A surgical ballet is her last hope

It was getting late, just after midnight.

Transplant surgeon Kim Olthoff knocked gently and quickly entered the pre-op room. She needed to examine Nadia Kadi before leaving Philadelphia on a Gift of Life charter plane to recover a new liver for the little girl.

The surgeon greeted Nadia's father, Joe Kadi, and began a brisk examination of the toddler.

She placed her palm and then a fist on Nadia's abdomen. By those measures the 46-year-old surgeon would later judge whether a piece of the donor's liver would fit.

Nadia had biliary atresia - a rare condition that destroys the bile ducts and causes serious damage to the liver.

Without a new organ, the little girl with curly brown hair and big, curious eyes would die before she turned 3.

Olthoff turned back to Joe. Not surprisingly, he was a wreck. His daughter was about to have a liver transplant, and his wife was about to have a baby. Allison lay 40 miles away in a delivery room at Doylestown Hospital.

The surgeon told Joe she would do everything possible for Nadia. Then she left for the airport to catch her charter to the city several hundred miles away where the deceased donor lay in a hospital operating room.

It was April 4. She'd be flying through rough weather.

The small plane pitched and jumped so much that Olthoff couldn't sleep. In a career filled with hundreds of transplants, the short flight was among the worst she had been on.

The doctor tried to relax.

It would be a long day of surgery.

A donor's legacy

The donor was on the table, already draped for surgery, when Olthoff and her team arrived at 3:30 a.m.

As usual, only the transplant staff knew details about the donor. That information, including the city and hospital where the donor lay, are kept confidential even from organ recipients to protect the privacy of the donor's family.

Though the donor was brain dead, the heart continued to beat. A ventilator pumped air into the lungs, and blood flowed through the body, maintaining the organs.

Olthoff scrubbed in and joined three other surgeons - all on recovery missions of their own.

Out of respect for the donor, Olthoff asked that no music be played during the operation. The surgeons began their work simultaneously.

Olthoff required more time than the others. The surgeon hoped to divide the liver and prepare part of its left side for Nadia and the entire right lobe for an adult waiting at the Hospital of the University of Pennsylvania.

The four liver transplant surgeons at CHOP worked at HUP as well. The combined transplant program, plus the other major liver operations the surgeons performed, kept them busy. In 2006, the team did 125 transplants, including 10 on children at CHOP.