One of the thousand children transplanted at Vall d’Hebron: “This is my home, I spent my whole life here”.

A day 19 years ago, Gemma got up in the morning and brought her daughter Meritxell to kindergarten. The girl had just 20 months old. They lived in Terrassa. At mid-morning I had a visit scheduled with the pediatrician because the baby, at times, did not seem to hear. In addition, his heart was beating very fast. Gemma had expected to eat at home with her family that day, but that was not to be. She was automatically referred to the Vall d’Hebron Hospital in Barcelona. And there, that same day, within two hours of arriving, he was admitted to the pediatric ICU.

Meritxell Brugueras Carreras, now 21 years old and a student of English and Catalan philology at the UAB, was suffering from a pulmonary hypertension which until then had not been diagnosed. A month and a half later, at just 21 months old, he was transplanted in both lungs. Vall d’Hebron has just surpassed the figure of one thousand pediatric solid organ transplants (lung, kidney, liver and heart) performed. since 1981. Meritxell’s was the sixth pediatric lung transplantation (the third in infants, which are those under two years of age) that the hospital performed that year. It was 2003.

“I don’t remember the transplant because I wasn’t even two years old. But afterwards I do have [recuerdos] I have been in Vall d’Hebron all my life. It is my home, is to feel safe. When I was nervous as a child, I would come here and calm down.” recounts the young woman accompanied by her mother, the head of the hospital’s Thoracic Surgery and Lung Transplant Service, Alberto Jauregui, and Dr. Antonio Moreno, the head of the pediatric section of the hospital. This is the pediatrician who treated her throughout her childhood. The one who was at his transplant. “I have already told him that, if he ever moves out and goes far away, To pick a nice place, because we’ll go with him,” the mother intervenes. How could she not feel affection And a deep trust in one of the people who saved his daughter’s life?

The diagnosis

“Meritxell was a child apparently normal, but at 20 months she turned blue, her oxygen was very low, and she was diagnosed with pulmonary hypertension. Within three weeks of admission to the ICU, he became so ill, he needed a ventilator. Soon after, he made a cardiac arrest and had to intubated. She was so serious that the doctors gave him medication in his vein and by mouth and administered nitric oxide as if it were oxygen,” Moreno recounted. Only a double lung transplant could save his life.

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The baby was waiting for the organs a month and a half and the wait, the mother recalls, was “hard”. Gemma also remembers the “inhospitable” which was then the pediatric ICU of Vall d’Hebron, nothing to do with the one we have now: “It was from the year 1967, when the hospital was inaugurated. It was the first pediatric ICU in Spain”, Moreno points out.

The organs for Meritxell, who had been in the ICU since the end of December 2002, arrived March 2003. Meritxell’s donor, in addition to giving her two lungs, donated more organs. to other children. “To one whose name was Ivan he gave a liver. And some corneas for another child from a foreign country; I remember the mother didn’t speak Spanish and had an interpreter. Ivan we kept seeing and for a while it was curious to think that they had organs from the same donor.” recalls Gemma, who at the time was pregnant of her second daughter.

The end of one stage and the beginning of another

Gemma’s voice is the authentic story of that time, for the young woman does not remember all that. “The arrival of the organs was the end of one stage and the beginning of another. But we didn’t know if that day really started something or if it was all over because the girl was very bad. We didn’t think she would be able to overcome the hardness of the intervention,” she recounts. For weeks, Meritxell had the “24 hours” a doctor “at the foot of the bed” from the uci.

In the month and a half while they waited for the organs, the doctors did not give the parents “expectations” that the little girl would live. “You are in the ICU waiting and you see that four or five children arrive every week, but two or three die.” They did not know if Meritxell would get out of there.

“For the families, that waiting time is a hell because they also know that at any moment something may happen and it may the organ may not arrive in time.” Dr. Jauregui specifies for his part. He explains how surgeons go “against time”: in a transplant there is a medical team that in one hospital is removing the patient’s organs and another medical team from another hospital, in another part of the continent, which, knowing that the organs will be compatible, is already opening the recipient patient. “We only have eight hours from the time we decide we’re going to do it until those lungs start breathing in a body like Meritxell’s.” There is no time to waste.

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Recovery and second complication

Meritxell overcame the transplantation, which lasted between five to six hours. For many years, Vall d’Hebron was the only hospital that performed transplants in infants. In fact, Vall d’Hebron is “reference center” in pediatric lung transplantation in both Spain and Portugal, Dr. Jauregui points out.

However, the three years Meritxell’s subsequent three years were complicated because, although the transplant went well and after five weeks the girl was at home, shortly thereafter she was found to have a nodule in her lung. “It is a complication that can occur in some tiny transplanted children.” Dr. Moreno explains. Medications for immunosuppression can lead to a Epstein-Barr virus infection, which in turn can cause lymphoma. That is what happened to Meritxell but, again, the hospital successfully treated the girl and succeeded in curing her.

“Mind you, I did all of elementary school with mask in class.” comments the young woman. What for the majority of the population has been a novelty of the pandemic is, however, a habit of people immunosuppressed, like Meritxell, who have a lot of more at risk of developing any infection. She also remembers spending many nights in the hospital. “I was always sick when it was the Kings, January.” he says. And she remembers, together with her mother, the day when the young woman turned 18: “We came here to the maternity and children’s hospital to say goodbye and bring them pictures because she was now a patient of the general hospital.”

Meritxell has now returned to this mother and child hospital that she knows so well, to celebrate those thousand pediatric transplants. She has been greeted, because they remembered her, by some of them. cleaning ladies. Gemma, the mother, also remembers many doctors who then treated her daughter: those who were 24 hours a day at the foot of her bed. “Then they were MIRs, now they are hospital chiefs.” he says. For Dr. Moreno, meeting patients like Meritxell, who manage to overcome their problems, is a “reward”. “But there are other kids who don’t make it through, so this teaches you too to be humble.” He assures that in his house he keeps all the gifts that his little patients give him. Drawings, for example. “They’re always there and I never take them down.”

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