Globe and Mail December 27, 2008

Xander Dolski grabbed a homemade gingerbread cookie from the Christmas tree, took a bite, then began tearing open presents, his favourite being a plastic workbench that reminds him of the television character Bob the Builder.It is a ritual that unfolds in millions of Canadian homes on Christmas, except this was different. Days before, in this same Manitoba home, mother Jennifer Martens had lit a candle in memory of the baby who died three years ago and whose heart now beats in Xander's body.Without that transplant, Xander would not have lived to see any Christmas, let alone his third. He wouldn't have known the joy of a toy drill, how fast plastic cars can race or the taste of turkey, ham and perogies that made up his family's holiday feast.
"It's such a wonderful gift they gave us," Ms. Martens said of the donor family in a telephone interview yesterday from her home in Rosser, Man., northwest of Winnipeg. "Here we are, everything worked out great for us and there's a family out there who lost their baby."
Shown here at eight weeks, Xander Dolski was only a few hours old when he received a heart transplant in Edmonton in 2005. (Jason Scott/For The Globe and Mail)
Ms. Martens, 33, has been in contact with the donor family through an exchange of letters, carefully edited by transplant officials to remove identifying information.
"We've said we really appreciate what they did, that we understand that it's a difficult thing because we thought we would be in that position," she said. "We think we understand what they've gone through. And they feel better knowing their loss has done some good."
Placed on a transplant waiting list as a fetus in December, 2005, Xander was perfect save for a terribly flawed heart. Without a new heart, he faced certain death hours after birth.
His chance at life came the way all transplants do - through another family's tragedy.
Xander's life is a testament to the magnanimity of the donor family, perfect precision and co-ordination in the Stollery Children's Hospital operating room in Edmonton, and a certain amount of good fortune.
First detected at 20 weeks into Ms. Marten's pregnancy, Xander's heart defect was the size of the point of a ballpoint pen. At the time, it was thought to be a valve problem that, while serious, could be corrected by surgery. But as the pregnancy progressed, it was apparent Xander's heart was so poorly developed only a replacement would do.
The aortic valve - the outlet from the heart that sends the blood to the rest of the body - was severely restricted. The muscle in the heart's main pumping chamber was weak. And the hole between the chambers of the heart, which fetuses normally have, was also restricted, so the heart couldn't blow blood out of the body and the blood inside the heart wasn't moving properly.
Today, the blond, blue-eyed boy looks more Gerber baby than transplant recipient. He has an idyllic family life: a younger brother Preston, 22 months; a sister Tanzi, four months; and his parents - Ms. Martens, who works in property assessment for the City of Winnipeg, and Walter Dolski, 43, a zookeeper.
There were so many gifts for Xander that "he's still in the midst of opening presents," Ms. Martens said yesterday.
Binoculars, a shopping cart and pyjamas were among Xander's Christmas gifts, as well as a harmonica from a favourite aunt. Last week, on Dec. 19, he received even more presents when he celebrated his third birthday with a cowboy theme.
"He knows he's different, he knows he has to see the doctor a lot more often than either of his siblings do," Ms. Martens said.
"He knows the doctors will give him pokes and no one else gets as many as he does."
Although there are no national figures on the number of fetuses placed on transplant waiting lists, Xander's was the second such transplant by 2005 for Stollery Children's Hospital in Edmonton.
The Toronto Hospital for Sick Children has put 26 fetuses on the waiting list from 1990 to July, 2006, of which 18 underwent heart transplantation, according to a study published this year in the American Journal of Transplantation. Seven babies died following transplant.
(Of the remaining eight, one baby was stillborn and seven others were taken off the transplant list by their parents. Five babies taken off the list underwent heart repair operations, while two others saw improvement in their condition without surgery.)
"We probably list about two to three fetuses a year, and that's quite a bit," said Dr. Anne Dipchand, head of the heart transplant program at Sick Kids and senior author of that study.

However remarkable Xander's survival, it has not been without a setback. In the spring of 2008, Xander developed what his mother described as a "scary hiccup."
He was diagnosed with post-transplant lymphoproliferative disorder, a serious complication of organ transplantation.
The condition is caused by an uncontrolled proliferation of B cell lymphocytes following infection with Epstein-Barr virus; children and those with heart transplants are at highest risk of developing the disease. Xander has since recovered.
As part of his regular checkups, Xander has his blood checked a couple of times a month, and every three or four months he has an echocardiogram, a test that uses sound waves to create a moving picture of the heart. Each day, twice a day, he takes two anti-rejection drugs.
Yashu Coe, the pediatric cardiologist at Stollery Children's Hospital who treated Xander, said the disorder is controllable. He described the outlook for Xander as being very good.
"He's done very, very well," Dr. Coe said. "He looks like a normal kid."
Each year, Xander sees Dr. Coe to undergo a biopsy of his heart to ensure he is not experiencing early signs of rejection. So far, he hasn't experienced any organ rejection.

"It's very gratifying," the doctor said. "It's a sense of accomplishment to see him behaving and taking part in all normal activities."
And years from now, when Xander grows up, he will take part in another activity with his mother: the annual lighting of the candle in memory of the baby who died on Dec. 18th.
"One day," Ms. Martens said, "I want him to understand what a huge gift this was."