A surgeon stops a heart in Anchorage, Alaska.
In the world of organ donation, this stoppage is known as "Cross Clamp Time." A clamp pinches the aorta, stopping blood flow. It's the official, recorded start of a race to get that heart wherever it's going. Too long, and the heart could freeze to the point of unviability.
The doctor in charge of this particular heart is Chris Schwartz, 42, a sports dad in Smyrna, Tennessee, when he's not preserving human organs. He has the Rolling Stones' "Paint It, Black" atop his heart-transporting playlist. "I look inside myself and see my heart is black. I see my red door. I must have it painted black."
Before this trip to Anchorage, the outer edge of preservation for a human heart outside the body was about six hours after Cross Clamp Time.
But now, three doctors from Vanderbilt University will try to stretch the viability of that heart past 10 hours, a time period beyond the boundaries of dreams just a few years ago.
The doctors will travel 2,900 nautical miles across the U.S. to Nashville where someone is waiting for their life to be saved. Their previous longest trip was 1,719 nautical miles from Seattle.
They believe they will be able to do it because they think they have cracked the code of organ transport. They have a heart-preserving contraption that looks like a cooler you would roll full of Gatorade to your kid's ballgame.
"We call it the Magic Carpet," Schwartz said. He's the heart preservationist on what Vanderbilt has said is the longest heart donation trip ever.
In the pre-dawn hours of a Sunday in Alaska, Schwartz hoped the magic carpet ride he and his colleagues were about to take would reset the edge of organ donation — and save more lives.
How do you pack for a life-saving trip?
Stephen DeVries, 37, was in Kissimmee, Florida, closing a real estate deal when he got the call about the Alaska trip. He's a primary recovery surgeon at Vanderbilt, and he's always on call.
He's the guy who cross clamps the aorta and removes the heart from the donor.
DeVries is from Wisconsin, and he has what the kids would call a chill demeanor. Every time he saves someone's life he does his best to make it "just another case." There is no urgency in his voice as he describes the amazing things he does.
He's just blandly brilliant. He said his heart rate doesn't elevate when he's removing someone's heart.
Vanderbilt did 143 heart transplants in 2023.
"It's very rare we have any issues," DeVries said.
Will Tucker, 31, an extracorporeal membrane oxygenation fellow at Vanderbilt (meaning: he oversees the removal and replacement of unhealthy blood from patients), was assisting in a surgery when he got the call.
Vanderbilt transplant traveling teams are made up of three doctors.
"I packed clothes and a jacket," Tucker said.
Schwartz was at his son's baseball game. A nervous dad, he paces when his son pitches.
He was pacing when his phone rang. He recognized the number. It was from Shelley Scholl, who coordinates transplant trips.
"Are you sitting down?" she asked.
He wasn't because his 17-year-old son, Aiden, was on the mound.
"No," he said.
"How do you feel about Alaska?" she said.
"It's cold," he said.
"We have a heart," she said.
Schwartz said he immediately knew the significance of Alaska.
"This was the pinnacle," he said.
Before this trip, doctors had been talking about Alaska like it was the final frontier.
It took Schwartz an hour and a half to pack. He's in charge of the magic carpet, a Traferox cooler that he would fill with charged gel packs designed to keep a human heart between 8 to 10 degrees Celsius.
He made a quick stop at a store for ice to cool the medicinal fluids in which the heart would be submerged.
"Knowing the weight of your job ... it's life and death," Schwartz said. "It's very humbling."
Things to do in Alaska: 1. See a moose
Transplants don't always go off as planned.
Sometimes there can be tension between the team who gets the heart and the team who gets the lungs. Donations of eyes, kidneys, pancreas and other body parts are high demand with waiting lists for patients across the country. Vanderbilt is a leader in aggressively searching for organs to help save lives.
This trip didn't have any of those issues.
There was, however, a hiccup.
The donor's lungs were first scheduled to go to one recipient, and that changed at the last minute. It delayed the transplant operation.
So Tucker and Schwartz, who arrived in Alaska before DeVries, had several hours to kill.
"We had to see a moose," Schwartz said.
They rented a car and went to an animal preserve, and the only moose they saw was in a barn.
"It was like seeing a cow," Schwartz said. "It wasn't in the wild."
They were driving back to their hotel when they saw a wild moose near the highway.
Mission accomplished.
Holding life in your hands
The heart donation began just after 1 a.m. on a Sunday morning (Vanderbilt did not release the date or the names of the patients involved due to medical privacy laws).
All donors have to be brain-dead and on a ventilator, meaning their hearts and lungs are still functioning.
DeVries inserted a needle into the heart to inject cardioplegia fluid to stop the heart. Tucker assisted with the procedure.
Schwartz waited until DeVries used a bovie knife to cut the aorta.
Then it was Cross Clamp Time.
DeVries removed the heart and put it in a basin. Schwartz took the basin to the "back table" where he inspected the heart for inflammation, holes, pus and other maladies.
"I never take it for granted," Schwartz said. "You are holding someone's life in your hands."
This heart passed inspection.
"Everything looked beautiful," Schwartz said.
It is required that a transplant heart be surrounded by three sterile barriers. So Schwartz put two plastic bags and fluids around the heart, then placed it in a white bucket.
"The solution keeps the heart from beating," Schwartz said. "You don't want the heart to beat."
Then he placed the bucket in the magic carpet for the ride of its life.
The doctors at Vanderbilt had fashioned a rectangle out of PVC pipe to hold the bucket in place.
Into the Alaska night they walked, Schwartz rolling the heart behind him like it was luggage.
They got into an SUV that whisked them to the airport.
'They were our pit crew'
With the clock ticking, the Leer 60 private jet had to stop to refuel in Billings, Montana.
They had stopped there on the way out, so the people on the ground knew a life-saving mission would be happening when they came back.
"They acted like they were our pit crew," Schwartz said.
The doctors went inside the airport for a quick cup of coffee.
The crew refueled the plane in less than 15 minutes.
As they lifted off again, DeVries and Tucker, who had been up all night for the surgery, tried to sleep. All of them are tall men, so getting comfortably stretched out on a Leer 60 isn't easy.
Schwartz had to monitor the heart. The temperature, which had to stay between 8 and 10 degrees, was at 9 the whole flight.
Back at Vanderbilt, a team of surgeons was waiting for the call from the plane.
With 90 minutes to go in the flight, Schwartz called Vanderbilt to signal the beginning of the recipient's surgery.
It took 25 minutes to drive the heart from BNA to Vanderbilt on a Sunday.
The total time from Cross Clamp to reperfusion (restoring blood flow to the heart) was 10 hours, 22 minutes.
After traveling more than 10 hours, what's next?
Schwatz usually goes home after he hands over the heart.
This time he didn't.
"I watched the entire case on this one," he said. "Seeing that first beat after they pulled the clamp off ... my heart jumped. We did it."
The transplant was a resounding success.
"It was the crown jewel moment of your career," Schwartz said. "More patients are going to be able to get transplanted."
And now that they've conquered the 10-hour time of going to Alaska, the doctors involved in Vanderbilt transplants are talking about another boundary.
"Hawaii is our next thing," Schwartz said.
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