It should have been a meticulous, synchronized transatlantic transfer: A tiny bag full of precious stem cells flown over the ocean from donor to recipient in a complex but increasingly common lifesaving procedure.
Instead, a British toddler is in critical condition in a U.K. hospital, having undergone extensive chemotherapy and conditioning to prepare her system for a rare stem cell match whose arrival now seems uncertain.
The young girl, who suffers from leukemia and whose identity hasn't been released because of confidentiality concerns, was supposed to receive the transplant from an anonymous Canadian donor her doctors had found she matched with - a rare find when it comes to non-family stem cell searches.
But the long-distance transfer, scheduled for this week, may not be able to take place.
"The patient is in a fairly critical state. … If she is at the point where she's waiting for a transplant to arrive, she will have exhausted all of the other treatment options, she will have had chemotherapy. She will be a very ill child," said Tracy Sands, a spokeswoman for the Andrew Nolan organization responsible for the young girl's transplant.
"It's obviously a really worrying situation: We've got about 16 patients who are affected."
Even as European airspace prepares to open after five days idle because of billows of volcanic ash spewing from Iceland's Eyjafjallajokull, dozens of international transplants were thrown into limbo as air travel ground to a halt.
The chaos was unprecedented, said Leonard Ebeling, physician with Netherlands-based Bone World Marrow Donor Association: The last time he can remember so many time-sensitive transplants being put on hold for so long was immediately after Sept. 11, 2001 - and that didn't ground European flights for as long.
Case managers on both sides of the Atlantic were working "around the clock" to try to come up with last-minute contingency plans, said John Bromley, spokesman for the Canadian Blood Services and OneMatch stem cell and marrow network. Canada conducts more than 130 transatlantic transplants annually, Mr. Bromley said. The procedures are infrequent but vital, and having to deal with such a prolonged air travel blackout is completely new.
"This is so unique, it really is an anomaly from the normal process of what we do. So we're working as we speak back and forth with the international registries," he said. "Case managers have been up all night and through the whole weekend working with these different people … trying to book charter flights, getting that delivery happening."
Transatlantic stem-cell transplants are precarious at the best of times: Once a rare match is found, both the donor and the recipient are prepped in advance. In leukemia or lymphoma cases the patient needs up to 10 days of intensive chemotherapy and treatment to neutralize his or her immune system in preparation for the introduction of foreign cells. A delay in the transplant, especially in someone already ill, can elevate the risk the immunocompromised patient gets far sicker.
After four hours of circulating the donor's blood to collect about a hand-sized bag of stem cells, transplant teams have barely 72 hours to get the cargo to the recipient. In most cases, it's put in a cooler and airlifted to the hospital where it's needed.
Over the past several days, physicians and case workers have been scrambling to make last-minute arrangements, co-ordinating overland refrigerated transportation and, in some cases, chartered flights to continental airports that have been able to operate.