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It was the type of heart transplant that might have been impossible a few years ago.

A registered donor in her 20s was declared brain dead at UC Davis Medical Center in Sacramento in mid-2023, according to Sierra Donor Services, the region’s federally designated organ procurement organization, or OPO. The woman’s lungs, liver, kidneys and heart would be destined for donation. The only challenge: The woman who needed her heart was in North Carolina.

Formerly, sending a heart so far would have been impossible, with the five-hour flight alone longer than the time a heart could remain outside the body before transplant. But in 2022, the United States Food and Drug Administration approved the TransMedics Organ Care System, or OCS device. Known as the “heart in a box,” this device uses normothermic perfusion to pump blood through a removed heart and preserve it for longer periods until it can be transplanted into a new person.

Sierra Donor Services determined the brain-dead woman’s heart could be a potential match for a woman who was to be operated on at Duke University Hospital, which set a national record by transplanting 161 hearts last year. A transplant team traveled from North Carolina to Sacramento, placed the heart into a TransMedics OCS device and made a five-hour flight home. Today, the woman who received the heart is doing well.

It’s the kind of story that illustrates the innovation that is currently transforming the organ transplant world and saving lives.

Why organ recovery is important

Every time someone died in a hospital in the greater Sacramento area in 2023, Sierra Donor Services was on the case.

Sierra Donor Services is one of 55 federally designated OPOs that coordinate organ recovery from deceased individuals at hospitals. This arrangement dates to Congress’ passage of the National Organ Transplant Act in 1984, with agencies like the federal Health Resources and Services Administration and the Centers for Medicare & Medicaid Services providing oversight. The service is vital, with over 100,000 people on the national waiting list for an organ and 5,600 people dying annually waiting, according to Donate Life America.

“Our mission, it’s to save and impact lives,” says Sean Van Slyck, CEO of Sierra Donor Services. “The core of what we do goes back to that literally every single day.”

Lacey Felder had heart transplant surgery as a young child more than 30 years ago. She is now program manager for Donate Life California, which shares office space with Sierra Donor Services in West Sacramento and oversees the state’s donor registry of over 19 million people. Felder says the biggest thing that helps people understand organ donation’s importance is this: One person can save eight lives being a registered donor, while their tissue can enhance 75 lives.

Preservation and transportation aren’t the only obstacles to getting donated organs to persons in need. She bristled at a National Public Radio report from mid-October that suggested a living person came close to having their organs harvested. Prior to the piece, Felder says, 30 people daily were removing themselves from California’s donor registry. Since then, it’s been more than 60 each day. “People are going to die because of it,” Felder says of the piece.

In general, organ recovery is like searching for the proverbial needle in a haystack. While roughly 170 million Americans are registered organ donors, less than 2 percent of people who die have organs that can be recovered, as they must be hooked up to a hospital ventilator. Not every organ will easily go to a recipient either, with OPOs checking the Organ Procurement and Transportation Network, or OPTN, to find prospective matches. OPOs then contact transplant centers. “It’s not uncommon for us to have to make several calls to different hospitals,” Van Slyck says.

Then there’s another delicate task: approaching grieving families. Diana Davis, who lives in Citrus Heights, remembers what she told her family when her daughter Danielle Eger, a 30-year-old mother of two, was dying in a hospital near Seattle in 2019 following a brain aneurysm. “I had actually warned our family,” I said, ‘You know, the talk is coming. Let’s prepare our answer: We are not interested. No thank you,’” Davis says.

Davis hadn’t realized representatives from the local OPO, LifeCenter Northwest, were separate from the hospital. The OPO staff surprised Davis. Because Eger had signed up as a donor, her organs could’ve been recovered after she was declared brain dead with or without her family’s consent. Instead, LifeCenter staff cried with Davis and her family and let them know Eger’s organs could potentially save lives. Her lungs, liver, pancreas, kidneys and corneas would all be donated.

“We started to see that she was not going to be a miracle for us,” Davis says. “She was going to be a miracle for someone else.”

How organ recovery happens

Of the 11,429 in-hospital deaths Sierra Donor Services was contacted about in 2023, it located 171 donors who provided 46 hearts, 247 kidneys, 93 livers, 53 lungs and three pancreases that were used for transplants. While there are two transplant centers in Sierra Donor Services’ 13-county area — UCD, which does kidney and liver transplants, and Sutter Medical Center in Sacramento, which does heart transplants — roughly 85 percent of the organs went to transplant centers elsewhere. Transplant centers and even other OPOs can send in their own teams for recovery.

“We can routinely have ORs where we could even be at UC Davis recovering for one of our local transplant centers,” says Justin Johnson, chief operating officer for Donor Network West, the OPO surrounding Sierra Donor Services. “In the room could be someone from California, a team from Texas, a team from Louisiana and a team from Minnesota.”

Innovation helps teams travel further, and it’s not just normothermic perfusion devices for hearts. A similar device for livers from TransMedics gained FDA approval last year. Sierra Donor Services surgical director Dr. Beau Kelly says his organization intends to purchase a liver perfusion machine from Organox in January. Kidney perfusion devices have been in use longer, though Van Slyck says they’re becoming more portable. Organ donations after circulatory death, when organs typically start shutting down, are also increasing. UC San Francisco began performing these types of heart transplants in 2022, says Dr. Charles Rickert, an abdominal transplant surgeon there.

“The numbers of heart transplants skyrocketed here from around probably 10 to 20 a year at the very most to now upwards of 80 a year, and hopefully still going up,” Rickert says. “A lot of that is thanks to the newer perfusion devices and some of the storage devices that have really expanded … who is considered to be a good donor for our hearts.”

In Sacramento, both transplant centers have each been exploring innovation. Of the 12 heart transplants that Sutter Medical Center in Sacramento performed last year, just one heart came from Sierra Donor Services. Five hearts came from Donor Network West with the rest from OPOs based in Southern California, Nevada, Oregon and Washington. Dr. Robert Kincade, Sutter’s transplant director for Sacramento, says about 75 percent of the center’s recoveries involve flight. He says his center is seriously considering purchasing a heart perfusion device, which can prolong a heart’s time outside the body.

“Typically the window has been about four hours in the past, but the heart in the box has sort of expanded that,” says Kincade, whose transplant center opened in 1989. “We don’t know exactly what that window is, but … it’s definitely expanded the donor pool for transplant centers.”

UCD has done kidney transplants since 1985, performing 299 for adults last year, the fourth most in California. The program sourced kidneys for 65 of these transplants from Sierra Donor Services, getting another 179 kidneys for transplant from 23 OPOs throughout the country. Living donors who traveled from as far away as Maine provided 55 kidneys for the remaining adult transplants. Beyond this, UCD relaunched a long-dormant liver transfer program in July 2023, doing 15 transplants by year’s end. Melissa Blevins, executive director of the UC Davis Transplant Center, says liver perfusion technology “has really broadened our ability to get organs.”

There is a clock that ticks ominously for centers like UCD, which had 62 people die waiting for a kidney last year. “We’re known as an aggressive program, and I don’t mean that in … what you would normally think of aggressive as being,” Blevins says. “We take offers that other centers don’t … because we really want to give patients a chance at getting transplanted.”

The people who are helped

There are different ways to gain humility in life. One good method is to listen to what transplant recipients had to go through.

Stockton resident Pam Stratford, 70, spent 13 fruitless months in Florida in the mid-2010s and another year in Arizona where she received a kidney and liver transplant in 2020. Kaiser Permanente, which doesn’t do transplants locally, reimbursed her living expenses. Stratford’s new kidney has since failed, with her now on dialysis three times a week. She says she’s been told she can’t rejoin the waiting list. “I have grandchildren that I want to see graduate from high school and go to college and get married,” Stratford says.

Nicole Clement Crook, a sixth grade teacher who lives in Modesto, went to the emergency room in late 2020 after feeling very sick, getting admitted and later coding (cardiopulmonary arrest) four times. Clement Crook soon got an 8-pound left ventricular assist device, or LVAD, which she carried with her while teaching. She was in the classroom in 2023 when Sutter Medical Center called to tell her it would likely be receiving a heart the next day. She finished the day with her class before traveling to Sacramento with her family and having her surgery the following day.

“I hit a year in September, had a big party for it, and I’m back at work, which is really nice,” Clement Crook says. “Because it makes me feel more human and normal.”

It takes technology and a broad network of self-sacrificing and dedicated people to get organs recovered and transplanted. They’re people like Blevins, who aside from her duties for UCD, is a living kidney donor, having helped a friend in Phoenix in 2010.

“I love working in the land of second chances — that’s what it feels like to me,” Blevins says. “I don’t know anyone who hasn’t needed one of those at least once.”  

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