The Man with No Heart

As I was en route to the parking lot on a cold autumn night, my pager started beeping. I was a new renal fellow on call, and this was an all-too-familiar, yet still unnerving, occurrence. The number to call back was one I didn't recognize: the OR. When I returned the call, I learned that a heart transplant had failed with disastrous complications. The patient was hypotensive and grossly volume overloaded. The transplant team was requesting intraoperative dialysis.

Minutes later, after probing unfamiliar corridors, I arrived at the scene. By perusing the patient's chart, I learned more about him. He was 47 years old and had a dilated cardiomyopathy. He had been in the hospital for more than 2 months, was dependent on intravenous inotropes, and was awaiting a heart donor. Early that morning a match had been found. The donor was a 20-year-old man who had died of head trauma sustained in a motor vehicle accident.

To enter the OR …