Heart-Lung Recipient Is a Donor Too
Surgeons in Baltimore have implanted a heart and two lungs into a desperately ill 28-year-old cystic fibrosis patient after removing his own healthy heart and damaged lungs. Then they implanted the man’s healthy heart into another patient who was dying of heart failure, Johns Hopkins University said Tuesday.
The controversial operations, which began on Monday and did not conclude until early Tuesday morning, are believed to be the first time that a heart from a living person has been used in a transplant.
Most donor hearts come from victims of traffic accidents who are declared brain-dead. The donor of the heart and lungs was a 32-year-old traffic accident victim.
Both Clinton House of Baltimore, the cystic fibrosis patient and the recipient of his heart, John Couch, 38, of Yardley, Pa., , were in critical but stable condition, as is to be expected, the university said on Tuesday. The hospital did not identify the three.
Dr. William Baumgartner, one of the Johns Hopkins surgeons, said the surgical team removed House’s healthy heart as well as his damaged lungs because experience in the 1970s showed that lung transplants alone had dismal results.
Transplanting a heart and two lungs, Baumgartner said in a telephone interview Tuesday, “was the best available therapy for this patient.”
But a leading Canadian heart and lung transplant surgeon questioned the decision to remove the healthy heart, saying that his team’s experience, acquired in the last 3 1/2 years, has shown that lung transplants alone can indeed produce “good” results.
In a telephone interview, Dr. Joel Cooper of Toronto General Hospital said that performing a heart-and-lung transplant when the patient’s own heart is healthy “doubles the jeopardy (because of rejection) without benefit.”
Baumgartner performed the heart-lung transplant with Dr. Bruce Reitz, another Hopkins surgeon.
Reitz and Dr. Norman E. Shumway performed the first successful heart-lung transplant at Stanford University Medical Center on March 9, 1981. Since then, nearly all of the 200-some heart-lung recipients around the world have been people whose hearts and lungs have been irreparably damaged by high blood pressure.
Hopkins opened its Heart and Heart-Lung Transplant Unit in 1982 and has done seven such procedures. Four of those patients are still living.
Overall, fewer than a dozen heart-lung transplants have involved patients with cystic fibrosis, an inherited disease that causes the body to produce thick mucus that clogs the lungs, and most of its victims die from a progressive breakdown of lung tissue, often by age 21.
Limited Time Left
Typically, heart-lung transplant candidates are put on an active waiting list when physicians consider them to have six months or less to live. House had been on that list for a year.
The first heart-lung transplant on a cystic fibrosis patient reportedly was done Oct. 29, 1983, at Presbyterian-University Hospital in Pittsburgh. The patient, a 25-year-old male, died about two months later.
Recently, Cooper and another Canadian surgeon, Dr. Ronald Grossman of Mt. Sinai Hospital, also in Toronto, have begun transplanting lungs without including the heart into patients with various kinds of lung disease.
Cooper said on Tuesday that he has placed a single lung into 11 patients, eight of whom are still alive, including one who has lived for 3 1/2 years now. In addition, he said, since November he has implanted both lungs into three others, all emphysema patients. They are also alive.
Cooper said of the Hopkins operations, “I find it so embarrassing because there was no need to do that.”
Baumgartner said he is aware of Cooper’s work, but that he nevertheless elected to transplant both the heart and lungs because he believes that Cooper’s work is based on an insufficient number of cases.
Way of Future
“But I agree with Cooper that (implanting two lungs without the heart) is a nice alternative (for cystic fibrosis) and probably in the future is the way it will be done,” Baumgartner added.
Asked whether he had any qualms about removing a healthy heart, Baumgartner said that “we thought about it, but not too much, because the patient was on oxygen most of the time” and that his activity was “quite limited.”
Baumgartner said he hopes the publicity about his latest case will not cause “false hopes” among cystic fibrosis patients because heart and lung donors are extremely rare, far more scarce than heart donors.
Arthur Caplan, a medical ethicist at the Hastings Center in Hastings, N.Y., said he saw no intrinsic harm in a patient giving up his own healthy heart under the circumstances of the Baltimore case--”as long as there is no coercive pressure to do so, as long as he does not perceive it as a requisite to getting the kind of therapy (a new heart and lungs) that he needs.”
