HEART TRANSPLANTS

Alexis Carrell and C G Guthrie began performing heart transplants in animals in 1905(4). Initially, they experimented on rats, and then went on to graft the heart of one dog into the neck of another(5) - the misplaced organ beat for a short while(6). The partnership dissolved in 1906(7) with Carrell continuing transplant experiments - but did nor reach the concept of rejection(11), nor did he understand the fundamental difference between autografts (transplanting the heart back into the same animal) and homografts (from one animal to another of the same species)(12).

Others tried and failed. Mann et al, in 1933, reported that animals lived for an average of four days after a heart transplant(16). Demikov, in Russia, in the 1940s, performed 22 heart transplants in dogs - only two functioned, for a few hours(21); another Russian experimenter, Simitsyn, in 1944, grafted the heart of a dog onto the neck of another dog and connected the circulatory system so that the recipient dog had two hearts working - again for a very short period(22).

In 1952, the `Lancet` stated "Most of the knowledge of transplantation is based on experiments in animals, but these, it seems, differ as much in their responses to homography as in the disease from which they suffer"(26).

Downie, in 1953, transplanted 30 hearts in dogs - of these 23 "survived" an average of five days, with one dog living for ten days(27); Sayegh and Creech, in 1957, reported that in their experiments average "survival" of transplanted puppy hearts was 81 hours(32). Others tried experimental heart transplants in dogs - and these, too, failed(33).

Shumway, at Stanford Uni Medical Center, San Franscisco, began transplanting hearts in dogs in 1959(36), and a year later - with Lower - developed a different method for transplanting the hearts of dogs(37) and by 1967 had published over 20 papers(38). As some dogs lived for several months after a heart-swop(39), they planned a human heart transplant programme(40) - but, as Shumway admitted "Survival of dogs after any kind of cardiac surgery is different from people"(41).

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WORLD`S FIRST HUMAN-to-HUMAN HEART TRANSPLANT

On 3 Dec 1967, at the Groote Schuur Hospital, Cape Town, South Africa, Christiaan Barnard took the heart from 25-year old road accident victim, Denise Darrall and transplanted it into the chest of 55-year old grocer, Louis Washasnsky(72). Washansky was kept in an oxygen tent and a machine monitored his heart and respiration, and throat, nasal and rectal swabs were taken(75).

On 14 Dec, Washansky complained of pains in his chest and x-rays revealed changes which the cardiologists believed indicated he had pneumonia(76) - which was later confirmed(79). Washansky was put on a respiator to help his breathing(78).

On 21 Dec, Washansky died(81) from acute rejection of the transplanted heart(80).

Years later, Barnard commented "Thinking back, he (Washansky) was not the right man to operate on. Firstly, he was too old. Secodnly, he already had an established infection. Thirdly, he had diabetes"(85).

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WORLD`S SECOND HUMAN-to-HUMAN HEART TRANSPLANT

On 6 Dec 1967, Kantrowitz, at Mainmonides Medical Center,USA, transplanted a donor heart into a baby, Jamie Scudero - but the "new" heart was not strong enough to support his circulation and Jamie died six-and-a-half hours after the operation(90).

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WORLD`S THIRD HUMAN-to-HUMAN HEART TRANSPLANT

On 2 Jan 1968, Barnard transplanted a heart into 59-year old dentist, Philip Blaiberg. Although Blaiberg was well enough to walk out of hospital(94), he was to suffer two bouts of heart failure, several episodes of jaundice (due to the drugs he was given) and meningitis (due to his resistence to infection being lowered(97).

Eight months after the heart-swop operation, Blaiberg died from severe atheroma(96).

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WORLD`S FOURTH HUMAN-to-HUMAN HEART TRANSPLANT

On 6 Jan 1968, Shumway transplanted a heart into 57-year old Mike Kasperak - who lived for just fifteen days with his "new" heart(98).

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During 1968, 47 different surgical teams in 18 countries carried out a total of 102 heart transplants - of which 40 recipients died within a week of operation; two-thirds of the recipients lived for less than three months, and only 24 "survived" for longer than six months(126).

"Success" only came with clinical experience. "Survival rates" increased as more human-to-human heart transplants were performed - from a 20% rate one year survival rate at Stanford University in 1968 to 60% in 1978(175); and from 62% rate for five years in the UK in 1985(178) to 80% in 1996(179).

But, as Dr Relman, editor of the `New England Journal of Medicine` commented in 1983 "It is a big mistake to put too much emphasis on transplants. The real drama lies in conquering disease, not in a technological tour-de-force that prolongs life a bit for a relative few"(180).

refs

4. Carrell,A. Guthrie,CG. Am Med. vol 10. 1905.

5. Carrell,A. John Hopkins Hos Bull. vol 18. 1907.

6. Stark,T. Knife to the Heart. Macmillan. 1996.

7. Acierno,LJ. History of Cardiology. Parthenon Pub Group. 1994.

11. Murray,JE. Science. vol 256. 1992. 

12. Shackman,R. British Medical Journal. 4 June 1966.

16. Sayeigh. Creech. J of Thoracic Surgery. vol 34. 1957.

21. Demikov,VP. Experimental Transplantation of Vital organs. Consultants Bureau. 1962.

22. Haldane. Daily Worker. 11 June 1944,

26. Lancet. 29 Nov 1952.

27. Downie,HG. Am Med Assoc Arch Surg. vol 66. 1953.

32. Sayeigh. Creech. J of Thoracic Surgery. vol 34. 1957.

33. Acierno,LJ. History of Cardiology. Parthenon Pub Group. 1994.

36. Stark,T. Knife to the Heart. Macmillan. 1996.

38. Lower,RR. Shumway,NE. Surg Forum. vol 11. 1960.

39. Stark,T. Knife to the Heart. Macmillan. 1996.

40. Murray,JE. Science. vol 256. 1992.

41. Shumway,NE in Stark,T. Knife to the Heart. Macmillan. 1996.

72. Stark,T. Knife to the Heart. macillan. 1996.

75. Declerk,G in ibid.

76. BBC TV. Knife to the Heart. transmitted 1996.

79. Hardy,J. The World of Surgery...  Uni of Pennsylvania Press. 1986.

78. BBC TV. Knife to the Heart. transmitted 1996.

81. Hardy,J. Surgery. vol 60. 1966.

80. Stark,T. Knife to the Heart. Macmillan. 1996.

85. Gould,D. The Medical Mafia. Sphere Books. 1987.

90. Stark,T. Knife to the Heart. macmillan. 1996.

94. Gould,D. The Medical Mafia. Sphere Books. 1987. 

97. Coleman,V. The Health Scandal. Sidgwick & Jackson. 1988.

96. Acierno,LJ. History of Cardiology. Parthenon Pub Group. 1994.

98. Stark,T. Knife to the Heart. macmillan. 1987.

126. ibid.

175. Gould,D. The Medical Mafia. Sphere Books. 1987.

178. UKTSSA. Thoracic Organ Transplantation Audit 1985-1992.

179. UKTSSA. Organ Transplants - a brief history. 1996.

180. Relman,A. in Newsweek. 1983.