Racing against missiles and time, Ukrainian doctors deliver lifesaving heart transplants

Inside the vehicle are surgeon Volodymyr Press, anesthesiologist Daryna Tkachenko and operating‑room nurse Inna Skrypka. Behind the partition, next to the driver, sits transplant surgeon Sofia Chaikovska. She will assess the condition of the organ, remove the heart, and take it to the operating room.

Ukraine’s national transplant program, operating only since late 2019, now presses on under missile alerts and curfews, its skies closed to civilian flights and medevac helicopters ever since Russia’s full-scale invasion in 2022—air assets that are essential to transplant logistics in most countries. Each overnight relay that sends a donor heart racing across the country by ambulance shows how civilian medicine endures amid the war and why every successful surgery has become a quiet act of resilience that resonates far beyond Ukraine’s borders.

On the road, the doctors doze. They wake at every jolt, then drift off again. The work of transplant surgeons is unpredictable, and they often have to leave at night.

The van stops at a gas station. Chaikovska slides open the small window in the partition and says, “Let’s get out.” The medics jump out of the ambulance, gulp coffee, and five minutes later are racing on. A hundred kilometers remain, so they stretch out on cots and seats. At their feet lie several travel cases stuffed with drugs and instruments. The crew brings everything it may need — no one knows what conditions await.

At 3 a.m., the ambulance pulls up to Korosten Hospital. Tonight, the first organ removal in the history of the medical facility will take place. A heart will be removed for a patient at the Institute, and a liver and kidneys for the Shalimov Surgery Center. The transplants will save four people who are on the verge of death.

A miracle in the OR

Before the heart is removed, the operating room at Korosten Hospital is bustling with activity. But in an instant, everything falls silent: Sofia Chaikovska thanks the donor. The doctors pay their respects with a minute of silence. The transplant surgeon asks for a scalpel and makes the first incision. Focused work begins.

An hour later, the surgeons have the organ. It needs to be taken to Kyiv. First, they place it in a container labeled “Human Organ” and then transfer it to a cooler in the car. Sofia Chaikovska monitors the temperature throughout the entire journey to Kyiv.

Outside the body a heart survives about four hours. But Ukrainian medicine is advancing: on a trip to the United States, Heart Institute doctors learned a method to extend that critical limit. It widens transplant possibilities, especially now, when Ukraine’s closed airspace rules out helicopter transport.

Meanwhile, in Kyiv, the operating room is being prepared. Seven surgeons are involved, among them is the institute director  —  legendary cardiac surgeon Borys Todurov. The team removes the failing heart. Less than an hour remains for the transplant.

An ambulance arrives at the Heart Institute.

Chaikovska steps out of the vehicle, holding the container. She hurries upstairs. The room is silent. Only the monitors beep — monotonous to outsiders, eloquent to doctors. Todurov issues terse commands. The workflow is so smooth the team can read one another without words.

It takes the team just over thirty minutes to sew a new heart into the patient’s body. Borys Todurov says that during the operation, he feels a fear that prevents him from making a serious mistake. Sofia Chaikovska talks about the responsibility for the outcome, as she was the one who brought the heart. Finally, the moment of truth arrives. The clamp is removed from the aorta, and blood begins to flow to the heart. It beats.

The heart had lain lifeless in a bag; now it beats on its own, without assistance. The doctors call it a miracle. A patient who was given no more than a week to live will survive.

A life that would have ended without a transplant

About 4,000 people in Ukraine are waiting for an organ transplant. The registry is managed by the Ukrainian Transplant Coordination Center, and allocation is handled by an automated system. For a heart transplant, the blood types of the donor and recipient must be compatible, and their weight and height must match. But urgency is also important. The first in line are people whose lives are hanging by a thread.

Due to the war, younger and younger people are beginning to suffer from heart disease. The number of military patients suffering heart attacks at the front has also risen; their severe condition requires special care.

Half the patients in the ward need a transplant right now. We can’t discharge them. They will either die or receive a new heart.

There are also those in the wards whose lives have already been saved by a donor heart. Among them is Eduard Beseda from Kyiv. A large white plaster bandage crosses his chest from neck to stomach, surrounded by drains, tubes, and catheters. Two days ago, Eduard received a new heart. Today, he smiles and speaks eagerly.

Heart trouble began to bother him four years ago. By February 2025, his condition had deteriorated so badly that doctors saw no hope without a transplant. Besieda turned to the Heart Institute. After examinations, he was placed on the waiting list. A few months later, the call came: Come for surgery immediately.

“It all happened so fast. I didn’t even have time to feel anything. I woke up in intensive care and immediately felt better,” says Beseda.

The stitches are still there, but he is confident that his recovery has already begun. The chance Eduard got made him rethink his life.

He used to take on any job and never turn down invitations from friends. Now he wants to devote all his time to his family.

“I promised myself that I would spend more time with my loved ones,” he says.

After transplantation the body will reject the donor organ. The process is inevitable, but medication can slow it. For the rest of their lives Beseda and other recipients will take immunosuppressants — drugs that prevent the immune system from attacking the new heart. They will always be at risk of infections and complications. Yet doctors emphasize that when a heart fails, nothing else can take its place.

In return, recipients have a life. They return to work, have children, do what they love. They can run, exercise, and be no different from anyone else.

Who can become a donor

Ukraine’s transplant system still has gaps, Todurov says, and not everyone in line will receive an organ.

Only a person who has been declared brain dead can become a potential donor. A panel of doctors must convene and carry out clinical tests  —  not yet routine practice in Ukrainian medicine.

“In the United States, I asked my colleagues how often they determine brain death. They looked at me in surprise and said, ‘Always,’” recalls Chaikovska.

After brain death is confirmed, permission to harvest organs is required. Ukraine operates under presumed refusal — unlike many European countries that follow presumed consent — meaning a person must give explicit lifetime permission, or relatives must approve, before organs can be taken. Understanding of transplantation’s importance is limited, so families often refuse.

Active military personnel and people killed in combat cannot become donors. This law prevents manipulation of the bodies of the deceased and speculation by Russian propagandists. With the start of the full-scale war, they claimed that Ukrainian doctors were taking organs from Russian soldiers.

What does the future hold for transplant medicine?

Ukraine’s organ‑transplant system began working only at the end of 2019. Before that, Heart Institute doctors watched patients die inside hospital walls — often 35‑year‑old men struck suddenly by rapid heart failure. Mechanical hearts cost about €250,000 (roughly $270,000) and transplants abroad are even more expensive. Heart Institute surgeons, including Todurov, campaigned for a domestic transplant program.

Worldwide, transplantation began in the 1960s with daredevil “mad geniuses” of medicine who broke laws for the first human transplants. Soon the procedures were saving lives. In Ukraine, enthusiasts took up the cause as well. Todurov performed the first heart transplants in 2001, when the state offered no support and he bought immunosuppressants for patients at his own expense. Those recipients lived 18 years after surgery.

The Heart Institute team loves its work. They lose track of time, working nearly without days off. In just the past two weeks they have performed five complex transplants. One took place under the explosions of Russian drones. Still, they carry on.

I dream of doing thousands of transplants. I dream that certifying brain death becomes routine and is approached seriously. That transplants become everyday procedures, performed not only by unique specialists.

A new frontier lies ahead. Doctors at the Heart Institute are constantly training abroad, participating in international conferences, and conducting their own research. From Stanford, New York, Nashville, Toronto and across Europe, they bring back knowledge that changes Ukrainian medicine, raising its prestige worldwide. Soon, the team will travel to the World Congress of Transplantation, held every 10 years. Todurov will give a 40‑minute presentation,  an opportunity few surgeons receive.

Alternatives are emerging as well. Mechanical hearts grow more advanced, and in the United States, experiments are already under way to transplant organs from genetically modified pigs.

“I hope that in five or 10 years we will not need donor organs at all. There will be a farm where genetically modified animals are raised,” Todurov muses.

 

Text: Diana Deliurman (adapted by Jared Goyette)
Photo: Oleksandra Rakhimova