Transplanting Hope

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Transplanting Hope

PBS Airdate: September 26, 2018

NARRATOR: A newborn infant with a defective heart…

KAREN ELGERT (Human Organ Procurement Exchange Program Co-ordinator): The coordinator was called.

NARRATOR: …a transplant is her only hope.

JUDY BERGEN (Mother of Heart Transplant Patient): It's terrifying. It's just something we've got to do. We love her and just want her to have the best life she can possibly have.

NARRATOR: A heart is found that can save her, but it's hundreds of miles away. It's a desperate race against time.

IVAN REBEYKA, M.D. (University of Alberta): No heart yet?

NARRATOR: An organ shortage means thousands of patients wait for months, even years.

JAMES SHAPIRO, M.D. (University of Alberta Hospital): We're desperately short of organ donors. A quarter of our patients will die waiting for a transplant.

ADRIAN HODGETT (Relative of Transplant Patient): If she doesn't get this now, within three months, I don't think she would be here anyway. So, that's how critical it is.

NARRATOR: Can scientists find new solutions to the organ crisis?

DORIS A. TAYLOR, M.D. (Texas Heart Institute): What we're talking about is having off-the-shelf tissues.

That's awesome.

NARRATOR: Courageous families face wrenching decisions…

LESLIE BABCHISHCHIN (Mother of Organ Donor): Our whole world has been turned upside down. In a matter of moments our life changed.

Everybody pray.

KAREN ELGERT: This is the loss of their son. So, if we can have, like, five seconds of silence to just remember the gift that this family is willing to give through their son.

NARRATOR: …and critically ill patients get a new chance at life.

JAMES SHAPIRO: It's exciting. That's what transplant's about, and, of course, it saves lives, it transforms lives. It's a wonderful privilege to be part of that.

NARRATOR: Transplanting Hope, right now, on NOVA.

A former builder of sets for films and television, Lee Sanderson is struggling for life. His lungs are fatally scarred from exposure to toxic chemicals at his job. His only hope is a lung transplant.

In another part of the hospital, Alex Reyda has suffered a fatal brain aneurysm.

NURSE #1: He's a 25-year-old.

NURSE #2: 25-years-old?

NURSE #1: Ruptured A.B.M.

NARRATOR: But before Alex is removed from life support, he has one last gift to give.

KAREN ELGERT: Heart, liver, lungs, kidney, pancreas and then a single kidney.

NARRATOR: Alex is an organ donor.

SCOTT GORDON (Human Organ Procurement Exchange Program): We'd like to take a moment to thank Alexander for his gift and for the family for consenting on his behalf. A moment of silence, please.

ALI KAPASI, M.D. (University of Alberta): Hi, Lee. How are you?

LEE SANDERSON (Lung Transplant Patient): Okay.

ALI KAPASI: Good. So, good news for you. There is a donor.

LEE SANDERSON: Already?

ALI KAPASI: Already. So, I think I warned you it would happen pretty quickly.

SCOTT GORDON: Is everyone okay to go ahead?

NURSE (University of Alberta Hospital): Yes.

SCOTT GORDON: Thank you.

DOCTOR (University of Alberta Hospital): The next time I see you, you have new lungs, you're in the I.C.U., okay?

SCOTT GORDON: Okay, pancreas is coming out.

NARRATOR: A donor like Alex can potentially give eight organs and save eight lives.

Lee got his new lungs from a different donor. Three days after his transplant, they're ready to breathe on their own.

NURSE: Nice, slow, deep breaths, remember? ‘Kay, you ready? One, two, three, nice deep breath in. Cough it all out for me. Keep coughing.

FEMALE RELATIVE OF LEE SANDERSON: Cough it out, honey.

NURSE: Keep coughing. Lee, can you say hi?

LEE SANDERSON: Hello.

FEMALE RELATIVE OF LEE SANDERSON: Hi, honey.

NARRATOR: Lee received his new lungs in Canada. In the United States, there are 116,000 people waiting for transplants. Another name is added to the list every 10 minutes, and 20 people die each day because they don't get the organs they need. Canada's population is much smaller, but organ donation here is less common, so the shortage is just as critical.

SAM SHEMIE, M.D. (The Research Institute of the McGill University Health Centre): Organ donation, relatively speaking, it's not a big volume of patients that we're talking about in the country. And although it's a relatively rare event, it is such an important impact event, because we know that organ donors can save many, many lives.

NARRATOR: The stakes are never higher than when a newborn needs a transplant. Harlow Bergen is just two weeks old. She was born with a fatal heart defect; only a transplant can save her. But for infants, donated hearts are extremely rare. And even if she gets a transplant, Harlow could face lifelong health problems, starting with the possibility that her body might reject the new heart.

SIMON URSCHEL (University of Alberta Hospital): I think we all agree that transplant for sure gives her the best chance to lead as close as possible to normal life. You do know, however, too, that it's not going to be a walk in the park. It is exchanging a life-threatening situation, in which she is now, with kind of a chronic disease, or chronic abnormality. So, you know that she will, lifelong, depend on taking medications. And in children that are immune suppressed, that can cause a lymphoma, which is basically a type of leukemia. And that's not that uncommon. But I think it's, in all fairness, important for you to be aware of that as a possible option. But also be aware that 90 percent of our kids do really, really well.

JUDY BERGEN: Yeah, you think about going through the whole transplant and then, maybe later on, dealing with cancer or something like that. It's terrifying. It's just something we've got to do. We love her and just want her to have the best life she can possibly have, so…

JASON BERGEN (Father of Heart Transplant Patient): I don't know if we really have many options at this point.

JUDY BERGEN: No.

Good morning.

NARRATOR: All across Canada, organ donation teams will now be on alert for a heart for Harlow.

NURSE: Karen.

KAREN ELGERT: Yeah?

NURSE: Watch your pulmonal bleed.

NARRATOR: Karen Elgert is overseeing the search.

NURSE: Pulmonal bleed gone.

KAREN ELGERT: On, in, perfused.

NARRATOR: Karen is a nurse with HOPE, the hospital's human organ procurement team. Once a family decides to donate, she coordinates the whole process.

KAREN ELGERT: So, it's going to be…

NURSE: O.R. 6.

KAREN ELGERT: O.R. 6, yeah. Wonderful. Thank you, Chris.

NARRATOR: Karen is in constant contact with hospitals across the country. She's the first to know when organs become available.

VOICE ON PHONE: So, I'm actually calling you with a heart offer.

KAREN ELGERT: Okay.

VOICE ON PHONE: Blood type is O positive.

NARRATOR: It's an infant heart, and it was found quickly. The Bergens have only had to wait for two weeks.

SIMON URSCHEL: I guess you can kind of guess what's going on, if we're coming with the big team. So, we actually do have an organ for her, a little bit smaller child than her. It's going to be sometime tonight, coming out sometime tomorrow morning. So, just wanted to give you a head's up. We're pretty happy about it, too. I think it's actually the perfect time, and it is a very good organ.

JUDY BERGEN: Hi, buddy. Guess what? Harlow's going to get a new heart.

JUDY AND JASON BERGEN'S SON (Brother of Heart Transplant Patient): Wow!

JUDY BERGEN: Yeah, say "yay!"

Thank you.

I prayed for it all week that it would happen this week.

NARRATOR: As Judy and Jason brace themselves for a long night of waiting, a massive effort gets underway to retrieve the heart for Harlow.

Now that Karen knows the heart is a match, she and a team of retrieval surgeons spring into action.

KAREN ELGERT: So, we are now en route.

NARRATOR: They charter a jet and take off for a hospital on the other side of the country, where a dying baby is on life support. The donated heart must maintain its oxygen supply and keep beating until the last possible second.

KAREN ELGERT: From the time the heart is stopped, 'til the time that it's beating again in the recipient, there's a very finite time which is, like, for adults, about four hours, and then for peds, they may be upwards of six or seven. They don't like that, but sometimes you have no choice.

Hi, yes.

IVAN REBEKYA: Hello?

KAREN ELGERT: Yeah, hi Dr. Rebeyka.

IVAN REBEKYA: What's going on?

KAREN ELGERT: So, the heart looks good.

IVAN REBEKYA: Yeah?

KAREN ELGERT: And our E.T.A. is about 2:30 to 3:00.

NARRATOR: Once Karen gives the green light, Harlow's surgeons prepare. Just before 3 a.m., she's wheeled in. The retrieval team must be close before Harlow is put to sleep, but she must be ready for transplant as soon as the heart arrives. Every minute the new heart lacks oxygen comes at a cost.

IVAN REBEKYA: They landed.

NARRATOR: Surgeon Ivan Rebeyka has been in contact with Karen all night, to calculate the perfect moment to open Harlow's chest.

KAREN ELGERT: Uh, the coordinator was called.

IVAN REBEKYA: No heart yet?

NARRATOR: Just as the new heart enters the operating room, Harlow's damaged heart is removed.

IVAN REBEKYA: Let's see the new heart.

Okay.

Okay, are the lungs on?

NURSE: They are.

IVAN REBEKYA: Let's have a look here. Let's just have a little peek, 'cause that left atrial line is a little bit fussy. Pull it back a smidge. Okay, that looks good. ‘Kay, start hemoing. So, heart's on its own now.

It's a good heart, it just, it came from a long ways away, so it was in the bucket there for like five and a half hours. You know, this one, it started up like within two minutes of us taking that clamp off, and that's usually a pretty good sign.

Hi. Mr. Bergen, we've met. I'm Dr. Rebeyka. How are you?

JASON BERGEN: Good, yourself?

IVAN REBEKYA: Good. So we're all done. Everything went very, very well. So… heart's working on its own now. It's a bit early to relax completely, but things look pretty good, so I think we're in good shape.

JUDY BERGEN: Good.

IVAN REBEKYA: Okay?

JUDY BERGEN: Thank you.

IVAN REBEKYA: Okay…

JASON BERGEN: Thank you.

JUDY BERGEN: Thank you.

IVAN REBEKYA: I'll talk to you later, folks.

NARRATOR: Because their immune systems are still developing, babies generally have fewer problems with rejection than adults. But Harlow will still have to take anti-rejection drugs all her life. And she could end up needing a second transplant, if anything goes wrong as she and her new heart grow.

One floor away, another surgical team is rushing to salvage what they can after an organ donor's death.

JAYAN NAGENDRAN, M.D. (University of Alberta Hospital): Seventeen years to go through: your undergrad for a few years and then going into medical school for four years, then doing your residency, which is a minimum of six years. But during mine and Doctor Freed's, we both did a Ph.D. during our residency. That's 17 years after you graduated from high school before you start working. So, I truly mean it, and I feel very privileged to say that I trained my whole life for today. Doesn't matter if we're going to get a little less sleep today, it's a big day for the team.

NARRATOR: These surgeons are retrieving multiple organs from a braindead donor.

JAYAN NAGENDRAN: These are some of the nicest lungs I've ever seen in my whole life. They're absolutely spectacular. They're as good as they could ever be, and it would've been such a shame had we not been able to use it. One in three of our patients waiting for lung transplants don't survive to getting one, and that's why there's no give up. It's fight to the very end for us, every time we get a chance.

NARRATOR: This donor's kidneys, liver and lungs are successfully retrieved. But tragically, the heart cannot be used. Trapped too long in the chest without oxygen, the heart tissue has died.

More than 60 percent of all donated hearts are not actually used for transplants, because too much time goes by after a donor's death. But a new experiment might offer hope that some of these hearts could stay viable for a longer window. It's called "ex vivo" technology, a way of keeping organs alive outside the body.

DARREN FREED, M.D. (University of Alberta Hospital): You want to start the insulin?

NARRATOR: Jayan Nagendran and Darren Freed have invented a machine that keeps a heart warm and oxygenated instead of storing it on ice. This could give doctors more time to use it for transplant. They've had some success experimenting with lungs. This is the first time they're trying to bring a discarded heart back to life.

DARREN FREED: Did you guys see that, the heartbeat? Did you see that? The heart is an amazing organ; you give it blood and it will beat. It's absolutely amazing. You actually don't have to do anything. Look at that.

NARRATOR: But after pumping for just a few minutes, a blood clot makes the heart seize up.

DOCTOR #1: You've lost it for sure.

DOCTOR #2: Oh, yeah, I just saw it go down.

DARREN FREED: So, this is our problem, right? We should, we shouldn't have clots.

DOCTOR #1: That clot.

DARREN FREED: And so, this has plugged up the tubing and the pumps and everything. We're very meticulous about anticoagulation to make sure that this doesn't happen. The heart is filling up with clot instead of heparinized blood or thinned blood. For the first, the first time we do this, to lose it this way, is, you know, devastating. It's incredibly frustrating.

JAYAN NAGENDRAN: This was still an important first step, even though it, it didn't go to fruition.

DARREN FREED: Even though it went down in flames.

JAYAN NAGENDRAN: Yeah.

NARRATOR: The doctors can't hide their disappointment. They'll study this failure to help refine the technology, and if they eventually perfect a technique to save more organs, it could change the odds for thousands of patients.

SAM SHEMIE: The fascinating thing about these ex vivo technologies is that organs that otherwise were not transplantable can now be removed and repaired. And so that means that you can use perhaps many more organs that previously you couldn't use before. So, I think the potential is phenomenal. There's no reason why you can't envision a future where I have a failed lung, maybe I need my organ taken out of my body, repaired outside of my body, remodeled and then transplanted back into my body, so I can be my own donor.

NARRATOR: Until that day comes, the essence of transplant medicine remains: saving lives always means losing someone who is precious to a family.

SAM SHEMIE: In intensive care, it is routine for us to work at the junction of life-saving treatments and the potential for people to die. And our job with families is to recognize when there is no longer anything that we can do to save that person's life; we've exhausted all possibilities.

LESLIE BABCHISCHIN: Jesus, please. Jesus, help my son. Please bring him back to me. Dear lord Jesus, help my son. I'll do anything, I'll do anything, Jesus. I'll do anything. I'll do anything, Jesus. I'll do anything.

NARRATOR: Twenty-eight-year-old Matthew Babchishchin is in intensive care with a serious brain injury.

LESLIE BABCHISHCHIN: You're such a giving man. You're so giving, Matthew. I know you can do it. I know you can fight.

Our whole world has been turned upside down, our whole world. We were such a content family and just, just felt so lucky, and then, bang, in a matter of moments our life changed.

DEMETRIOS KUTSOGIANNIS, M.D. (University of Alberta): What I'll need is a flashlight.

NARRATOR: For three days, doctors have been searching for any sign that Matthew's brain is still functioning.

CARL BABCHISHCHIN (Father of Organ Donor): This is a very scary day for us. We do know we were told 72 hours. We do know these tests are going to show a lot, give some answers. I'm very afraid of what the answers could be.

DEMETRIOS KUTSOGIANNIS: You may turn on the light now. So, you're able to come in, if you wish. I'm just repeating what we did this morning, okay?

LESLIE BABCHISHCHIN: Yes, sir.

DEMETRIOS KUTSOGIANNIS: You can hold his hand if you wish.

LESLIE BABCHISHCHIN: My son, my beautiful boy. You're so blessed, Matthew, you're so blessed.

DEMETRIOS KUTSOGIANNIS: Yeah, he will be moving. We just stopped the drug for the exam, and then…

LESLIE BABCHISHCHIN: My blessing, my boy.

DEMETRIOS KUTSOGIANNIS: I'm just going to put this in his mouth to check his gag reflex.

LESLIE BABCHISHCHIN: Don't suffer, my boy. Don't suffer, my boy. I love you my son, I love you.

DEMETRIOS KUTSOGIANNIS: Okay. Would you like to stay here? I'm just going out to the family conference room to meet with your family. Would you like to stay here or join me?

LESLIE BABCHISHCHIN: I want to join you if you're going to…

DEMETRIOS KUTSOGIANNIS: Okay, we'll come back. You have an opportunity to come back, so we'll just go out there now.

CARL BABCHISHCHIN: I've been pacing up and down these hallways and all of a sudden it reminded me of when Matthew was born and the similarity of me pacing that hallway. And it struck me how I was waiting for a birth of Matthew again. That's what I'm waiting for. I'm waiting for a birth.

DEMETRIOS KUTSOGIANNIS: I'm Dr. Kutsogiannis. I'm the attending intensive care unit physician this week here. I've been caring for Matt since Monday. As you're aware, he had an episode where his heart stopped for a prolonged period of time. It was at least 20 minutes before he recovered his blood pressure. When we look at everything from start to finish, he's been ill in the I.C.U., he's been comatose in the I.C.U. I had organized another special test yesterday to be done today, and we know, when we don't receive signal in the lower part of the brain on both sides, that we can tell you with a very, very high certainty that he won't recover meaningful brain function. So, we're left at this circumstance, where I don't think any family would want an individual to be left on life-support in this circumstance, in the long run.

CARL BABCHISHCHIN: So, what you're also saying is there is no miracle?

DEMETRIOS KUTSOGIANNIS: I'm saying that I can tell you with…

CARL BABCHISHCHIN: It's done, yeah.

DEMETRIOS KUTSOGIANNIS: Yeah, pretty good. We don't want to make an error in this situation, because you can understand, it's someone's life, so…

CARL BABCHISHCHIN: Yes, I understand what you've…

DEMETRIOS KUTSOGIANNIS: Well, I think at this stage, I'd recommend that he, in the long term—by that I mean days—not stay on life support, because we're really prolonging the dying process.

CARL BABCHISHCHIN: Les, what do you think?

LESLIE BABCHISHCHIN: Yeah. I just want to be by Matthew's side. Now I know I'm saying goodbye. He's such a special boy. I personally would like it the sooner the better, because I don't want him to be in this comatose state. All I want to do is hold my boy for the last couple of days or hours that I have.

DEMETRIOS KUTSOGIANNIS: I have one more thing that I want to discuss. It's an obligation on my part by law, too.

LESLIE BABCHISHCHIN: Mm hmm, I know what you're going to talk about.

CARL BABCHISHCHIN: Yes.

DEMETRIOS KUTSOGIANNIS: And that is the issue of organ and tissue donation. But it's an introduction to that, to think about, to discuss, and we can have another discussion tomorrow regarding that.

CARL BABCHISHCHIN: I love you.

LESLIE BABCHISHCHIN: Thank you.

DEMETRIOS KUTSOGIANNIS: You're welcome.

LESLIE BABCHISHCHIN: I love you so much. I love you, Matthew. I love you so much, Matthew. I love you so much.

NARRATOR: For Matthew's family, this is the end of hope, and in the face of their loss, they must make a profound decision. There's a narrow window of time to decide whether part of him could save the life of someone else.

Surgeon James Shapiro understands the urgency. Many of his patients are dying on the transplant wait list.

JAMES SHAPIRO: Hello, David. Morning, how are you?

PATIENT #1: Oh, still pretty sore.

JAMES SHAPIRO: You probably want some creon. Good morning.

PATIENT #2: Morning, sir.

JAMES SHAPIRO: He didn't get dialysis over the weekend?

NURSE: Yesterday they didn't send him out to do it.

JAMES SHAPIRO: Okay. You might need to go back to the dialysis again a little after the surgery. It's always a possibility. We'll see you later.

We're desperately short of organ donors. A quarter of our patients will die waiting for a transplant. Some of them will wait years for a transplant in certain blood groups. Some of them will go straight, you know, close to the top of the list, because they're so sick. Many people will die waiting, because an organ doesn't come in time.

NARRATOR: The shortage of organs means many patients get sicker and sicker as they wait.

ADRIAN HODGETT: You all ready for your big day?

PAT FISHER (Liver Transplant Patient): Yeah.

ADRIAN HODGETT: Yeah?

PAT FISHER: Scared, but all ready.

ADRIAN HODGETT: That's normal.

NARRATOR: Pat Fisher is in end-stage liver failure.

ADRIAN HODGETT: It's going to be a good day.

PAT FISHER: Yeah.

ADRIAN HODGETT: Yeah.

NARRATOR: She's been waiting for weeks, and, finally, there's a matching donor. But by now Pat is very weak. This will make her transplant even riskier.

ADRIAN HODGETT: The end result would be if she doesn't get this now, within three months, I don't think she would be here anyway. So that's how critical it is. It was a very tight timeline for her.

JAMES SHAPIRO: She has what we call a high "MELD" score, which means that the liver's been very diseased, very scarred, lot of pressure in the veins, lot of risk of bleeding. This is big surgery. This isn't just routine. There's nothing routine about this.

PAT FISHER: I'm so scared.

ADRIAN HODGETT: Don't always get a second chance. This is it, this is your second chance.

JAMES SHAPIRO: We've just clamped the major vein for the liver, the vena cava. So we're about to cut the liver out. All right, so here comes the liver. Can you see how horribly diseased this liver is? It really is. It's horrible, yeah.

DOCTOR: So, actually, she required a little bit of resuscitation.

NARRATOR: With a patient as fragile as Pat, the surgeons are working at the limits of medicine.

ADRIAN HODGETT: You can't say that it's definitive that she's going to be all right, right? There could be lots of problems and the end result of some of them is death, right? So, it's not fair, but these things happen in life and that's the way it is.

JAMES SHAPIRO: And let's go salad bowl. Three, two, one, in we go. Now the liver enters the field.

NARRATOR: As expected, Pat's transplant is difficult. It takes the entire night to complete.

JAMES SHAPIRO: So, we're ready to unclamp in about 30 seconds, Tim.

DOCTOR: All right.

JAMES SHAPIRO: When you watch a new organ come to life like this—the patient's own blood fills the organ and starts to function—it never fails to, you know, give me some thrill. It still, still gives me a kick, even now.

Good job.

Somebody has end-stage liver disease at one moment, you release the clamp, and now, they suddenly have a new chance at life again. It's exciting. And that's what transplant's about, and, of course, it saves lives, it helps people, transforms lives. It's a wonderful privilege to be part of that.

NARRATOR: Pat's new liver begins working right away, but she has many other complications, including a series of life-threatening infections that are resistant to antibiotics. It takes four months of round-the-clock intensive care before she's finally well enough to move to a regular ward.

PAT FISHER: Oh, is this Dr. Shapiro?

JAMES SHAPIRO: It is.

PAT FISHER: Oh, hello.

JAMES SHAPIRO: Pat, how are you?

PAT FISHER: Good.

JAMES SHAPIRO: Very nice to see you again. I'm coming to shake your hand in a second. Been a long haul, hasn't it?

PAT FISHER: Too long.

JAMES SHAPIRO: Yeah.

PAT FISHER: Yeah, but I did it.

JAMES SHAPIRO: You really did…difficult transplant. You were very, very, very sick. Yeah, and this liver's worked very well for you.

When you set on a journey with transplant, you're taking an organ that can save somebody's life, and once you've made that commitment, you've got to make sure that you do everything possible to get a successful outcome. Others will approach you and say, "This is hopeless. You've been here for three months now, we're making no headway. We should just pull the plug and let the person die.

But we've got to think more than how much is a person's life worth and how much to give, how much not to give. You ought to think about the value of the organ. You have a huge responsibility to the organ donor family and to the organ to do what it's meant to do, which is to save a life.

JAMES SHAPIRO: Very lovely to see you, Pat.

PAT FISHER: Yeah, it's nice to have met you, my lifesaver.

JAMES SHAPIRO: Well, likewise, it's been a pleasure to look after you, great pleasure to look after you. Have a hug, all right? Good luck in rehab. Keep your spirits up. Nice to see you, Pat.

PAT FISHER: Okay, bye bye.

NARRATOR: Despite her struggles, Pat is still one of the lucky ones. Hundreds of people die in Canada each year waiting for transplants, and thousands in the United States.

At the Texas Heart Institute, in Houston, Doris Taylor and her team are taking a new approach to addressing the organ shortage.

DORIS TAYLOR: Let's try the light on this one and see if we can get a good image of the vasculature, okay?

As the number of people who need organs goes up, the number of donors has plateaued. What that means is we had to find new solutions.

NARRATOR: The new solutions they're working on start with donated organs that are not suitable for transplant.

DORIS TAYLOR: We take an organ, a cadaveric organ that couldn't otherwise be used for transplant, and we strip that organ of its cells by using a detergent or other solution to basically wash those cells out of the existing organ scaffold. And what's left is what we call the extracellular matrix.

When you wash the cells out, what you have left is that underlying framework where the cells sit that looks like a heart, looks like a liver, looks like a kidney, because it is a heart, a kidney, a liver framework.

NARRATOR: Building a new organ starts with stem cells that could come from a patient's own body.

DORIS TAYLOR: Stem cells are simply cells that can do two things. They can make more of themselves, self-renew, and they can differentiate, or become different kinds of cells.

RESEARCHER: It's good. There are no clumps. No.

DORIS TAYLOR: No clumps and lots of cells. I'm excited.

RESEARCHER: Yes.

NARRATOR: The stem cells they're using don't yet have a specific function, but when they're infused into the organ framework, an amazing thing happens.

DORIS TAYLOR: Those stem cells seem to get cues from that matrix about where to go and what to become. There are biologic cues in there that say, "Oh, I should be a muscle cell here. I should be a blood vessel here. I should be an artery here and a vein here." And we can put cells in and have them migrate to the right place.

NARRATOR: But getting stem cells to the right place is only the first step. The real question is, will the organs work? Can they build a heart that will actually pump blood and beat?

Each heart spends several days in a special incubator that mimics the body's natural environment. Then the heart is removed from the incubator and a flow of nutrients is pumped through it, to see if it will beat.

DORIS TAYLOR: You can see the vessels. That's gorgeous.

RESEARCHER: And what's beautiful is you can see that there's actually even blood going to the coronaries. There's an air embolus, but, I mean, you can see it.

DORIS TAYLOR: That's awesome. It feels really good.

RESEARCHER: Yeah.

DORIS TAYLOR: When you could take that heart, take cells that you were growing in the lab and transplant them back in and have them beat again, that was one of the "wow" moments in my life.

Good, good. Turn it just…yes, yes, nice.

Everything that could have gone wrong didn't. It was, it was just a homerun.

NARRATOR: These hearts are not yet ready for human transplant. But Taylor believes organs by design could someday save the lives of thousands of patients.

DORIS TAYLOR: This one's still underway, right?

NARRATOR: Her team is also experimenting with building lungs, livers and kidneys.

DORIS TAYLOR: What we're talking about is potentially having off-the-shelf tissues. They're, they're two pieces to that that are revolutionary. One, we can potentially build an organ; two, we can build an organ that matches their body, because, as you know, when you get a transplant you're essentially trading your original disease for another disease, which is fighting rejection for the rest of your life. I'll be happy when we do our first clinical trial; I'll be happier when there are enough organs for patients who need them.

NARRATOR: Research like Taylor's could transform transplant medicine, but for many patients, these advances will come too late.

WILLIS WOOD (Heart Transplant Patient): I came here for a two-hour doctor's appointment, been here ever since. Waiting sucks.

NARRATOR: Eight months ago, Willis Wood's heart began to fail. As he waits for a donor, he's being kept alive by an external pump that circulates his blood. There have been no matches, and his doctor knows time is running out.

NAKUL SHARMA, M.D. (University of Calgary): I need really big breaths this time. So, you're probably the highest status person in Alberta right now. You're a big guy, and this is why it's become difficult. The organs that I've seen that have come in are about 60 to 70 kilos. That's like 60 pounds smaller. That's a small child, right?

WILLIS WOOD: Yeah.

NAKUL SHARMA: So, if there's an organ for a heart that's anywhere between 80 to 90, Dr. Mullen, in Edmonton, and Dr. Kim have agreed that we will go ahead and do it, if it's a perfect match otherwise. He's on call for the weekend, I'm on call for the weekend, so if we get a heart…

WILLIS WOOD: I'm on call for the weekend.

NAKUL SHARMA: You're on…I know, you're always on call. And I'll be here the whole weekend, so I'll keep you updated every day, okay? Anything else I can help you with?

WILLIS WOOD: Find me a heart.

NAKUL SHARMA: I'm on it. Okay, talk to you later.

WILLIS WOOD: Okay, thank you, sir.

NARRATOR: There just aren't many donor hearts large enough for Willis, but if he gets any weaker, he won't survive a transplant.

WILLIS WOOD: I have grandchildren. That's what it really means to me. It's, I want to get out and do things with them, and I'm willing to fight for that. If it was just for me I'd've probably gave up, but I want to be there for my grandkids.

NARRATOR: Meanwhile, Matthew Babchishchin is still on life support. Scott Gordon from the HOPE team has come to discuss his family's decision about organ donation.

LESLIE BABCHISHCHIN: Thank you for coming, yeah.

SCOTT GORDON: I'm sorry that… I mean, you can't even talk about it.

LESLIE BABCHISHCHIN: Yeah. These are all the "have-tos" in life that you never prepare yourself for, right? If we could do any good, Matthew would want that.

CARL BABCHISHCHIN: Matthew was born here, and it's kind of sad that he started his life and finished his life in this hospital.

LESLIE BABCHISHCHIN: We were so proud that he was born here.

CARL BABCHISHCHIN: So we have all agreed that we will…Matthew's organs are…it will be donated.

LESLIE BABCHISHCHIN: Which are listed as, like you said…

SCOTT GORDON: I can go through all that specifically.

LESLIE BABCHISHCHIN: Yeah.

CARL BABCHISHCHIN: When it comes to the tissue, we did not realize part of the skin part was…to the degree. And we did not realize the need for it at the same time.

LESLIE BABCHISHCHIN: I just want to donate the organs, and I'm not comfortable with the tissue at all.

CARL BABCHISHCHIN: I know it would be going against Matthew's wishes.

LESLIE BABCHISHCHIN: I'm not comfortable with it either. I want to keep that intact. I've had Matthew taken from me, he's giving his organs, he's lost his life. I'm just going for how I feel.

Can we just…Let's move forward, okay? We're moving too slowly for me, I need… Let's, let's, let's move forward. You know, we're being all this delicate…and I need to get to my son. Let's move forward.

CARL BABCHISHCHIN: Let's do it.

Given the person that we know Matthew was, we would know that this is what he would have wanted. He would have done it without hesitation.

LESLIE BABCHISHCHIN: Oh, my god. Oh, my god. Oh, Matthew, you should be filling out that form for me. Why did I have to fill that out for you?

KAREN ELGERT: Karen speaking.

VOICE: Hi, Karen.

KAREN ELGERT: Hi Ali. We're trying to rush this as quickly as possible. This is a 28-year-old male, 84 centimeters and 101 kilograms.

NARRATOR: Matthew's death is just hours away. A huge effort has begun to save his organs, and a handful of people across Canada have just gotten the call that could save their lives.

KAREN ELGERT: I need to talk to Darren.

NURSE: Do you want me to page him?

KAREN ELGERT: Yeah, I need to page him.

NARRATOR: Before Matthew's life support is withdrawn, surgical teams and transplant recipients all over the country must be ready. Delays are inevitable.

LESLIE BABCHISHCHIN: Oh, no. This is so unfair. This is so unfair.

KAREN ELGERT: The O.R. has delayed. They would like to delay for one hour.

NURSE: Just one second.

KAREN ELGERT: Okay. Can I call you at a different phone, Darren?

LESLIE BABCHISHCHIN: I want away from this nightmare, I want to be away from this nightmare. Oh, my son. Oh, my god. Oh, my god.

NARRATOR: Two floors away, the operating room is getting ready.

KAREN ELGERT: This has been an incredibly stressful time for everyone, because it's been so busy, but this is a loss of their son, and it's been really, really hard on them. And as always, it's so totally unexpected. So, if we can have, like, five seconds of silence to just remember the gift that this family is willing to give through their son.

So, they're going to withdraw life support, like, any minute now.

JAYAN NAGENDRAN: Okay, what I will need from you, in sequence, is the scalpel, the skin knife and the saw coulee.

KAREN ELGERT: Asystole 20-06.

LESLIE BABCHISHCHIN: Go, Matthew. Go save some lives, Matthew. Go do it, Matthew. Goodbye, my son. 'Bye, Matthew. Goodbye, my son. Goodbye, my son. I will see you again, Matthew.

NURSE: I'll call you when we're done, okay?

LESLIE BABCHISHCHIN: I'll see you again, Matthew.

BROTHER OF ORGAN DONOR: I love you, bud.

LESLIE BABCHISHCHIN: I love you, Matthew. Goodbye, Matthew. I love you, Matthew. I love you. I love you, Matthew. I love you, my son.

NURSE: Okay, so we're going to go to the right.

NARRATOR: Off the respirator, Matthew's organs are starved of oxygen. everyone knows it's now a race against time.

KAREN ELGERT: Who's checking the I.D.?

DOCTOR #1: I'm sorry. I'm sorry.

DOCTOR #2: Skin knife, please. Skin knife. Knife moving.

DOCTOR #1: Work faster.

DARREN FREED: We have found you a very good heart. Lots of complications that can occur along the way…

WILLIS WOOD: Yeah, well, infection, bleeding and…

DARREN FREED: Any one of those things can contribute to not actually making it through this whole experience.

WILLIS WOOD: Yeah. I'm raring to go. I'm ready to start the final leg of this journey.

NARRATOR: The identity of Willis's donor is unknown to him and to us. Matthew's organs went to others.

LESLIE BABCHISHCHIN: You know, Matthew is going to shine down and just, just say, "Thank you, Mom and Dad, for doing this. And I'm so grateful that you made this decision for me." I'm so happy where they're doing this for Matt. It's all for good for Matt.

NARRATOR: Two years after his transplant, Willis Wood is fully recovered and playing with his grandchildren.

Unfortunately, Pat Fisher continues to struggle with health issues, but Harlow Bergen is a healthy toddler.

JAMES SHAPIRO: Taking people near to death's door and eventually seeing them go back to leading an entirely normal life, we know that can happen every time we do a transplant. That's what we see time and time again, and that's what's rewarding for us.

SAM SHEMIE: The first thing that we tell people, all the time, is become aware, and whatever you decide, make sure you tell your family, because it will be your family that will be asked to make a decision for you when you're incapacitated and you might die and become a donor.

CARL BABCHISHCHIN: Tonight's event is a celebration in memory of Matthew.

LESLIE BABCHISHCHIN: We want you to know that Matthew was an organ donor. We knew that he would want to give this gift of life to someone who needed it.

Credits

DIRECTED BY Niobe Thompson PRODUCED BY Rosvita Dransfeld NARRATED BY Jay O. Sanders FOR NOVA PRODUCED BY Elizabeth Arledge EDITED BY Doug Quade ASSOCIATE PRODUCER Karinna Sjo-Gaber AUDIO MIX Heart Punch Studio ONLINE EDITOR AND COLORIST Jim Ferguson FOR NATIONAL FILM BOARD OF CANADA Vital Bonds EXECUTIVE PRODUCER FOR VITAL BONDS Rosvita Dransfeld EXECUTIVE PRODUCER FOR NFB David Christensen PRODUCER FOR NFB Bonnie Thompson WRITER Niobe Thompson DIRECTORS OF PHOTOGRAPHY aAron Munson
Sergio Olivares EDITOR Brenda Terning ASSISTANT EDITOR Esther Viragh MUSIC BY John McMillan ORCHESTRATION Andrew Reid MUSIC CONSULTANT Darren Fung ADDITIONAL CAMERA Daron Donahue
Tamarra Canu
Blake McWilliams PRODUCTION MANAGER Sandra Tober PRODUCTION COORDINATORS Esther Viragh
Tamarra Canu PRODUCTION ASSISTANTS Tamarra Canu
Dylan Rhys Howard
Myles Belland SOUND RECORDISTS Phillip Dransfeld
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Iain Pattision
Chris Szott
Jordan Ivey ONLINE EDITOR AND COLORIST Joe Owens PRODUCTION ACCOUNTANT Richard Warburton PRODUCTION BOOKKEEPER Hui Min PRODUCTION SOLICITOR Norman Bishop VISUAL RESEARCH BY Gina Cali PRODUCTION STILLS Tamarra Canu PROMOTION University of Alberta
Alberta Transplant Institute
Northern Alberta Kidney Foundation
Canadian National Transplant Research Program SPECIAL THANKS Margaret Lidstone
The staff at The University of Alberta Hospital
Stollery Children’s Hospital
The Mazankowski Heart Institute
Royal Alexandra Hospital
Calgary Foothills Hospital
Montreal Children’s Hospital
The Staff of The Human Organ Procurement and Exchange Program (HOPE)
Alberta Health Services.
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STARS Air Ambulance Edmonton
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A NOVA Production by Gurney Street Films for WGBH Boston.

© 2018 WGBH Educational Foundation

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Additional Material © 2018 WGBH Educational Foundation

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This program was produced by WGBH, which is solely responsible for its content. Some funders of NOVA also fund basic science research. Experts featured in this film may have received support from funders of this program.

Original funding for this program was provided by Draper, Fidelity, the David H. Koch Fund for Science and the Corporation for Public Broadcasting.

IMAGE: Image credit: (Emergency Room) © WGBH Educational Foundation, Courtesy Cambridge Health Alliance/Cambridge Hospital Emergency Department

Participants

Darren Freed, Jayan Nagendran, James Shapiro, Nakul Sharma, Sam Shemie, Doris Taylor, Simon Urschel