On Mother’s Day, Anna Hutt listened to her son’s heartbeat through a stethoscope. Sixteen-year-old Payton had been dead for three years after a biking accident not far from his family’s home in Iowa, but since 2014, his heart has kept Gary Flint, 64, alive. Flint was suffering from nonischemic cardiomyopathy, an enlargement of the heart and was one of seven patients who received life-saving organs from Payton.

According to the US Department of Health & Human Services, there are currently more than 119,000 Americans on the national transplant waiting list. Forty-eight percent are registered donors.

Hutt and Flint met three years after the transplant and her son’s death but the amount of time and the process of connecting a donor’s family with a recipient varies according to the transplant center and the organ procurement organization involved.

The University of Miami Health System’s Life Alliance Organ Recovery Agency requires that both parties express interest in communicating and that each party exchange a minimum of two pieces of written correspondence including contact or other identifying information before they meet. The possibility of meeting is a delicate matter for several reasons. One is that the recipient may feel a kind of survivor’s guilt, which could be compounded or overwhelming upon meeting the donor’s family. Another is that it often takes a long time for the recipient to recover from the procedure. Also, the family of the donor may not want to communicate with the recipient even if a long time has passed because it could make them re-experience their loss. On the other hand, if both parties want to meet, it can be highly beneficial to the healing process.

Gary Flint and Anna Hutt began writing and calling each other one year after the transplant. Not only did Flint let Payton’s mother listen to his heart with a stethoscope, he had a recording of it stuffed inside a bear, which he and his family gave to her. Even though Hutt questioned her son’s decision when he filled out his learner’s permit at the Iowa Department of Motor Vehicles, she has come to embrace his decision. Flint says Payton’s gift has given him a “second chance at life.” Hutt says she “couldn’t think of a better man for the heart.” “I want him to live. I want him to smile and I want him to be happy.”