Future of Transplants

PUBLIC AFFAIRS

For countless viewers, TV's man of the holiday week proved to be no beer-bellied, chortling Santa Claus, but a lean, rather stern-faced man in a dark business suit who spoke through thin lips with a noticeable Afrikaans accent. He offered no tinseled presents, but the hope that his kind of surgical pioneering may eventually bring the vastly more valuable gift of renewed and prolonged life to many victims of heart disease. He was Dr. Christiaan Neethling Barnard (TIME cover, Dec. 15), who flew to the U.S. from Cape Town to Face the Nation on CBS, appeared on Today, filmed a future episode for The 21st Century, and began this week with a second full hour for NBC. Sandwiched in was a respects-paying call on President Johnson at the LBJ Ranch. For his CBS debut, Barnard was flanked by the two surgeons most prominently identified with artificial hearts and transplantation: Houston's Dr. Michael E. DeBakey and Brooklyn's Dr. Adrian Kantrowitz. He also faced two expert interrogators: Newsman Martin Agronsky and Science Editor Earl Ubell. If anyone showed strain it was Dr. Kantrowitz -- understandably, because his transplantation of a heart into a 19-day-old infant had failed after 61 hours. Dr. Barnard was lit up by the glow of a far greater success -- the 18-day survival of Louis Washkansky's transplant.

Short Supply. That operation raised many questions. Was it, asked Agronsky, just a surgical spectacular? On the contrary, said Barnard, medicine today is developing methods that offer curative treatment instead of palliation for hundreds of thousands of patients suffering a lingering death. What, asked Ubell, persuaded Barnard that no treatment short of a transplant would be effective in Washkansky's case? For answer, Barnard showed a screen-filling photograph of Washkansky's original heart, so damaged by the growth of fibrous tissue that only about one-tenth of the muscle in its main pumping chamber was working properly.

What's more, Barnard disclosed, this heart had been working so poorly that for weeks Washkansky's other organs --notably the liver and even the brain --had shown signs of deterioration from shortage of blood and oxygen. After Washkansky received Denise Darvall's heart, these organs improved enormously. One thing that his 30-man team learned from Washkansky's case, said Barnard, is that the recipient's body is less prone to reject a heart transplant than a kidney, so future patients will not be so heavily dosed with drugs to suppress the immune reaction. That means less danger of infection and more hope of lasting success.

What bothered all the panelists was the problem of supply. Though there are 500,000 adults in the U.S. dying each year of coronary disease and 6,000 to 7,000 children dying of incurable inborn heart defects, there is no prospect of more than a few thousand hearts becoming available. The pressing question, therefore, is how will these be allocated? Dr. Barnard was not worried by the chance of having two or more patients at one time with equal need. He was confident that one would have the more urgent need for a new heart, and he would get it. If forced to choose between a psychotic who could never be a really useful citizen and one who is mentally normal, he admitted, he would operate on the normal man first.

Three Criteria. Surgeon Barnard was equally confident that the time of a prospective donor's death can be determined clearly enough to indicate when his heart may be taken, although the subject is technically complex. Under South African law, he said, a patient is dead when he has no reflexes, is no longer breathing, and his heart has stopped. The Groote SchuUr Hospital team faithfully applied these criteria in the case of Donor Denise Darvall. Certainly, said Barnard, he could have restarted her heart, but it would soon have stopped again because her brain was dead.

The supply of hearts for transplantation will increase, Barnard predicted, when the public has been sufficiently educated so that relatives will give the necessary consent when someone has suffered a fatal injury. Christiaan Barnard's television appearances were calculated to win just such broader public acceptance of an idea that would have been greeted with universal horror only a month earlier.

TV ABROAD

Fab? Chaos Ever since the Beatles gave up personal appearances, they have been searching for new ways to occupy their time away from the recording studios. The guru bit was a kick, and so was making home movies. Say, they thought, why not combine the two and make a sort of visionary flick for TV? Fab! Paul directed, Ringo mugged, John did imitations, George danced a bit and, when the show hit the BBC last week, the audience gagged. Titled Magical Mystery Tour after their latest album, the one-hour show was never magical but always mysterious. Try as they might, viewers were unable to divine just exactly what was going on. Chaos is perhaps the best description. To make the film, the Beatles loaded 39 friends and bit actors into a yellow bus and drove through the English countryside for three weeks, improvising dialogue and filming whatever struck their fancy. The result, often played to a soundtrack of their latest songs, was a disjointed series of daydreams, nightmares, cloudscapes, reveries and slapstick skits ending with the foursome prancing down a spiral staircase in white tie and tails in a takeoff of a 1930s Hollywood musical. "We didn't worry about the fact that we didn't know anything about making films" said Beatle Paul. "We realized years ago you don't need knowledge in this world to do anything. All you need is sense, whatever that is." Trouble was, the Beatles carried this theory to the point of nonsense by taking turns operating the hand-held cameras. If there was anything worth shooting, it was often hard to tell, because the film was so shaky and out of focus.

"Tasteless nonsense," "blatant rubbish," "a great big bore," howled the London critics. Worse yet, many viewers got the feeling that perhaps fame had at last gone to the Beatles' heads. Concluded the Daily Express: "The whole boring saga confirmed a long-held suspicion that the Beatles are four rather pleasant young men who have made so much money that they can apparently afford to be contemptuous of the public." In reply, Paul could only say: "Aren't we entitled to have a flop? Was the film really so bad compared with the rest of the Christmas TV? You could hardly call the Queen's speech a gasser."

The real gasser, though, is the fact that Mystery is scheduled for further airing in several other countries. It will net the Beatles about $2,000,000.

VARIETY SHOWS

Boff of the Week Standing in as host of NBC's Kraft Music Hall, Woody Allen produced a wicked parody called Bonnie's Clyde-- with Allen as "Warren Beauty" and Liza Minnelli as "Faye O'Laye." Best boff: after Bonnie recites her ode to the Barrow Gang exploits, Clyde's brother Buck says, "I'm only a dumb hillbilly, ma'am, and I don't hold much truck with poetry, but you know what you've done?" Bonnie: "What's that, Buck Barrow?" Buck: "You've managed to combine the intellectual disillusionment of Eliot with the ambiguous symbolism of Baudelaire and still come up with a poem that stinks."

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