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Karen had been on the transplant list for a year. She had suffered from a congenital heart defect since birth and had already undergone open heart surgeries three times, when she was four, 13, and 23, said her husband, Dave, a social worker in the Paynesville School District.

While she always struggled with her heart, and with related health problems, things took a turn for the worse in the fall of 2001, said Dave. "Really," explained Dave, "the doctors knew there was nothing more that could be done."

So Karen started the evaluation and application process to get a heart transplant. The evaluation not only looks at your physical health but your social and psychological make-up, according to Dave, since a successful transplant requires you to follow your treatment precisely. They also had to get preapproval from their insurance company to pay for the transplant.

They got on the transplant list in January 2002 as a 2A, the third highest classification, based on need. Then, last spring, Karen needed a medicine pump. Since she was now dependent on a machine, this moved her level to 1B, the second highest level. The only level higher than 1B is 1A, who is someone confined to a hospital on a heart machine.

The heart transplant list is fluid, said Dave, with patients moving up or down depending on their health. Karen, small in stature, needed a smaller heart, from a small adult or a teen. It had to be the right size, had to be a blood match, and could not have any conflicting antibodies.

Karen and Dave have had to live the past year within a two-hour drive of the university hospital, since the transplant call could come at any time. The only exception were trips to Sioux Falls, where his family lives and where they could fly to the Twin Cities in time.

Their first call came on Monday, Jan. 20, just as they were set to come to a Lions Club meeting in Paynesville. Two other patients were ahead of Karen for that heart, but they drove down to the university hospital and got prepped for surgery, only to learn that the heart went to someone else.

At 3:30 a.m. on Monday, Feb. 3, they got another call. The weather had been fine throughout the past year, but this time the call came amidst a snowstorm. Dave didn't think they could get to the Twin Cities in time.

Luckily, a snowplow had just gone by their house and they were able to get to Highway 23 and then to the Twin Cities. This time they were second in line, and when Karen called from the northern suburbs the hospital told them that the heart was a match for her.

They got to the hospital in plenty of time, but the heart, which had to be flown to the Twin Cities was delayed due to the delayed flights.

By 3 p.m. on Monday, Karen was prepped for surgery, and the surgeons soon started the procedure, wanting to get Karen ready for the heart so as soon as it arrived it could be attached. When Karen's chest was open around 7 p.m., the surgeon came to Dave and said that she wasn't sure if it would work and that Karen's best chance for survival was to skip the transplant.

With seconds to make a tough decision, Dave said the deciding factor was thinking about having to tell Karen the next morning that she had not had a transplant after all. "To go through all this and nothing's changed, I can't accept that," he recalled thinking.

By 8 p.m., though, the nurse gave Dave a thumbs-up, saying they had successfully hooked Karen to a heart and lung machine and believed they could complete the transplant. By 9:30 p.m., they had Karen hooked up to the new heart. "By the surgeon's reaction," said Dave, "I could tell we were doing well."

By midnight, they had unhooked the heart machine and Karen's new heart was beating on its own.

Karen was kept under sedation for four days. On Saturday afternoon, they took her off the respirator and she had regained consciousness. By Sunday, she was sitting in a chair and starting rehab, said Dave.

While recovering from heart transplant is on a case-by-case basis, depending on each individual's health, Karen can expect to spend another week or two in the hospital and then will have to live in an apartment on the university campus for a couple months for continued testing and rehabilitation. "She's excited," said Dave. "She's stunned, but there's a long road to go."