In a pioneering operation that brought two Canadian infants and an internationally renowned heart transplant specialist together in California last month, Paul Hole of Surrey, B.C., became the world's youngest recipient of a heart transplant—less than eight hours after he was born. What follows is a reconstruction of the wrenching events in the lives of two families as medical teams fought to keep a tiny heart beating. (All times are local.)
At Vancouver’s Grace Hospital, an advanced scanning technique that uses ultrasound waves to produce a three-dimensional picture reveals that the 28week-old male fetus that Surrey, B.C., homemaker Alice Hole is carrying has a congenital heart defect. Specialists tell her that the defect will prevent the left chamber of the heart from pumping blood through the baby’s body. Hole, 35, and her husband, Gordon, a 39-year-old video store owner—who also have a healthy five-year-old son, Jason—learn that the unborn baby will likely die within 48 hours of birth. His only chance for survival, doctors tell the numbed parents, is a complicated, difficult and risky heart transplant.
Late August: Nearly 3,500 km to the east, in Orillia, Ont.’s Soldiers’ Memorial Hospital, a couple awaiting the birth of their first child receives shocking news. Two ultrasound tests show that the 32-week-old female fetus is anencéphalie—that is, she has a genetic defect that will cause her to be born without a brain. Obstetricians tell the baby’s mother, Karen, 26, and her husband, Fred, a 36-year-old business consultant, that if they choose to go through with the birth, their baby will have no chance of surviving. The baby’s brain stem will stop functioning, she will cease breathing and she will die.
Early September: Karen and Fred (who have asked that their surname not
be revealed) decide to offer their daughter’s organs for transplant.
Mid-September: Alice, Gordon and Jason Hole visit California’s Loma Linda University Medical Center. The 575-bed Seventh Day Adventist hospital, located more than 1,800 km away from the family’s home in British Columbia, is worldrenowned for performing transplants on infants. There, specialists confirm the bleak diagnosis on the unborn child. The Holes meet families of other heart
transplant recipients and infant transplant specialist Dr. Leonard Bailey. They weigh the risks and costs (more than $200,000) of the proposed surgery and the fact that the doctors still must find a suitable donor.
Oct. 9: The Holes tell their family doctor that they want the Loma Linda specialists to begin searching for a donor.
Oct. 11: In Orillia, Karen celebrates her 27th birthday. Her baby is three weeks overdue.
Oct. 12, 11:30 a.m.: Labor begins as Karen prepares to cook a turkey for a Thanksgiving dinner.
Oct. 12, 6:30 p.m.: Karen delivers a six-pound, three-ounce girl at Soldiers’ Memorial Hospital. Nurses place a bonnet on the baby to cover the opening at the back of her head. She is breathing on her own. Doctors notify Dr. Timothy Frewen, director of Canada’s largest infant transplant centre, the Children’s
Hospital of Western Ontario, that the baby’s parents wish to donate her organs to save another child. The centre is in London, 230 km southwest of Orillia. Later, Baby Gabriel, named for the Biblical guardian angel, is baptized in a Roman Catholic ceremony.
Oct. 13, 6:30 a.m.: As Gabriel’s breathing becomes shallower, doctors put her on a respirator and intravenously administer a sugar solution and medication to help sustain her heart and other organs. It is the first time that an anencephalic baby has been kept alive as a donor for a transplant operation.
Oct. 13, 2:00 p.m.: Gabriel, still attached to the respirator and accompanied by a five-member medical team, arrives in London by plane, where she is transferred to Frewen’s care. There, doctors begin turning the machine off at six-hour intervals in order to determine if she can still breathe unassisted.
Oct. 14, 5:25 p.m.: After three full minutes away from the respirator, Gabriel fails to breathe on her own and doctors declare her clinically brain dead.
Oct. 14, 6 p.m.: Transplant co-ordinator Michael Bloch of London’s University Hospital is searching for a recipient for Gabriel’s organs. He telephones Loma Linda pediatric cardiac transplant co-ordinator, Cheryl Mathis.
Oct. 14, 4:01 p.m.: Mathis telephones Alice Hole in Surrey, now three weeks away from the date when her baby is due. She tells the expectant mother that Loma Linda has located a potential donor.
Oct. 15,4:30 a.m.: In London, Bloch, a pediatrician, a nurse and a respiratory therapist board a chartered air ambulance jet bound for Loma Linda with Gabriel. The infant is lying in a heated Plexiglas bassinet. She is breathing with the aid of a ventilator.
Oct. 15, 5:30 a.m.: Because of a delay due to rough weather, the batteries in the heating unit are running low, and Gabriel has used up most of the ventilator’s oxygen supply as the plane lands in Denver, Colo., for refueling. Bloch makes an urgent telephone call, and specialists from a local children’s hospital deliver chemical heating packs and oxygen tanks to the waiting plane.
Oct. 15, 6:00 a.m.: Alice and Gordon Hole arrive in Loma Linda aboard an air ambulance after a five-hour trip from Vancouver. They begin to get ready for caesarean section and transplant operations scheduled for that afternoon.
Oct. 15, 9:45 a.m.: Fog diverts Gabriel’s plane from Loma Linda to Norton Airforce Base, 95 km east of Los Angeles.
Oct. 15,11:45 a.m.: Gabriel arrives by ambulance at Loma Linda where specialists examine her. Bailey, worried that the infant’s heart is not strong enough, schedules further tests and
postpones surgery for one day.
Oct. 16, 8:00 a.m.: Doctors check Gabriel’s heart and decide to proceed with the operations.
Oct. 16,10:54 a.m.: Dr. Elmar Sakala, chief of obstetrics and a native of Kelowna, B.C., delivers Paul Hole by caesarean section. He weighs about 6V2 lb. and has red hair, like his mother.
Oct. 16, 10:55: As a duct in the newborn baby’s heart squeezes closed, specialists quickly administer Prostaglandin, a hormone that opens the duct. They connect the infant to a respirator to stabilize his condition before surgery. Specialists take tissue samples for testing to ensure that they are compatible with Gabriel’s. Doctors begin intravenous administration of cyclosporine,
an antirejection drug, to Paul.
Oct. 16, 1 p.m.: Surgeons move Paul into an operating theatre. In an adjacent operating room, doctors continue to administer morphine to Gabriel to guard against the remote possibility that she would suffer during the transplant operation.
Oct. 16, 1:45 p.m.: Technicians pack ice around Paul’s brain. To slow his body functions they route his blood through a heart-lung machine, which cools it to 20° C—17 degrees below normal body temperature. Doctors remove Gabriel from life-support equipment. Then, with approximately 20 people—including surgeons, anesthetists, nurses and co-ordinators—in the room, Bailey makes an incision in Paul’s chest.
Oct. 16, 2 p.m.: Surgeons remove Gabriel’s walnut-sized heart. Surgical assistants then rinse the organ in a saline solution, pack it in a plastic bag, immerse it in a container of ice and take it to the adjoining operating room.
Oct. 16, 2:05 p.m.: Bailey removes the defective heart and completes preliminary implant of Gabriel’s heart into Paul’s chest. The operating team begins to circulate donated blood through Paul’s body, gradually warming the transfusion.
Oct. 16, 3:35 p.m.: Paul’s new heart begins to beat spontaneously.
Oct. 16, 3:55 p.m.: Satisfied that the heart is functioning properly, Bailey begins sewing the organ into place.
Oct. 16, 6:30 p.m.: The operation ends. Paul Hole has become the world’s youngest heart transplant recipient.
Oct. 17: Paul gradually awakens and begins to move his arms and legs.
Oct. 18: Gabriel’s remains arrive back in Orillia for her cremation the next day. _
Several days after the transplant operation Karen and Fred were eating dinner in a restaurant near their Orillia home. Several staff members who recognized them from news coverage of the transplant operation brought flowers to their table to show their sympathy for the couple's loss. The couple told the staff that they were proud of their daughter's sacrifice. They went to that dinner, they said, not to grieve but to celebrate.
Last weekend Baby Paul remained in hospital in good condition, and the Hole family took him to their home for the coming year—an apartment near the Loma Linda Medical Center. After that crucial period of adjustment, he will likely have to take antirejection drugs for the rest of his days. But Bailey said that he expects the child to develop normally—and enjoy what is literally a second chance at life.
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