After some soul-searching, the Dela Penas decided to try again, and Deborah conceived in October 1985. During the initial months of pregnancy, she was carefully monitored by a pediatric cardiologist at U.C.S.F. Two fetal echocardiograms - ultrasound scans of the heart -performed in the first four months were normal. The cardiologist told them that it would probably not be necessary to repeat the test. They would have a normal child.

ANDREW WAS BORN in July 1986, weighing a healthy 8 pounds, 13 ounces. But two weeks later, he began to breathe a little too fast. Steven and Deborah rushed him to Oakland Children's Hospital, the same hospital where their daughter had died a year earlier. Andrew was placed on a respirator, and an emergency echocardiogram confirmed his parents' worst fears: Andrew probably had EFE. As in his sister's case, Andrew's heart stabilized, and he went home a couple of weeks later. At first he seemed to be getting along well, but Deborah, still worried, asked the cardiologists about the possibility of a transplant. They said she could wait. This time she did not wait; she contacted Stanford.

The Dela Penas met with Dr. Shumway in September, just after Stanford inaugurated its infant heart transplant program. Andrew's initial echocardiograms were encouraging, but by early December, the heart showed ''alarming deterioration,'' even though Andrew still looked well, just as Sarah had until the very end. Another test two weeks later was substantially worse. Doctors told the Dela Penas that if they were considering a transplant, it should be done as soon as possible. Although there was no donor so far, and perhaps there wouldn't be one soon enough, Deborah took Andrew down to Stanford for preliminary blood tests.

It was about 1 P.M. on Dec. 22 when Deborah met Dr. Starnes for the first time. His opening words to her were stunning: ''You're not going to believe this,'' he said, ''but we have a new heart for Andrew - today.''

Today ran through her like an icicle. What was she committing her son to? She called Steven at work. They knew that this was Andrew's only chance to survive, but they also knew that there could be no guarantees. Deborah hung up the phone and turned to Starnes. ''Let's go,'' she said. AT 1:30 P.M. BROWN BE-gan assembling the group for the trip to Fargo. This case was special. It was an infant, and the liver would be taken as well. In addition to the usual crew, she needed someone with a great deal of experience, so Stinson would head the donor team. Brown then notified the operating room and the ambulance service that would take the team from Stanford University Hospital to Moffett Field Naval Air Station, 15 minutes away, where they would board a Learjet for the trip to Fargo.

It was my last week as the general surgery resident on the cardiovascular surgical service, and I was on call yet again. News of the transplant spread rapidly, and I knew immediately what that meant: another sleepless night in the heart palace.

At 2:45 P.M., the team gathered at the entrance to the operating room suite on the second floor of the hospital. On the team with Stinson and Brown were Dr. Mark Grattan, a cardiac surgery resident; Dr. Virginia Gudas, a transplant fellow; Dr. Steven Merlone, an anesthesiologist, and Sharon Butler, an operating room nurse. Dressed in surgical scrubs and white coats, they picked up two metal suitcases containing special surgical instruments and a red Igloo Playmate cooler of the sort usually used on picnics. This would store the donor heart.