it behaves like a supermarket trolley.
This is the organ care system,
an ex vivo perfusion machine for the heart.
A local charity has funded the surgeons to trial it,
but it costs about £40,000 a go.
The heart sits in that box.
It gets blood pumped through it
and the heart actually sits there, beating.
It's a very impressive piece of technology,
there's no doubt about it.
In 50 years of transplant,
this is the first machine of its kind available to surgeons.
This allows you to take some of the time pressures out of the equation.
It means the surgeon can do a more meticulous job at the beginning
without people shouting everything,
saying the heart's due back in ten minutes, we need to be ready.
It gives you a good heart right from the word, "Go".
This is a huge step forward.
I think it's going to make a big difference.
Now all they need are cases
where they can push this technology to the limit.
In the intensive care unit,
Kelly has not left Claire's side since her transplant.
Hello.
You going to give James a thumbs up?
That's my girl. Well done, Claire.
Superhero.
Yeah, you are. You are.
Her surgeons have managed to get her new heart beating on its own,
but it's now clear that, over the years,
her old heart has damaged her other organs,
making recovery much harder.
The heart is a pump and, when it fails, it affects all the organs -
the liver, the kidney and the gut.
And although we did transplant Claire, we did correct the heart...
..she died as a consequence of the comorbidities
she had accumulated over 30 years of her life.
We failed.
We know that we've done all that we can
but, at the end, Claire didn't make it.
There is a famous saying
that every surgeon has a private cemetery to which he,
from time to time, goes and prays.
In the middle of the night,
you do sometimes...
..wake up and think about these things.
INTERVIEWER: How are you feeling right now?
Anxious, nervous, numb.
Excited, scared.
Everything.
Half of me's looking forward to it, and half of me is...
..not.
It's weird to feel so scared
of something that you want so much.
But...
..this is it.
It's going to make everything OK.
After nearly three years on the waiting list,
David has finally been matched
to a donor who shares his rare blood group.
Coordinator Phil is waiting to hear from the retrieval team,
who are examining the heart inside the donor.
Hello. I still don't know any more news at the moment.
We've got echoes and we've got all the other information we need.
It's literally now just the visualisation.
What does it look like, physically?
What are we looking for?
Yeah. That there's no damage to the heart,
that there's no coronary artery disease.
There might be something not right about it when we look in there and
we're not going to put a heart into you which isn't good.
Yeah. Because, obviously, we need a good heart for you, don't we?
Yeah, definitely. But what we're going to do is
we're going to move you to the anaesthetic room
and then, if it's a yes, then we can just crack on.
Plenty of space.
The retrieval surgeons will arrive at the donor hospital
and open the chest of the donor,
and then do some physical examinations.
And then they physically look at the heart
to see if there's any disease
or any damage to it.
Then we make the final decision
whether we're going to accept it or not.
20 minutes later, the retrieval team give the go-ahead.
David can be put to sleep.
The patient's called David...
..and he's 31 years old.
We've been reassured by the donor team
that the heart is a good function,
so we are going to proceed with the operation.
But just as they're about to start,
Phil finds out there's a problem with the donor heart.
All right, thank you very much. Thanks, bye.
Hi, Fabrizio, it's Phil.
Apparently the donor has gone into a PEA arrest.
I think the surgeon's going to give you a call.
It was, you know, completely unexpected. I'm sorry. So...
That organ is not good to be used any more
and we need to abandon our plan.
Unfortunately, we moved forward here
because we were ready,
we were happy with the previous judgment of the donor heart,
but suddenly something has changed dramatically and...
There's no chances to use that organ any more.
Oh... I'm sorry. Don't be daft. It's just, you know...
There was the risk of instability in David if we put it into him
and David was already a very complex patient
and, weighing up the risk and the benefit,
it wouldn't have been beneficial for him to have that organ.
Just devastated.
We just thought it was going to go ahead.
It's just going to be upsetting telling him.
You can come in. Is he ready?
To wake somebody up
and tell them that the heart was no good...
I was just absolutely devastated for him.
Surely this can't happen twice.
Ta.
Our donors are from all walks of life
and some people have lived a life
and some people have abused their lives.
They're not new. You know, they've all had a history.
You know, my mum doesn't know what I do
or have done in the past,
and I'm sure your mum doesn't know what you've done in the past,
and therefore it's hard for the families to give a full history.
If you've got a 60-year-old donor who's had a really good...
..you know, enjoyed every minute of their life -
drunk, smoked, partied - they've had a fab life
but so has their heart, you know,
and it might just be coming to the end of that usefulness.
The surgeons are now hoping their new ex vivo perfusion machine
might help them make better use of these second-hand hearts.
The commonest cause of death
early after transplant is the new heart not functioning well.
And if you have a bit of intrinsic disease,
then the risks to your recipient become prohibitive,
which is why we turn down 70% or 80% of the hearts offered to us.
We're nearly there.
How are you going? It's all right.
Newcastle's retrieval team have just got an opportunity
they've been waiting for for months.
We don't travel light when we go places.
A donor has been found in another country,
but the heart won't survive the journey if transported back on ice.
The only way they can do it
is if they use the organ care system.
A lot of kit required, absolutely.
We've got several surgeons,
one perfusionist, one anaesthetic nurse,
two scrub nurses and any observers that we can take, students, so...
Kath, are you happy with everything?
I think so. Yeah. You're sitting on that one.
Yes. Thank you very much.
You wish them all luck, safe journey
and bring me back something nice,
which is what we want.
If it's healthy enough, the heart is going to 54-year-old Joie.
This heart is beating all on its own,
just like it was a few hours ago in the donor's body...
..so they can assess it en route.
We can see the function of the heart,
we can see the heart beating
and we can assess the other parameters
which can suggest whether the heart is struggling
or whether the heart is beating very nicely.
So, we regularly check the blood specimen...
..and Paul is checking the oxygen and the lactate.
So, that is not only reassuring but it's very amazing as well.
Everyone can see the heart beating
and not many people in their lifetime get to see that.
Even for somebody who operates on hearts every day -
day in, day out - it still took me by surprise
the first time that I saw it.
By the time the old heart is ready to be removed,
his new one has been outside the body for almost six hours.
But because they can keep monitoring it,
surgeons Fabrizio and Karen can afford to take their time.
The numbers that we measure on the OCS system,
they were all promising, so there were no signs of complication.
So, we could be positive about the outcome.
I think it's a really comfortable environment
for us to get a real feel for how the heart is actually performing.
And if you are somebody that has been very debilitated
for a long time and is waiting on that organ
and desperate to get that second chance,
we do want to make sure that what you get allows you an opportunity,
a better quality of life.
We've now disconnected all the arterial and venous supplies,
and the heart's about to be explanted.
Can I have scissors, please?
They cut through the last remaining connection
between Joie and a heart that was supposed to last a lifetime.
To see this organ come out of somebody's body
and it's still trying to beat...
..there's just something really sad about that.
OK, are we starting to get the heart out?
Yes.
Before they can implant the new heart,
Fabrizio's got to stop it beating.
We administer a solution that is called cardioplegia,
and it's the solution that will paralyse the heart, basically,
and make the heart not beating.
Isolate it, please.
It's more weighty than you'd expect.
It certainly feels very precious
and something that you want to be very protective of.
It's like a good piece of meat.
That would be the kind of feeling.
How are we doing, Fabrizio? OK.
We're just checking that everything's all right.
It looks beautiful.
From the minute you lift it out,
you have a feel for disease of the coronary arteries
that lie on the surface of the heart. We make sure we're happy.
Nearly there.
It's pristine, as if it's just been removed from the donor.
There is some confidence in saying
that the heart was performing well in the donor,
was performing well in the OCS machine.
You expect that heart to work very well in the recipient.
OK.
They're now ready to start sewing it into Joie's body.
So, pop it inside.
Should be OK.
That's fine.
Thank you.
Then just 20 minutes later,
Joie's new heart springs into life.
Yeah, that's his own rhythm.
OK, come off like this.
They successfully get him off bypass
and, layer by layer, close him back up again.
Joie waited 287 days for this donor heart,
one he could never have had without ex vivo perfusion.
It both enables the "good" hearts
to be better and enables us to...
..eat into those hearts we currently turn down
because we think we can make them better too.
We could potentially double the number of transplants we do.
The long-term goal in Britain
is to build perfusion hubs
where donor hearts, lungs, livers and kidneys
can all be repaired before being dispatched
to hospitals around the country.
It's the most exciting area in the transplant community.
It's shown me what medicine's capable of.
You know, to never think that something's impossible
because it probably isn't,
you just haven't tackled the problem correctly.
INTERVIEWER: Did you ever think you would be doing this, Joie?
I can't do before.
Can't walk near five, six steps or so.
Showing your new heart who's boss. Yeah.
After 794 days on the waiting list,
a heart was finally found for Joe.
See you later, Joe.
When you've seen somebody you've known for quite a while
who's been blue, blue lips, struggling for breath...
He's in safe hands.
..you cannot put a price on seeing somebody recover after a transplant.
It's magical.
After 180 days,
a baby's heart was finally donated
small enough to fit Saraya.
She's now doing well, home with her mum.
There is no greater act.
Giving parts of your body,
parts of the body of someone you love
to some unseen stranger to save and transform lives.
It is a truly remarkable thing.
With his new Vad pump,
Richard was allowed to go home.
He can get six hours out of his battery
before he has to plug it back into the mains.
He still needs a new heart.
As does David, who's now approaching his fourth year on the waiting list.
Come to Dad.
But Max is now beginning a new life with his donor heart.
In the morning, I say good morning to it
and I close my eyes and send it all the love I can
so it settles in.
And I'm just trying to give it a nice welcome.
"Welcome to your new body."
Just the biggest "thank you"
to whoever gave it to me
because they've saved my life.
Yeah.
It's just suddenly started raining like mad.
Oh, I really want to go out there.
How do we feel about going out in the rain for two minutes?
Yeah, do you want to?
I really want to do this.
You're still behind me.
Oh, yes, it's still raining!
Oh!
Why can't...?
How can you...? Oh, you pull it.
It's getting heavier.
Whoa. THUNDER RUMBLES
Did you hear that thunder?
Can you hear that thunder?