In a hospital many kilometers from Madrid, a few weeks ago, a Cardiology team from Gregorio Marañón was working around the clock.
The heart of a baby of just over ten pounds had stopped beating and, at that moment, his parents said yes to his loss being another baby's chance to live.
They donated their son's heart to Naiara, a premature one who had turned one month old and who had to be intubated in the ICU 24 hours earlier.
There were not many options left for him.
That operation set a milestone in science: the first heart transplant in the world to babies performed in asystole - with a heart that has already stopped - and with an incompatible blood group between donor and recipient.
Little Naiara after the transplant.
GREGORIO MARAÑÑO HOSPITAL
At that time, says Juan Manuel Gil, the head of the Children's Cardiac Surgery service at that hospital, they weren't thinking about what it meant for medicine: “It's the last thing you think. You have a baby in a precarious situation, they call, and all you see is a guardian angel who is giving you a chance and you go to work thinking: 'You have to get out of this'. They left. Naiara, who has now served two months, left the intensive care unit and is already recovering on the ward. "And that's fine, the prognosis is good," says the surgeon, who pauses and adds: "This, three years ago, would have been impossible."
In 2018, Gregorio Marañón activated the program to perform heart transplants in children with incompatible blood groups. Until now, Gil says, "there have been very few cases of donation in asystole in children and never with the addition that the blood groups were incompatible". It has not been more than a decade that abdominal organs (such as kidneys or livers) have been transplanted in asystole, and the first heart transplant in Spain, in adults, was carried out at Puerta de Hierro last year. Now Naiara is the first girl to undergo surgery with these characteristics.
"Transplants always suffer from being few for the number of recipients," explains the surgeon: "And in Spain we are fortunate for the generosity of people and families and the work of the National Transplant Organization." Spain has been a world leader in this field for almost three decades. In 2019, it validated this title for the 28th time both in transplants (5,449 were produced that year), and in donations, with a rate of 48.9 donors per million inhabitants. Even with these good numbers, it is those who need a heart who spend the most time on the waiting list.
"And those who are most likely to die [due to lack of one] are young children, those under one year of age and even more those under one month," deepens Gil, who estimates the number of transplants in around half. children who practice the Marañón with respect to the entire national territory.
In the last five years he has done 41 - seven in 2020, despite the pandemic - and 35% of those surgeries are in children under one year of age.
"Fortunately, few children die, but the children we have on the waiting list are unlikely to receive a heart," which is why "increasing the number of donors in the most vulnerable age groups is so important."
Naiara, the transplanted baby, in the room where she recovers at the Gregorio Marañón. H.
Gregorio Marañón
Not long ago, Gil assures that no one was considering transplanting a heart that had not been beating for a few minutes: “In a conventional extraction, what we call brain death, when the surgeon arrives he finds the donor with a beating heart, he checks that he is in good shape. conditions, he stops it, extracts it, packs it in ice and brings it to the hospital ”.
In asystole, “when the surgeon arrives, the heart has already stopped for a few minutes, first that heart must be resuscitated with a machine similar to the one we use in conventional operations [ECMO, an extracorporeal circulation system], and once that heart beats and it is verified that it is valid, the protocol is the same ”.
Stop again, extract, pack in ice and travel with it to the hospital where the receiver is.
12 hours to a milestone
In Naiara's case, the team literally flew to save that plum-sized heart. Not being in the same hospital made the distance and time it took to cover her another obstacle. They did it in 12 hours. José Ángel Zamorano, perfusionist from Marañón, explains that his job is "to be the heart and lungs of the child during surgery, during the grafting process." It does so in the statement sent by the center: “Given the characteristics of this transplant, the perfusionists had to travel with the pediatric cardiac surgeons to the donor's hospital because we had to recover the heartbeat to be able to transfer and implant it. The extraordinary thing was that we had to recover our hearts twice and not just once, as usual. What's more,we had to modify the whole heart-lung bypass pump to fit such a young child. "
Gil, on the phone, remembers the “magnifying glasses with extreme precision” that they needed, which they always need in these interventions: “But when we transplanted the heart it began to beat strongly. It went right". And it was not the first time that a medical decision, and the work of the professionals at that center, had made it go well for Naiara. Before birth, the baby had already been detected heart problems and, from the center where her mother was followed, in another autonomous community, she was referred to the Infant Heart Area of Marañón, a national reference center for congenital heart disease from the fetus.
Despite the follow-up, the situation worsened. They decided to advance the delivery and the professionals of the Neonatology and Infant Cardiology services were able to stabilize her. In the hospital statement, Manuela Camino, head of the Child Heart Transplant Unit, recalls that “the little girl was able to evolve and we managed to make the rest of the organs mature enough to consider the possibility of Naiara entering the transplant list. We explained to the parents that there were very few possibilities because there are few donors at that age, so very small. However, thanks to the immense generosity of other parents, the opportunity came ”.
He did it just when the possibilities were exhausted: “It was a very important moment, because we were faced with the heart transplant that we had performed on the smallest baby so far and because, 24 hours before, it had gotten much worse.
If that heart had not arrived, there would have been little chance of survival. "
But Naiara has already served two months, weighs three kilos and 200 grams, and climbing.
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