Question of Timing

Ever since the first heart transplant last December, the timing of such operations has been a source of much medical dispute. But few transplants are likely to trigger the controversy that surrounded the 17th, performed in Brazil at Sao Paulo's Hospital das Clinicas last week by Heart Surgeon Euriclides de Jesus Zerbini.

Zerbini announced that he had a re ipient, Joao Ferreira da Cunha, four weeks ago. Last week providence provided an unidentified victim of a traffic accident. The prospective donor's eyes were dilated and his breathing was labored--but his heart was still beating. Zerbini had the victim wheeled to an operating room; tissue tests determined that he was a suitable donor. After the electroencephalograph showed that all brain waves had stopped, they opened the victim's chest--even though the heart was still beating. One hour and 25 minutes later, the heart stopped, and two surgical teams went to work. Temporarily kept warm by artificially circulated blood, then quickly sutured into place, the new heart began beating immediately without the usual electrical shock. "Silence," said Zerbini, as a murmur of astonishment swept the room, and he proceeded to sew up his patient's chest.

Following the transplant, the common-law wife of the donor, Janitor Luis Ferreira de Barros, 41, arrived at the hospital. When she found out what had happened, she threatened to sue the doctors for removing the heart without permission. She may yet have her day in court. Presently, a bill to legalize such quick transplants is stalled in the Brazilian legislature. Cause for the delay: a proposed provision for assigning mistresses priority over parents, brothers and sisters in granting permission for heart removals. sbsbsb The day before the Sao Paulo transplant, Rio de Janeiro's Dr. Edson Teixeira implanted a pancreas in diabetic, ex-soccer-star -turned -government-official Arari Charbel Rios, 28. Rather than remove Rios' failing pancreas, Teixeira simply stitched the new organ, donated by a heart-attack victim, to his patient's duodenum--snugly against the old one. At the first sign of rejection, says Teixeira, he will simply snip the implant out and Rios will be back where he started--on insulin.

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In Edinburgh, 15-year-old Alex Smith, Europe's first lung-transplant patient, died last week. Doctors at Edinburgh's Royal Infirmary had told the boy's father that the new lung would require at least twelve days to establish itself. Before it could, young Smith's remaining lung, also damaged by swallowed weed killer that prompted the transplant, collapsed.

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