Questions of the Heart

TRANSPLANTS Questions of the Heart History's first transplant of a heart, from a chimpanzee to a dying man (TIME, Jan. 31), was a significant surgical achievement. But the difficulties that surrounded the operation, say University of Mississippi Surgeon James D. Hardy and his colleagues, were more than problems of cutting and suturing. What bothered the doctors as much as anything else, they report in the A.M.A. Journal, were matters of timing and questions of ethics.

The doctors knew well in advance that they wanted a human heart for a transplant. They figured that one could be taken from a relatively young patient dying of brain damage, and that it could be placed in a man dying of incurable heart-muscle failure. But how were they to find the proper brain patient dying just when the proper heart patient was waiting?

Kill a Patient? The doctors thought that in their small hospital they were likely to have many more suitable recipients than donors. But they were wrong. Three men were admitted to the medical center in Jackson with incurable brain injuries--one from a fall, one from a tumor, and one from a suicidal gunshot wound. Each of the doomed men was kept alive for a while by artificial breathing apparatus, and any one of them might have been a suitable donor if there had been an equally suitable recipient handy. But even if they had had a dying heart patient on whom to try a transplant, Dr. Hardy and his team felt that switching off the artificial respiration to let a man die before removing his heart seemed too much like killing a patient. Say Dr. Hardy and his colleagues: "We were not able to conclude that we would be willing to do this."

Even the selection of a patient to receive a heart transplant brought problems. The doctors planned to pick a man whose heart failure had progressed to the point where they considered it irreversible, so that nothing could save him but a new heart. But they had underestimated the amazing powers of recovery that even a damaged heart possesses. About the time they were ready to try a transplant, a man was admitted to their hospital, apparently dying after a heart attack. He astonished the doctors by getting well enough to go home. Clearly, it would have been wrong to try a transplant in his case--but this became evident only after his recovery.

Turn to the Chimp. Eventually, the surgeons and physicians decided that unless they were willing to take the question of life or death in their own hands and shut off the artificial breathing of a potential donor, it was "exceedingly unlikely" that such a man would die at just the right time, while a waiting heart patient was being kept alive on the heart-lung machine.

When they finally got a patient unquestionably in need of a heart transplant, they turned to the chimpanzee as a source. The chimp's heart proved too small for the patient, who was a big man, and the transplant failed after a couple of hours. The Mississippi doctors say they learned enough about the surgical techniques involved to convince them that "this operation may some day add years of life to many patients." But the process of learning has only pointed up the problems that are still far from solution--the ethical questions and the matter of timing.

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