When the phone rang in the middle of the night, Zhang Liang was flipping through the books in his hand as usual. It was 23:30 on January 6, 2022, as a doctor in the Second Department of Cardiology of the First Affiliated Hospital of Zhengzhou University (hereinafter referred to as "Zhengda First Affiliated Hospital"), he was sorting out a full day of work.
However, it was destined to be an extraordinary night.
On the other end of the phone is Zhang Xin, director of the Second Department of Cardiology of zhengda first affiliated hospital, who just received a call from Qiao Chenhui, the old director of cardiovascular surgery of this hospital, "A heart failure patient in Wuhan who is eager for heart transplantation has successfully matched with a donor from Zhengzhou Seventh People's Hospital, and you need to take the team to a trip." ”
Usually, organ harvesting and transplantation are done by the same medical team. However, the outbreak in Henan has re-emerged in recent days, stopping the pace of the Wuhan medical team.
So, a 16-year-old young heart began a special "solo walk". Guarded and supported by layers, it spans 520 kilometers, drumming out a new pulsating pulse in an unfamiliar dry chest cavity.
▲ This precious donor heart spanning 520 kilometers is being implanted in the patient's body. Courtesy of respondents
16-year-old donor
For late-night emergency calls, Zhang Liang has long been accustomed to it, but this night, he is still slightly surprised, after all, the team has not recently needed a heart transplant patient. Moreover, he vaguely felt that Zhang Xin's tone was a little more cautious than in the past, "There is a sudden heart acquisition operation, about 5 hours later, you need to rush to the donor's hospital, and there are 4 organs that need to be obtained at the same time." ”
Hanging up the phone, Zhang Liang made his first call to organ procurement organizations (OPO) and began to carefully check the information about the donor, "This is a 16-year-old brain-dead donor, not only the heart, but also his lungs, kidneys, liver will be donated." ”
When it comes to multi-organ donation, "simultaneous acquisition" is the standard operating procedure in organ harvesting surgery, but the challenge has just begun, "This time, after the heart is acquired, the transplant part needs to be delivered to the medical team in Wuhan, which is the first time I have ever been in the industry." ”
According to Zhang Liang, in the world, the specific evaluation criteria for human organ transplantation are only general rules, and the evaluation rules of each transplant center are not completely consistent, "so under normal circumstances, organ acquisition and organ transplantation are completed by the same medical team." However, the outbreak of the epidemic in Henan has stopped the footsteps of the Wuhan medical team and made the other party's field access, and there is no possibility of realization. ”
Zhang Liang didn't have more time to think. Next, he has to contact the medical team that obtains other organs to pack related medical devices and disposable consumables, which are tedious tasks.
"The phone has been uninterrupted, and there is too much information to check." At 00:00 on the 7th, he appeared in the ward of the Heart Transplant Center of the River Hospital District of the First Affiliated Hospital of Zheng University, and in the external sound of the mobile phone, he carefully counted the familiar "partners" at hand - taking the pericardium, sternal saw, sterile ice, crushed ice hammer...
All the surgical instruments were packed up, it was already 2:30 a.m. on the 7th, but his spirit was still excited, "This seems to be the professional habit of every surgeon, who can fall asleep at the first time during rest and wake up at the first time in case of emergencies." Considering that this was the first time helping other medical teams obtain a heart, Zhang Liang forced himself into a state of rest.
Before 4 a.m., Zhang Xin dialed Maning's phone. This is another team member he has chosen. "Ma Ning and Zhang Liang have been working together for more than three years. Given that everyone is facing such a situation for the first time, the team's choice has to be careful and meticulous. ”
Fifteen minutes after the phone hung up, Manin woke Up Zhang in the hospital lounge, and the two once again counted all the equipment. More than three years of continuous cooperation, has long been the tacit understanding of the "tacit understanding", the weekday preoperative communication is often only one or two sentences, but this time, they communicated for more than ten minutes.
At 5:15, Zhang Xin's headlights neatly cut through the pre-dawn chaos, picked up Ma Ning and Zhang Liang on the first floor of the hospital, and the three of them sped towards the Seventh People's Hospital of Zhengzhou. A relay race for life began.
Misfortune and luck
520 kilometers away, in the Zhongnan Hospital of Wuhan University, around a depleted heart, the treatment that races against the clock has already begun.
Two months ago, a patient with heart failure was admitted. Liu Jinping, director of the Cardiovascular Surgery Department of Zhongnan Hospital of Wuhan University, clearly remembers the situation at that time, "The patient was only 27 years old, suffering from cardiopedic heart disease, severe heart failure, and had sought treatment in many hospitals in China. ”
After admission, the patient had been using medication to stabilize vital signs, waiting for a transplant, but three weeks ago, his condition suddenly deteriorated. "His heart was almost dysfunctional and we carried out emergency rescue and implanted an intraortic balloon counterthroctor to sustain life. But that only temporarily pulled him back — the device only bought him the time and conditions to get a heart transplant — and if he couldn't find a suitable heart, he would have to live for less than three months. ”
The balance of luck favored this young life. At 5 p.m. on January 6, Liu Jinping received a call from OPO. The long-awaited match appeared in Henan, when two weeks had passed since the patient entered the rescue period, "According to the relevant provisions of OPO, the recipient rescue for more than two weeks can enter the priority matching sequence." In order to ensure the absolute fairness of life, all organ transplant matching is done by the OPO system, and there is no human intervention. ”
Liu Jinping did not hesitate to identify the transplant needs, "At that time, it was too late to consider the problem of not being able to obtain it on the ground, because there were more urgent problems to be solved." To avoid blood clotting in patients near balloon devices, Liu Jinping and his team used heparin, "which is a common clinical anticoagulant drug, and only a very small number of people's platelets will have antibodies." ”
Unfortunately, they bumped into this tiny probability — meaning there was more uncertainty about the patient's heart transplant. Although a matching donor has been obtained, during the heart transplant procedure, the patient needs to build a circulatory system outside the body, so that the patient's vital signs during the operation can be maintained. "Heparin is the drug of choice in this process, unfortunately we can only choose other options."
The only alternative drug that Liu Jinping and his team had to choose from, a synthetic anticoagulant drug that was approved for marketing in the United States in 2000. However, in the 44 years since the completion of the first heart transplant in China in 1978, no more than 5 cases have used the drug during surgery. "We're not 100 percent sure, but we have no choice."
On the evening of the 6th, Liu Jinping formulated a detailed surgical plan and called Qiao Chenhui, who believed that the team of the old director of cardiovascular surgery of Zhengda First Affiliated Hospital could ensure the smooth acquisition of this precious heart. "We've worked together many times and I have a lot of confidence in them."
At 6:30 a.m. on the morning of the 7th, in the operating room of the Seventh People's Hospital of Zhengzhou, the acquisition work began. Zhang Xin remembered that the first knife was extra cautious, and then fully entered the state, "As usual, the process of acquisition was very smooth, there were no accidents, and the whole process lasted for an hour." Ma Ning and Zhang Liang were extra careful when pouring preservation fluid into the heart, "This is the smallest donor we have met at this stage, and there are no other thoughts other than awe and emotion." ”
▲Heart acquisition surgery site. Courtesy of respondents
Heart transplantation is the most pressing of all organ transplants, and heart muscle cells, like nerve cells, are the only two remaining cells in the human body that cannot be regenerated. This means that the heart is most poorly tolerated ischemia, and the whole process from the donor to the recipient should not exceed 6 hours.
"Donor hearts over 6 hours are clinically known as 'marginal donor hearts', and the risk factors for transplant surgery and patient recovery will increase geometrically." Zhang Xin and Ma Ning could not hesitate. The incubator was filled with a mixture of ice water, placed into the donor heart, and they rushed out of the operating room with the box.
Zhang Liang stood quietly in front of the operating table. Because there was still follow-up work to be done, he couldn't go with his heart, but he didn't start the work at hand right away. He remembered a heart transplant that had just been completed, by an 18-year-old boy who he and Manin had been involved in. He feels that it is somewhat regrettable that he could not complete the transplant himself this time, "When the heart enters the recipient chest cavity and relieves the blood flow blocking, we can clearly hear the powerful 'thumping' beating sound of the heart, which is also the biggest difference between heart transplantation and other organ transplants." The sense of continuity of life is even stronger in this moment. ”
At less than 8 o'clock in the morning, Zhang Xin and Ma Ning had already driven to the entrance of Zhengzhou East Railway Station. Zhao Yan, deputy director of the passenger workshop of Zhengzhou East Railway Station, had been standing in the drop-off area of the high-speed rail station for an early time - the heart of the car was waiting for him to take over the baton, and a life channel to Wuhan had been built overnight.
Life channels and arenas
Zhao Yan received a call from Zhang Xin at 00:00 on the 6th. After 10 minutes, the train escorting the heart to Wuhan was finalized. "We originally planned to take the G93 train at 7:55 on the same day, but due to the slight delay in surgery, we temporarily changed to the G2045 train of the 8:14 distribution car."
Jia Yang, the captain of the G2045 train, only temporarily learned the news after picking up the train, "I have never encountered such a situation, nor did I think there would be such an experience." At first there was more fear, but the moment it touched the incubator, the calm overwhelmed the fear. ”
Nearly 40 pounds of the box was carried into the dining car by Jia Yang and Liu Zhiping, "The box can indeed be pushed and pulled, but considering the narrow aisle of the carriage, we have no experience, nor do we know the situation inside the box, afraid of bumps, so it is careful to carry it in." ”
▲ Jia Yang and Liu Zhiping carefully carried the incubator containing the donor heart. Courtesy of respondents
At the same time, during the epidemic, the food truck is not open to the public and does not accept tourists, so it has become the best place to stay. Liu Meng, the head of the food truck, temporarily became a full-time caregiver for this heart.
At 8:14 on the 7th, the G2045 train left Zhengzhou East Railway Station on time, at this time, in the operating room of the Cardiovascular Surgery Department of Wuhan University Zhongnan Hospital, patients waiting for heart transplantation were already making final preparations before anesthesia.
At 10:25, the G2045 train arrived at Wuhan Station. After 25 minutes, Liu Jinping saw the heart from Zhengzhou in front of the operating table, "whether it is color, surface condition, texture or structure, it is very ideal." ”
▲The donor heart enters the operating room. Courtesy of respondents
At 11:30, the extracorporeal circulation system was officially opened and the operation began. Dark red venous blood slowly flows out from the upper and lower vena cava intubation, enters the cardiopulmonary bypass machine, undergoes oxygenation, filtration, and temperature, transforms into bright red arterial blood, passes through arterial intubation, enters the body again, enters every piece of tissue, every cell, and tightly ties the life on the operating table.
Previously, Liu Jinping completed a heart transplant most of the time in two and a half hours, "considering that there is no antidote to bivaluidine, the clotting function of platelets can only rely on the patient's body to recover itself, the hidden danger of bleeding complications is higher, and the requirements for surgical precision are also improved, so this operation lasted nearly four hours." ”
"On the same day, after we completed the docking of the heart's blood vessels, as soon as we opened the block, the heart instantly re-beat." Liu Jinping told the Beijing News reporter that because of the patient's long waiting period, there was a certain degree of kidney failure after the first rescue, and it is still necessary to go through the observation of infection, rejection and function, "but I am very confident." ”
Zhang Liang said that due to ethical requirements, the donor's family and the recipient's family could not get in touch, and after completing the last heart transplant, he recorded the sound of the 18-year-old donor's heart beating in the new body and sent it to the donor's mother. "I believe this is not only a relay of life, but also the only gratitude I can give to this great mother."
"The sound of heartbeat breaks life and death, prolongs life, and carries hope." At the moment when the epidemic is raging, every life's sacrifice and miracle are worth remembering. ”
Beijing News reporter Liu Yipeng
Edited by Li Binbin Proofreader Zhao Lin