JERUSALEM — A three-and-a-half-year-old boy from Jerusalem named Rafael received a heart transplant using the organ of a six-and-a-half-year-old girl, Saba, from Kafr Qasim. Saba's father consented to organ donation after her sudden death.

Rafael had been a patient at Clalit-Schneider Children's Medical Center for nine months. He was born with a complex congenital heart defect and underwent his first heart surgery at three and a half months old. Dr. Amichay Rotstein, a senior pediatric cardiologist, cared for Rafael. "We went through many hardships. I had to tell the family that we were not moving in the right direction, that his heart was failing, and that he would most likely need a transplant," Rotstein said.

After his heart collapsed during surgery, doctors placed Rafael on ECMO. He was then connected to a Berlin Heart ventricular assist device. "Suddenly, we saw a different child. A child who had barely been functioning began eating again, gaining weight, and smiling," Rotstein said.

Rafael's mother described her son's interaction with the device. "Whenever the machine beeped, he would immediately check that the tubes weren't bent. At night, he would remind me to connect it. He embraced the device with love because he knew it gave him strength," she said. Doctors had made plans for Rafael to travel to the U.S. for a heart transplant.

Saba traveled to Eilat with her father, Mahren Badir, and her sister. "She laughed and enjoyed herself. We had plans for the next day," Badir said. Saba became unresponsive on a Friday morning. "I woke her up, but she didn't respond. I tried again and again, but she wouldn't wake up," Badir said. Saba was first taken to Yoseftal Medical Center in Eilat and then airlifted to Soroka Medical Center in Beersheba.

Physicians at Soroka Medical Center determined that a congenital weakness in a vein in Saba's brain had ruptured, causing a large bleed. Saba was declared dead two days after her hospital admission. Badir immediately consented to organ donation. "We immediately said yes, without hesitation," he said. "My daughter is gone. What am I going to do with her heart? What am I going to do with her kidneys? The body is buried, but the organs can give life. At least let them save other children."

Rafael's father had flown to New York in preparation for his son's potential arrival for a transplant. Rafael's mother, two physicians, a nurse, and a technician were preparing to leave for the airport when they received notification that a donor heart had been found. "When I entered the room, there were far more doctors than usual. I thought they were coming to talk about the flight. Then the doctor told me, 'We've found a heart for Rafael.' I almost fainted. I was in complete shock," Rafael's mother said. Rafael's trip to the United States was canceled.

At Soroka Medical Center, medical teams began recovering Saba's organs. Dr. Gabriel Amir, Director of Neonatal Cardiac Surgery Service at Clalit-Schneider, and his team disconnected Rafael from his Berlin Heart device. "Everything is timed down to the minute. The goal is to have the child ready at the exact moment the donor heart arrives. The shorter the waiting time, the better the chances for the new heart," Amir said. Saba's heart was transported from Soroka Medical Center to Schneider Children's Medical Center.

Following the successful transplant, Rafael fulfilled a wish to feed a giraffe at the zoo. "My daughter's heart is alive. It is a gift from God. Thank you," Badir said. "She was the spirit of our home. The most playful one. Daddy's girl. Whenever she heard my truck coming home, she would run to greet me."