A Vital Mission

It is about 5 p.m., and UCLA surgeon Daniel Marelli’s pager is going off, alerting him that a donor heart or lung has become available.

As evening rush hour begins, a helicopter arrives at UCLA Medical Center to pick up Marelli and his team to rush them to Van Nuys Airport. Joining Marelli on this trip are Maria Espejo, 25, his assistant, and Barsam Kasravi, a UCLA medical student who is along to observe.

They carry with them a medium-size ice chest and a duffel bag filled with solutions that will preserve the donor organ--in this case, a heart.

At the airport they are met by two pilots who will take them on the next leg of their journey. They board a five-seat Lear jet and, as the sun sets, munch a quick dinner of cold sandwiches.

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Once the jet lands in a Northern California coastal town, Marelli’s crew is met by a limousine and driver, who whisks them to a hospital about 15 minutes away. They ask for directions to the operating room, then settle down in the physicians’ lounge--and wait. It’s about 10 p.m. The donor is a 14-year-old male--a car-accident victim who has suffered irreversible brain damage.

The medical staff starts the preparations for the surgery as Marelli’s team scrubs up and prepares the preserving solutions. The UCLA surgeon begins the process of opening the chest cavity and delicately isolating the heart. Marelli gently removes the heart and immediately packs it in ice. The delicate surgery has taken about 1 1/2 hours. And now there’s no time to waste. Marelli and the others, with the heart packed in the ice chest, walk briskly to the waiting limo. It is nearly midnight, and the long day shows in their weary faces.

As they head back to the airport, Marelli asks a question just to reassure himself: Is the cooler in the trunk? After boarding the plane, they use the one-hour flight to catch up on sleep.

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Marelli speaks of the sacrifices he and others with jobs like this must make. He is on call 24 hours a day and must be ready to go at a moment’s notice. He has been interrupted during Thanksgiving dinners, sports events and once during a screening of “Titanic.”

Back at UCLA Medical Center, surgeons have been preparing the recipient, a 65-year-old man with a badly damaged heart, for the transplant procedure. Marelli has a short conversation with the transplant surgeon, who in minutes will begin the process of placing the life-saving heart into his patient. Marelli stays only briefly. He knows he must get more sleep before facing another busy day.

Despite performing hundreds of such surgeries, Marelli says he is still moved by the experience.

“It is an experience that not many human beings have had,” he says. “It really puts you very close to that fine line between science, art and medicine.”