Heart Transplants begin
Heart transplants represent a significant advancement in medical science, allowing patients with severe heart disease to receive healthy donor hearts. The concept of transplanting a heart has roots in ancient mythology, but practical applications awaited advancements in surgical techniques and immunosuppressive medications. The early 20th century saw pioneering work by scientists like Alexis Carrel and Charles Guthrie, who conducted the first heart-lung transplants in animals. The field evolved dramatically in the 1960s, highlighted by Christiaan Barnard's first successful human heart transplant in 1967, although early procedures faced high mortality rates due to organ rejection and infection.
The introduction of cyclosporine in the late 1960s revolutionized post-transplant care by effectively managing rejection, significantly improving patient outcomes in subsequent decades. Despite challenges such as donor organ shortages, the success of heart transplants has laid the groundwork for ongoing innovations in cardiac surgery and artificial hearts. As more patients continue to benefit from these advancements, heart transplantation stands as a testament to the collaborative efforts of medical professionals and researchers dedicated to extending and enhancing lives.
Heart Transplants begin
A spectacular accomplishment in the history of cardiac surgery. In the 1960’s, surgeons first proved that they could successfully transplant a human heart.
Origins and History
The idea of transplanting a heart can be found in ancient myths and legends. Actual transplantation, however, had to wait for the development of vascular surgical techniques, cardiopulmonary bypasses, and medications to manage the body’s rejection of a new healthy heart. In the early twentieth century, Alexis Carrel and Charles Guthrie performed the first heart-lung transplantations on animals in the Hull Laboratories of the University of Chicago. Later studies by Frank Mann, director of the experimental medical laboratories at the Mayo Clinic, demonstrated the rejection phenomenon.
In the 1940’s and 1950’s, Vladimir Demikhov, a Soviet scientist, made major contributions to knowledge of cardiac surgery. Historians credit him with being the first person to implant an auxiliary heart within the chest, to replace the heart, and to perform a complete heart-lung transplant. In 1962, Experimental Transplantation of Vital Organs, the English translation of his 1960 book, was published.
Animal experimentation conducted by Stanford University’s Norman E. Shumway, Adrian Kantrowitz, James Hardy, and South African Christiaan Barnard helped develop a technique by which a human heart could successfully be transplanted. The research showed that a surgeon could cut a heart out of a donor dog and preserve it in a cold, 40-degree saline solution. Then, surgeons could attach a heart-lung machine to the recipient dog to keep circulation going while its heart was removed and the donor heart sewn in place. After the stitching was done and the clamps released, blood would flow through the heart but not normally until the heart was given an electric shock.
In 1964, Hardy, a professor of surgery at the University of Mississippi, transplanted the heart of a large chimpanzee into a human patient. The patient, Boyd Rush, died two hours after receiving the heart.
Cardiac surgeon Barnard attempted the first human heart transplant on December 3, 1967, at Groote Schuur Hospital in Cape Town, South Africa. His patient was a fifty-five-year-old grocer, Louis Washkansky, who had experienced several heart attacks since 1960. Upon waking up after surgery, Washkansky proclaimed, “I am the new Frankenstein.” He died of a bacterial infection eighteen days later. Three days after Barnard operated on Washkansky, cardiac surgeon Kantrowitz performed a heart transplant on an infant at Maimonides Hospital in Brooklyn, New York. The infant died two hours after surgery.
Barnard’s second patient, a dentist named Philip Blaiberg who received a new heart on January 2, 1968, survived seventeen months, stimulating a rash of transplant activity. Shumway, through additional canine experiments, developed a way to simplify the operative technique. He showed how to leave about 5 percent of the old heart part of the walls of the heart chambers to which six veins are attached which cut the length of an operation in half. On September 15, 1969, Denton Cooley of the Texas Heart Institute of Houston performed the first heart-lung transplant on an infant. The infant lived only fourteen hours, dying of respiratory insufficiency. By the end of 1970, approximately three years after Barnard operated on Washkansky, 166 heart transplants had been attempted worldwide. Only twenty-three of those patients, however, were still alive, which was a mortality rate of 85 percent.
Shumway’s research also proved that the major challenge of heart transplants was rejection after the surgery. In 1969, the key that helped resolve this problem was discovered in a soil sample in an isolated highland plateau called Hardanger Vidda in southern Norway. Jean-François Borel, a microbiologist for Sandoz Limited, a pharmaceutical company based in Basel, Switzerland, discovered a compound called “cyclosporine.” Research would show that it could control rejection, and the drug became widely used in the early 1980’s.
Impact
The 1960’s was a significant and spectacular period in the history of cardiac surgery. Without the combined daring, efforts, imagination, and skill of medical scientists, physicians, and surgeons, heart transplantation would not have become a reality. The transplants performed in the 1960’s created the foundation for later surgeries that enabled many deathly ill patients to extend their lives.
Subsequent Events
Because of the limited availability of suitable donor hearts and problems with rejection, efforts to create an artificial heart began as early as 1969 and continued into the following decades. By the 1990’s, more heart recipients were living longer, healthier lives, in part because of advances in preventing rejection of the transplanted organ.
Additional Information
An exhaustive history of heart transplantation can be found in The Evolution of Cardiac Surgery (1992), by Harris B. Shumacker, Jr.