Heart Recipients Can Thank Shumway
Successful heart transplantation depends on both scientific expertise and serendipity. The right recipient must be paired with the right donor at the right time and place.
In the fall of 1967, Dr. Norman Shumway of the Stanford University School of Medicine was ready.
Serendipity was not.
The road to this pivotal moment had been long and emotional. Heart transplantation experiments began in 1933 at the Mayo Clinic in Rochester, Minn. After a 10-year lull, World War II forced advances in repairing hearts shredded on the battlefield. With that, the long-held notion that the human heart was far too delicate to operate on faded.
In the early 1950s, doctors discovered they could use hypothermia to lower the body’s temperature and temporarily stop the heart to work on it. Later, the heart-lung machine, which kept those organs functioning during an operation, opened new surgical vistas.
But there were more than technical obstacles to overcome in the pursuit of heart transplantation. Before the 1960s, public opinion held that the heart sheltered an individual’s soul. It was only after the invention of the heart-lung machine that the heart came to be viewed for what it is--a muscular pump.
Shumway had spent eight years perfecting heart transplants on dogs before he announced, on Nov. 21, 1967, that he would attempt to transplant a heart as soon as a donor and recipient could be matched. The ideal donor, he advised, would be a young person dying of causes unrelated to heart disease. The recipient would be someone who could not withstand the rigors of traditional heart surgery.
On Dec. 3, less than two weeks after Shumway’s headline-making announcement, the world was stunned by news that South African surgeon Christiaan Barnard had transplanted the heart of a 23-year-old auto accident victim into the chest of a middle-aged man.
The recipient, Louis Washkansky, lived only 18 days--no surprise, considering that there were few options available then to keep the body from rejecting the foreign heart tissue.
Nevertheless, Barnard, a handsome and flamboyant man who had used surgical techniques that Shumway had painstakingly developed, instantly became famous.
One month after Barnard’s historic feat, serendipity blessed Shumway when a 54-year-old man with a severely diseased heart received the heart of a 43-year-old woman who had suffered a massive brain hemorrhage. America’s first heart transplant might have occurred even sooner--about a week after Barnard’s--except that the family of a potential donor refused to give up the organ for transplantation.
To be sure, the refusal was a sign of things to come. Although the surgery has been perfected to produce one-year survival rates today of 85%, the lack of donor hearts results in about 2,000 deaths each year in this country alone.
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It took many more years for survival rates to creep up, however. Shumway’s first patient, Mike Kasperak, died Jan. 21, 1968, of kidney failure, 14 days after his transplant. Barnard’s second transplant patient lived for 18 months. Still, by 1971, 146 of the first 170 recipients were dead.
The high death rate was a public relations disaster. By 1971, Shumway was the only doctor in the world still pursuing the surgery, so discouraged were the others. A modest man and dedicated scientist, Shumway forged ahead, searching for a solution to the major problem: How to prevent rejection of the new organ.
By the late ‘70s, Shumway’s diligence was rewarded when a chemical, cyclosporine, was found that prevented rejection without destroying the patient’s immune system.
Thanks to cyclosporine and other anti-rejection medications, enthusiasm for transplantation soared in the 1980s. About 35,000 people worldwide have received new hearts, the vast majority in the United States. About 150 American hospitals perform heart transplants.
Recipients typically lead normal lives with good prognoses. The longest-living survivor received a transplant in 1975 and the longest-living child survivor received a new heart in 1977--both at Stanford. Shumway, 76, continues to work there as professor emeritus.
Barnard’s transplant career was short-lived. He went on to lead a life of intense publicity and high style, divorcing twice, dating famous actresses and, in 1986, endorsing an anti-aging skin cream that was so ineffective it disappeared from the market a year later.
Barnard, 77, who lives today on a farm in South Africa, once said he regrets his foray into beauty creams. But he remains proud of his role in heart transplantation.
The operation, he said, years later, “was the right thing to do.”
