Majadahonda (Spain) (AFP)

Extract a liver, kidneys, a heart to reimplant them, all in saturated intensive care units: in the midst of a pandemic, organ donation has proved to be an even more difficult challenge than Spain, world champion in the matter, knew how to raise.

The ambulance rushes at an open speed at 150 km / h on the Madrid ring road towards the airport.

The cars pull away when the blue flashing light passes and the words "organ donation" appear.

On the tarmac, a private jet waits, ready to take off.

The three caregivers in green surgical gear rush into the device, one dragging a blue cooler on wheels.

Somewhere in Spain, a person is brain dead.

You have to go find your heart to bring it back to Madrid and try to save a life.

- The key role of intensive care -

On the plane, Juan Estebán de Villarreal, 28-year-old surgeon, and Erika Martínez, 41-year-old nurse, remember the first wave, when the pace of transplants suddenly slowed down.

"The pandemic has mainly changed one thing: the number of transplants. The main problem has been the collapse of intensive care in all hospitals," says the nurse who has 450 transplants to her credit for 15 years.

Cardiac surgeon Juan Esteban de Villarreal pulls a roller cooler containing the heart of a donor that is going to be transplanted to a patient at the hospital in Majadahonda, near Madrid JAVIER SORIANO AFP

Intensive care, where the Covid-19 tragedy takes place, is also the place where transplants are decided.

"It is in these units that the donors are identified and that the collection takes place," explains Beatriz Domínguez-Gil, director of the National Transplant Organization (ONT).

This is also where "recipients should stay for at least the first few days after their transplant".

In 2020, the number of transplants in Spain fell by around 20%, she said, but even at the height of the health crisis, the country posted better results than other countries before the pandemic ( 37.4 donors per million inhabitants in 2020 compared to 29.4 in France and 36.1 in the United States in 2019).

Spain has thus maintained its leadership with 5% of transplants in the world, while it represents only 0.6% of the world's population.

In March 2020, at the start of the pandemic, Amparo Curt was placed on the waiting list urgently after a devastating autoimmune hepatitis.

He only has "a few days" left to live.

"You realize that you are going to die. And you think: what organ am I going to be able to have in full Covid?", Entrusted to AFP this woman of 51 years.

By "miracle", it is called a few days later to receive, "at the strongest peak of the pandemic", a new liver.

Subjected to three successive PCR tests during her hospitalization (like all donors and recipients from March 2020), she returned home five days later.

Cardiac surgeon Juan Esteban de Villarreal prepares the heart of a donor who will be transplanted to a patient at the hospital in Majadahonda, near Madrid JAVIER SORIANO AFP

A scenario of "science fiction" that she relates between a few sobs: "grateful for life", Amparo "understood that anything was possible".

- "He moves well" -

In Majadahonda, near Madrid, a recipient at Puerta de Hierro hospital awaits the heart that the medical team has gone to seek in a place whose location will remain confidential in order to protect the identity of the donor.

Somewhere in the air, Juan Estebán de Villarreal does not know if the very expensive trip will be successful, but "a heart is not something you can buy".

Three quarters of organ transport that takes place by air is carried out through commercial lines (which offer this service free of charge), but some organs, which cannot wait, must travel by private jet.

Heart transplant at Majadahonda hospital, near Madrid JAVIER SORIANO AFP

During the first wave, with reduced air traffic, it was necessary to improvise, juggle mobility restrictions, accept - in the case of heart transplants - that the extraction be done by teams close to the donor hospital and have the organ travel alone.

The aircraft landed on an airport.

Ambulance, hospital, locker room, change of equipment.

In front of the sliding door of the operating room, several coolers await their organ before leaving for unknown destinations and recipients.

Inside the block, about fifteen people are busy.

Juan Estebán de Villarreal approaches the body, delicately palpates the organ that is still beating in the gaping rib cage.

After a few minutes, he walks away.

"I would say yes, he moves well," he said over the phone.

Green light for extraction.

The heart is placed in a simple tupperware filled with serum, then placed in three hermetically sealed plastic bags.

"Air is the enemy," repeats the surgeon.

Cooler.

Changing room.

Ambulance, tarmac, take off to Madrid.

In the center of the plane, a blue plastic chest filled with a treasure: an organ isolated from a body and from the rest of the world is waiting to come to life.

Landing, ambulance and, finally, Majadahonda hospital.

The patient is already open.

The old heart is withdrawn.

A few hours later, the patient is ex-cased.

A new life begins for this heart and especially for its new owner.

© 2021 AFP