On the morning of Sept. 11, 2001, a six-month-old Houston baby named Kareena was dying inside Texas Children's Hospital, her liver scarred beyond saving from a congenital defect called biliary atresia. Hundreds of miles away in Nashville, a matching donor liver had just become available. The only problem: every civilian plane in the United States was about to be grounded.
Kareena was born with biliary atresia, a congenital defect in which the bile ducts fail to form properly, according to the Houston Chronicle. Dr. John Goss, who would go on to perform her transplant, said at the time that she was too ill to leave the hospital and would not survive long without a new liver, per the same account. Dr. Ravi Chari had reported a possible match for Kareena coming out of Nashville, where a Tennessee family had lost an infant overnight and chosen to save another child through organ donation.
A Nation's Skies Went Silent
Tennessee Donor Services had planned to charter a flight to carry the liver, roughly 800 miles, from Nashville to Ellington Field in Houston. Then the Federal Aviation Administration grounded every civilian aircraft in the country, an unprecedented nationwide ground stop the Chronicle's reporting places squarely in the middle of that morning's chaos. The order, according to the U.S. National Archives, was the first unplanned nationwide emergency ground stop in American history, executed under SCATANA emergency procedures and forcing more than 4,500 airborne aircraft down at the nearest available airports.
With commercial and private aviation frozen, the liver — described in the Chronicle's reporting as about the size of a plum — had nowhere to go. That is when Jill Grandas contacted the air-traffic control tower at Nashville International Airport, and a supervisor there authorized the Tennessee Air National Guard to fly the organ to Houston. The mission, Grandas said, was simply to get the liver to Houston.
A Surgeon-Turned-Senator Clears the Skies
The escalation reportedly reached U.S. Senator Bill Frist of Tennessee, a former heart-and-lung transplant surgeon, who helped secure federal authorization for the emergency military flight, according to The Alliance News Center. Frist's surgical background meant he grasped the urgency of the situation without needing a lengthy explanation, the outlet notes. The stakes were medically absolute: donor livers preserved through static cold storage typically begin to decline after eight to 12 hours, according to the American Association for the Study of Liver Diseases, making rapid transport essential.
Nine guardsmen with the Tennessee Air National Guard flew the donor liver to Houston aboard a C-130 Hercules that day. The aircraft belonged to the 118th Airlift Wing based at Berry Field in Nashville, and co-pilot John Howard later noted that the 10-ounce organ container was the lightest payload he had ever transported, according to WPLN News. It was a striking contrast: the same C-130 Hercules model is built to carry up to 47,000 pounds of cargo, yet on this flight it ferried an organ that fit in one hand.
Racing Down Interstate 45
The donor liver arrived at Ellington Field within a few hours, the Chronicle reports, and was handed off to another group of soldiers around noon before being rushed down Interstate 45 toward Texas Children's Hospital in the Texas Medical Center. WPLN News reports that the Tennessee crew handed off the liver container without even shutting down the C-130's engines, shaving every possible minute off the journey. The liver matched Kareena's size and blood type, and Dr. John Goss performed her transplant in Houston that day.
Kareena spent most of her early life inside the Texas Medical Center as she began a path toward a normal life following the surgery. The attacks that day killed nearly 3,000 people in New York, at the Pentagon in Washington, D.C., and in Shanksville, Pennsylvania, a scale of loss that stands in stark relief against the single life saved hours later in Houston.
Biliary Atresia's Long Shadow
Kareena's condition remains the most common reason children need liver transplants nationwide, accounting for more than 40% of all pediatric liver transplants performed in the U.S., according to the Kellner Pediatric Liver Foundation. Even children who undergo early corrective surgery in infancy often are not spared: roughly 80% of those diagnosed with biliary atresia will eventually need a transplant before turning 20, per the UCSF Department of Surgery.
Texas Children's Hospital, where Kareena was treated, has continued to grow into a national leader in pediatric transplantation. The hospital set a national record in 2025 by performing 144 solid organ transplants, leading the country in pediatric liver and kidney transplants under Medical Director Dr. John Goss — the same physician who operated on Kareena in 2001, according to Texas Children's Hospital.
A Bond That Endures 25 Years Later
Now 25, Kareena graduated from college and is studying health policy in law school, with plans to work on health equity. She lives in the Houston area and calls Jill Grandas in Nashville every Sept. 11. This year, the two met in person for the first time in Houston.
Kareena has said the strangers who saved her life created a family, friendships and communities that continue to this day. It's a quieter thread of the day's history, one that ran alongside the broader military response that followed — the U.S. Air Force, in the crisis's aftermath, expanded its domestic alert fighter fleet from 14 jets nationwide to 35, backed by refueling tankers and AWACS surveillance planes, according to Air & Space Forces Magazine. Amid that unprecedented military buildup, a single unarmed cargo plane carrying a plum-sized liver had been cleared to cross an otherwise empty sky, and a Houston baby lived because of it.
