Mags’ heartbreaking journey in Transplant Season 4

Medical drama series Transplant has been dropping hints about Dr Magalie “Mags” Leblanc’s heart condition since its first season. Now, in the fourth and final season, it becomes a matter of life and death – just as Mags and her dearest love and friend Dr Bash Hamed (Hamza Haq) are told that they’ll be competing for the one and only ER Fellowship position at their hospital. 

By episode 2, Mags is sitting with a job offer in one hand, and a phone call revealing that she needs to get in line for a heart transplant in the other. While opting for the heart transplant seems like the obvious choice, it’s not the easiest choice. And the series takes us inside the realities that major organ transplant patients have to confront.

Watch the trailer for Transplant S4

Binge Transplant Season 1-4 now.

The physical journey

Mags had a brush with death in her childhood thanks to a condition called heart block. The experience of surviving that and having a pacemaker installed was one of her greatest drivers to become a doctor. She has been discreetly managing and monitoring her heart her entire life, but in Season 3, things started to slip when Mags passed out in front of Dr Fisher (Deena Aziz) while suffering a “massive arrhythmia”. While Dr Fisher warned her that she needed to manage her stress – as an emergency room doctor – it always pays to get a second opinion. 

In Season 3, episode 12, Mags met with Dr Adam Viri (Bruce Horak, Hemmer in Star Trek: Strange New Worlds) and Dr Samantha Levesque (Dawn Lambing), who reinterpreted both her current symptoms and her past medical records and picked up results that passed as “normal”, but in her case hid some important information. 

It’s a reflection of a real-life issue in medicine, in that women have been significantly underrepresented in studies on heart failure (and clinical trials in general). As a result, the clinical signs used to detect heart failure are based on measurements that are largely taken from male patients, and they can and do miss indications of heart failure in women, leaving them less likely to be referred to heart failure centres, and less likely to receive treatment. 

A mental roadblock

In the Season 3 finale, as part of her evaluation, Dr Viri urged Mags to think seriously about her life goals and career for the next five years. He revealed that one of her heart valves has been steadily weakening, explaining her abnormal fatigue and tachycardia. As a result, her heart has been dilating and its ability to pump blood has been weakening. He told Mags that she would be a good candidate for a heart transplant. And if she refused transplant, she would need to scale back her levels of stress dramatically. 

It was time for a serious rethink about her life, and a talk with her support team of friends and family. And at the end of her shift in the Season 3 finale, Mags told her frenemy turned bestie and new housemate Dr June Curtis (Ayish Issa) that she was completely paralysed by the decision she had to make. Mags doesn’t have long to think, either. While she was told the decision could take as long as six months, in Season 4, episode 1, Dr Viri announces that the organ donor board has accepted her on the transplant list. And as Mags comments, “Something like this isn’t ‘on your radar’, it’s all of your radar.” Possibilities about transplants suddenly eclipse everything else in her life. 

Mags’ biggest question

The biggest question mark for Mags is the one hanging over her career. If she lands the Fellowship, what then? She’s gotten where she is while keeping her health condition to herself. Once the cat is out of the bag, will people have a picture in their head of her as someone fragile, and close all sorts of doors before she can even see them? Will every mistake she makes just reinforce the idea that she is “weak” rather than human and fallible like every other doctor?

Should she get a career transplant, too? And what would that mean to someone who considers patient-centered medicine in a physically demanding field to be their calling? Perhaps Mags could look to real-life doctors who’ve had heart transplants and returned to work. One shining example is Dr Robert A Montgomery, who retrained from his surgical field to become a physician when his heart issues started impacting his work. He went on to become the director of the transplant programme at Johns Hopkins before becoming a heart transplant patient himself. After his transplant, he was back running his programme on a half-day basis just a week after being discharged from hospital. Three months later, he was back to seeing patients. He is now the director of the Transplant Institute at NYU Langone Health.

Get ready to live or die

We’re jumping ahead, though. From the moment Mags is accepted onto the transplant list, she needs to be ready for a matching donor heart to be available. And it’s a lot to mentally juggle with her busy job.

• She will be in communication with a transplant nurse and must keep them updated about her movements around the country.
• She needs to hand in all her intake forms because hospitals love paperwork.
• She needs more blood work, even though she literally just had a full workout done to get onto the transplant list in the first place.
• She needs to set up reporting from her current pacemaker to her transplant team.
• She’ll need to avoid picking up any infections, as her transplant nurse reminds her over the phone, “Emergency doctors are more likely to be exposed to the most common kinds of viral and bacterial infection.” This is vital because if the heart comes, but you’re fighting a serious infection, you miss your miracle and go back on the list.
• She needs to select a caregiver and primary support person. In Mags’ case, her mom Camille (Mylène Mackay) will take that position, whether Mags wants her to or not.
• She needs to plan rapid transport to hospital the moment a donor heart becomes available.
• She needs to organise her personal affairs in case things go wrong. And this comes with a massive hidden workload including updating wills and taxes and figuring out which passwords people will need to manage your digital and physical presence in the event of your death. Don’t forget mental hurdles like planning your own funeral and corpse disposal.
• And she needs to hand over all her patients and cases at work, which is its own mountain … especially as Mags has not actually told her boss what’s happening by the time she gets the call that a heart is available for her!

Life after death

Mags is going to have to spend about two frustrating weeks in hospital before starting her long road to recovery. Along the way, she’ll need to keep the following things in mind.

• The transplant will take about seven hours without complications. From there, she will be in ICU for a few days, in a ward for about a week. And then it’s home for a long recovery. On the optimistic side, that would be six months.
• Mags’ return to work would have to be negotiated to accommodate her post-transplant life.
• Organ transplant patients need to take drugs to prevent their own immune system from attacking the donated heart for the rest of their lives. So for Mags, working in a hospital and being exposed to germs all day every day poses significant risks.

But odds are, she’ll live to complain about it all! Ninety percent of adult heart transplant patients survive their first year, 80% survive five years, and around 50% of all heart transplant patients are still alive 11.9 years after their transplant. The current long-surviving heart transplant patient, Bert Janssen, has been living with his donated organ for the past 40 years. 

Did you know?

• Heart transplantation is still relatively rare. According to the International Society for Heart and Lung Transplantation, around 5 000 heart transplants are performed every year around the world, while an estimated 50 000 patients are on the waiting list. Meanwhile, in South Africa between 1997-2019, only 625 people in South Africa were referred for heart transplants. And of those, only 130 received hearts. If you have a donor heart, you already beat the odds.
• The world’s first successful human heart transplant was conducted by South African Christiaan Barnard at Groote Schuur Hospital in Cape Town in December 1967. His patient, Lewis Washkansky, survived for 18 days but died of a lung infection. (The Afrikaans movie Hartstog, which follows this remarkable true story, is on Showmax.) 

Where will Mags’ journey take her? Binge Transplant Season 1-4 now to find out.