Some years ago inside an operating room at Le Bonheur Children’s Hospital, Dr. Mohan Karkara, an anesthesiologist born in Mumbai, India, kept watch over a 6-year-old girl during a heart transplant surgery.

As a team of doctors and nurses worked in practiced rhythm, one of Dr. Karkara’s assistants pointed out a small but terrifying sign. Blood in the child’s urine was the first indication that the transplanted heart was already failing.

The surgeon made a daring decision to place the girl back on the heart-lung machine and send an urgent plea across the country for another heart.

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