It is logical reasoning to recognize that throughout history, many doctors saw the human heart as the base of the soul. It is for that reason that medical professionals found the heart too fragile to manipulate. However, near the beginning of the 20th century, research of heart transplantation and several operative attempts in that field were pursued in several countries, ranging from the United States to Russia, with the goal of eventually conducting a human heart transplant. As with many organs, the first successful human to human heart transplantation finally occurred in the middle of the 20th century.
Although modern medical research and advances historically have occurred in the West, the first notable workings in the field of heart transplants began in Russia. By 1940, Vladimir Demikhov had developed an artificial heart that could substitute for a dog’s heart, functioning for as long as 5 ½ hours. He also began to transplant hearts into the chests of dogs in 1946, eventually perfecting the process so that some animals would survive for as long as 32 days after the transplant. Additionally, Demikhov began the first series of combined heart-lung liver transplants from between 1946 to 1955. As it turned out, his research on these subjects, which could have possibly assisted and advanced Western medical professionals who were attempting some of the same types of procedures, was unfortunately not published in English until 1962 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC325641/).
As a precursor to heart transplantation, what could be seen as the first steps in heart surgery was performed by military surgeon Dwight Harken during World War II, as he removed shrapnel and bullets from the hearts of approximately 130 soldiers. No fatalities occurred as a result of those procedures. On a similar note of first steps, in 1953, Dr. John Gibbon Jr. of Philadelphia repaired a hole in the heart of an 18-year-old patient, using a heart-lung respirator to keep the individual alive; thereby providing a pathway for future open-heart surgeries (http://content.time.com/time/health/article/0,8599,1939493,00.html).
It was nearly 15 years from that time until the next significant advancement in heart transplantation. On December 2, 1967, a 25-year-old woman suffered a fatal brain injury in a car accident. The following day, based on techniques originally developed by Stanford researchers in the 1950s, South African Dr. Christian Barnard performed the world’s first human to human heart transplant. The recipient, a 53-year-old grocer, survived for 18 days post-transplant before succumbing to double pneumonia. Demonstrating the success of the surgery and technique was that the donated heart was functioning normally at the time of the recipient’s death.
The news of that operation spread, and colleagues began to perform similar heart transplantation surgeries. During the span of two years, approximately 60 teams conducted these transplants on roughly 150 patients. To prevent organ rejection, large dosages of immunosuppressant medication were administered to the heart recipients. However, the abundance of these drugs caused the individuals to be susceptible to dangerous infections. As such, the one-year survival rate for heart transplant patients in the late 1960s was 20%. The reality of those results is reflected that the number of surgeries fell to 18 in 1970 from 100 in the previous year.
Despite that seemingly insurmountable barrier, Dr. Norman Shumway of Stanford and Dr. Barnard continued to pursue methods of improving this transplantation process. Dr. Shumway worked to develop a technique that enabled the surgeon to identify when the body was about to reject the organ, at which point the dosage of immunosuppressants could be adjusted. Accordingly, nearly 200 heart transplants were undertaken at Stanford from between 1968 and 1980. Applying Dr. Shumway’s practices, about 65% of his patients survived for at least a year, with 50% surviving for five years. Similar positive outcomes were recognized during that same time period with work conducted by Dr. Barnard and his team, as they improved protection and preservation of the heart prior to transplant (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4200566/).
These studies led to the biggest advances in heart transplantation to date, which occurred in the 1980s. In addition to Dr. Richard Jarvik implanting the first artificial heart in 1982, the most significant advances occurred two years later, when the first successful pediatric heart transplant took place on a four-year-old boy.
Toward the end of 1984, the historic “Baby Fay” heart procedure was performed. Conducted by a team at California’s Loma Linda University Medical Center, a walnut sized bamboo heart was transferred into the chest of 12-day old Stephanie Fay Beauclair. Stephanie survived for 21 days before she passed away from kidney failure.
The key to the long term success of heart transplantation operations was the discovery and proper application of immunosuppressant drugs. In 1958, Dr. Keith Reemtsma of Tulane University was the first to show in laboratory settings that immunosuppressant agents would prolong heart transplantation survival, while in 1980, Dr. Shumway began using the anti-rejection drug Cyclosporine A in his clinical practice (http://columbiasurgery.org/heart-transplant/brief-history-heart-transplantation).
In December of that year, it is recorded that the one, two, and three-year survival rates for Dr. Shumway’s transplant patients at Stanford using this med was 63%, 56%, and 52%. Five years later, each of those rates rose by more than 15%. The introduction of Cyclosporine A played a significant role in allowing heart transplantation to its current level of success and acceptance.
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Topic for Saturday, February 17th posting – Transplantation Firsts, Part 4 – First Lung Transplants