Broken hearted
6:42 a.m. Chuck Reynolds goes "on bypass." His blood is piped to a machine that will pump and oxygenate it until the replacement heart is connected and working.

With a scooping motion, Cochran lifts out the old heart. Tubes take blood to the bypass machine, which oxygenates and circulates it.

There's a small, bloody geyser as the tubes are connected. Anesthesiologist Diane Head explains that surgeons try to minimize time on bypass, since blood clots and central nervous system problems can develop when blood contacts non-flesh. (Hint to reporters: Anesthesiologists are a great source of chatter during operations, and they seldom have sharp objects in their hands.)

6:50 a.m. Starkey has brought the heart into the OR and peeked at his patient. As he trims the heart at a nearby table, Starkey comments that it was almost ruined when the donor's body became acidic after death. Starkey neutralized the acidity by pumping sodium bicarbonate into the blood, but he was only 10 minutes away from returning with an empty cooler. Dry runs are common, he says, and one way to get more organs available is to educate doctors about caring for brain-dead "patients" (we'll return to this later).

A greater problem is the shortage of transplant donors. Although the potential benefits have grown with the increasing variety of transplant operations, some families are reluctant to have their loved ones cut up to benefit strangers. Later, in an interview, Starkey laments that individual tragedies are compounded when good organs are buried." If the family does not donate, two people will stay blind due to the lack of a cornea transplant, two people will stay on dialysis for lack of kidneys, someone is not going to get a pancreas and will have to stay on insulin, a whole bunch of people can't use the skin and long bones, one or two people will continue to suffer from lung disease and probably die, someone dies from heart failure, another person dies of liver failure." All that, he says, comes from the simple act of saying, "We're not going to donate."

In 2000, 2,198 hearts were transplanted in the United States, but on Sept. 28, 2001, 4,176 people were waiting for hearts. The Organ Procurement and Transplantation Network says 591 people died while waiting for a heart in 2000, a year in which the lives of 20,000 people were saved or improved by transplant.

7:08 a.m. The potassium added to Chuck's blood has paralyzed his coronary nerves, and his heart has ceased beating after a problematic 54-year run. The pacemaker is pulled out.

With a gaping hole where his new heart will go, Reynolds is well past the point of no return. His new heart is cradled in the hands at left.

7:14 a.m. The entire heart is lifted out and set in a stainless-steel bucket, headed for analysis in a pathology lab.

7:38 a.m. As the new heart is installed, a leaking clamp causes a small geyser of blood. It is quickly controlled.

A sophisticated replacement part, ready for installation. The heart is kinda blue, because it's been without new blood for hours. This healthy, muscular organ should have a lot of pumping in its future.

8:00 a.m. Part of the old left atrium remains in place, and Cochran trims it and the new heart, striving for a perfect joint. At this point, the operation is an expert, hasty and bloody sewing job. To preserve his tissues from degradation while on bypass, Reynolds's body has cooled to 32.9 ° Celsius.

8:10 a.m. The aorta, the industrial-size artery that carries blood from the heart to all of the body except the lungs, is reconnected.

8:24 a.m. Three hours to the minute after the first cut, Cochran announces, "Five minutes to clamps off."

After a brief hiatus, this new heart is getting back to work.