Fighting for Life at Jet Speed : Turbulence Over Heart Transports

It was 12:45 p.m. Jan. 12 when a noisy jet took off from Van Nuys Airport on a race to the East Coast and back in which every minute saved improved the odds for a 3-week-old girl in desperate need of a new heart.

In less than seven hours, the plane would travel 5,400 miles to carry the precious cargo back to the ill infant at Loma Linda University Medical Center.

From the moment Dr. Steven R. Gundry, who boarded the flight with his three-member surgical team during a touchdown at Norton Air Force Base, clamped the aorta and removed the heart from the donor baby, he would have just over eight hours to fly back and implant it. Any longer and the cells of the heart, the size of a small plum, would begin to break down and die.

The high-risk endeavor’s chance of success would depend on the almost miraculous skills and stamina of the surgical team, an array of high-tech gadgets, precision timing, good weather and luck.

But another element, just as important, was the fast, but relatively noisy Gulfstream 2 fan jet--with its nom de guerre in this war against the clock “Lifeguard 65 Sierra Tango”--powered by two 13-year-old Rolls-Royce engines.

Takeoffs of such noisy jets are prohibited from Van Nuys Airport between 11 p.m. and 7 a.m., except when the departures are part of a “lifeguard” flight, the official name used by flight controllers to give priority status to such medical emergency flights.

But noise activists who live near the airport want the charter companies to be required to use quieter jets for such flights, except when none are available. That could mean forcing them to use slower jets as well.

“These are ambulances when used for this purpose,” Gundry said, referring to the luxurious executive jet. “At 2 a.m. if I hear an ambulance go by . . . I’m not particularly annoyed by it. It’s the same thing here. We’re carrying some human baby’s life with us. It seems that’s a small price to pay.”

A $300,000 federal study of the noise generated by the airport to be completed in early 1991 could result in a ban on the use of the louder jets for emergency flights. Transplant surgeons say that would make it more difficult to find organs, especially for infants, and could result in more deaths. Of the approximately 20 jets regularly chartered from Van Nuys, only six satisfy the airport’s 74-decibel nighttime noise restriction.

Chatfield Air Ambulance, a Van Nuys firm that arranged the Jan. 12 flight to the Pennsylvania city, is one of the busiest such companies on the West Coast. Loma Linda officials requested that the name of the city not be disclosed to ensure that the identity of the donor baby would not become known.

About 250 medical emergency flights were arranged by Chatfield during 1989 for organ transplant programs at Harbor-UCLA Medical Center, Cedars-Sinai Medical Center and elsewhere. The company’s flights also accounted for many of the 30 “lifeguard” takeoffs during 1989 that exceeded the Van Nuys Airport’s nighttime noise restriction.

Gundry and other transplant surgeons and coordinators said the Van Nuys Airport is suited to be the hub for organ retrieval flights because it is centrally located and has a relatively large number of jets and services to support them. In addition to the transplant programs served by Chatfield, the heart transplant program at St. Vincent Medical Center and others use Van Nuys.

At airports such as Ontario and Los Angeles International, regularly scheduled commercial flights can delay emergency flights, pilots and charter representatives said. Smaller airports, such as Santa Monica and Torrance, already ban nighttime flights.

Some anti-noise activists in the San Fernando Valley insist that charter companies should be forced to buy quieter jets for life-saving flights to pick up donated organs.

“What they really want to do is fly the oldest, noisiest equipment possible and we’re just saying, ‘Hey, if you’re going to have these kinds of flights . . . use proper equipment,’ ” said Gerald A. Silver, head of the Homeowners of Encino, one of two prominent anti-noise groups.

Joe McGuire, the president of Raleigh Jets, which owns the plane used for the flight to the East Coast, said the quieter Gulfstream 4 would cost $21 million, compared to $6 million for the Gulfstream 2.

The commercial fee for leasing a Gulfstream 2 is $3,600 per hour, but Raleigh Jet provides a discount for medical emergency flights. Even with the discount, the cost of retrieving the heart used to revive the 3-week-old baby girl would approach $40,000, on top of the $115,000 cost of the operation.

Silver said homeowners will soon tire of arguments by airplane leasing companies that they cannot afford to buy the quieter aircraft. He said they consider warnings that a nighttime ban could result in babies dying as a cheap shot that will “create a most negative reaction with homeowners eventually saying, ‘Take your aircraft out of here.’ ”

Finding infant hearts to transplant is often difficult under the best circumstances because babies rarely suffer the sudden, traumatic injuries that make them potential donors. So when it was determined about 11 a.m. on Jan. 12 that the heart of the East Coast baby fit the blood type and weight of the baby at Loma Linda, the surgical team did not hesitate to fly across the country.

“We were next on the list and that’s where the heart is and that’s where we will go,” said Gundry, referring to the national registry of patients needing donor organs.

The longest time the Loma Linda surgeons have ever kept an infant heart alive without blood circulating through it is 8 hours and 17 minutes, and with stiff easterly winds slowing the plane’s return it would be a close call. “We might be right around that today,” said Gundry.

The plane landed at Norton to pick up Gundry and his team 17 minutes after leaving Van Nuys. Four minutes later, the engines whined to life and the 31-ton, nine-passenger jet was soon airborne once again. At 1:21 p.m. the plane rose above the clouds over the Mojave Desert and Gundry, 39, and the other members of his team peered out the windows.

Also on board was David Hale, 34, of Chatfield Air Ambulance, the company that chartered the plane, arranged for ambulances at both ends, provided food during the flight and handled all other arrangements.

The baby whose life depended on the flight was born Dec. 24 at County-USC Medical Center with an underdeveloped heart. Her parents, who asked not to be identified, had been notified at noon that the team had found a heart for the baby, their first child. They would spend much of the day at the hospital, cuddling the child whose heart was too weak to pump enough blood to keep her alive for long.

Infant heart transplants--pioneered in 1985 by Dr. Leonard L. Bailey, head of the program at Loma Linda, in western San Bernardino--are done in only a few hospitals in the country. Bailey and Gundry did 42 transplants in 1989 and every one, Gundry said, was “nerve-racking.” More than 90% of the 61 infants who have received heart transplants at the hospital are still alive.

A brisk tail wind at 43,100 feet boosted the plane’s maximum speed to as much as 627 m.p.h., although the outbound speed was far less important than during the return flight, when the plane would be bucking head winds. The red and ochre arms of the Grand Canyon came into view about 1:50 p.m. To the north, the faint gash of Zion Canyon and the famous buttes of Monument Valley were visible.

At 4:18 California time, with the lights of Chicago to the north and Indianapolis to the south, an oval moon rose from the horizon like a dusky orange balloon. Incongruously, the Sidney Poitier thriller movie “Shoot to Kill” started on the plane’s VCR.

“Looks like civilization down there,” Gundry said, as the lights of the destination city came into view. The wheels hit the ground at 5:27 p.m.

Gundry and the others scrambled down the stairs and into the waiting ambulance, its emergency lights flashing. Twenty-four minutes later they arrived at the hospital where sick children were crowded into the emergency room.

Gundry began working to remove the donor heart at 6:21 p.m. and finished at 7:13 p.m. Relief as well as tension filled the ambulance returning to the airport as the team excitedly compared notes on the operation.

It “went very, very smoothly,” Gundry said. “We were in and out in less than an hour. That’s as good as we can do.”

Takeoff from the Pennsylvania city was at 7:54 p.m. On the return trip, the surgical team would watch another movie, eat dinner and settle down for naps. “We try to keep them comfortable, whatever they want,” Hale said, “because they’re going into surgery again when we get back.”

West-northwest winds cut the jet’s speed by 100 m.p.h. By pushing the plane’s engines close to their maximum speed the pilots managed to pick up an hour that would otherwise have been lost. At Norton, McGuire would have to buy fuel to have a safe margin for the flight back to Van Nuys.

Meanwhile, at Loma Linda, doctors and nurses had begun preparing the baby for surgery at about 10:30 p.m. They anesthetized her, started her on anti-rejection drugs and began cooling her body temperature to about 65 degrees. Usually, Gundry would do the entire operation, including removing the defective heart. But because the team would be up against the tight deadline, Bailey had come to the hospital to get the operation started the moment Gundry began scrubbing up.

The plane landed in a light rain at Norton at 1:14 a.m. Kay Ogata, a nurse on the surgical team, telephoned the hospital from her cellular phone on the airplane to let them know. “Are they ready?” Gundry asked her. “They’re ready,” she replied.

At 1:18 a.m., the plane rolled to a stop and the team ran down the stairs. As they arrived at the hospital with the new heart, Bailey opened the baby’s chest. He placed the heart in the baby about 1:35 a.m. Circulation was halted while the team worked, listening to zydeco and reggae music on the operating room stereo system. Fifty-two minutes later, at 2:27 a.m, circulation was restarted.

Seven hours and 14 minutes after the heart was removed in Pennsylvania, the heart began beating.

A week later, the hospital reported, the baby was in good condition.