IOWA — Isabella Hagemann will be the first to admit the last year hasn’t been an easy one for her three-year-old daughter, Ali.

“It’s been a lot of ups and downs,” she says. “She’s had a few bouts with pneumonia, and we made a trip to the hospital on New Year’s Day.”

But compared to Ali’s first two years, it’s also been a relative cake walk.

Born with a congenital heart defect, spent months in the NICU. Then, in January of last year, her heart began to fail, and she had to be confined to the University of Wisconsin Children’s Hospital while she waited for a transplant.

The call finally came, and on July 31, 2024, the doctors in Madison replaced Ali’s heart with a new one.

“They said it was a perfect fit,” Isabella remembers. “They said it started working immediately.”

A year later, nothing has changed. Ali and her new heart have combined to rush headlong into the wide world of an American toddler—one who’s had some catching up to do.

“I was expecting her to really struggle socially to be around kids because she couldn’t be around them for like nine months straight,” Isabella says, “but she is a great friend.”

“She’s really starting to be more of a kid and interact and play,” says grandfather, Al Hagemann. “It’s just been so fun to watch.”

Since we last saw her in October, Ali has been able to put on needed weight and lose the yellow tube that fed medication through her nose.

She now blends in with the crowd of three-year-olds at daycare.

“She doesn’t have any mobility issues,” Isabella says, “her scars healed fine, she’s doing well.”

Having reached a full year since the transplant, Ali’s family can now do something they’ve been looking forward to since last July.

“I’m hoping to meet the donor family,” Isabella told us in October. “I want to thank them. I want to say ‘thank you for my baby.’”

For now, all she can do is hand the donor network a letter—one she’s written and rewritten three times.

“It mostly just talks about my gratitude for their selfless decision,” she says. “It has a picture of Ali and me enclosed.”

The decision to open or even agree to receive the letter will be left up to the donor family. At this point, the Hagemanns know absolutely nothing about them. Despite the opportunity for closure, gratitude, or even celebration, the reality is only a small fraction of these potential meetings between recipients and donor families ever happen.

Isabella knows this.

“You just never know the circumstances,” she sighs. “That family has lost their baby.”

Nonetheless, the Hagemanns are crossing their fingers and allowing themselves to imagine such a day.

“I’ll start with thank you,” Al says. “But then I’m really hoping that maybe they’ll want to listen to Ali’s heart. Both the parents, the siblings, whatever—to be able to listen to Ali’s heart because…that’s a part of them.”