An Act of Desperation

For nearly 65 hours, an artificial heart beat within Haskell Karp's chest. Then, 30 hours after the 8-oz. plastic device was replaced by the heart of a 40-year-old woman, Karp died last week in Houston's St. Luke's Episcopal Hospital, succumbing to pneumonia and kidney failure. By becoming the first human recipient of a completely artificial heart, Karp had briefly raised all sorts of expectations the world over. His death immediately touched off an angry controversy over the wisdom of trying out the device without further experimentation. It also brought into the open a feud that has long simmered between two noted surgeons: Dr. Denton A. Cooley, who implanted the mechanical heart in Karp, and the equally famous Dr.Michael E. DeBakey.

Starkly Explicit. Cooley said that his decision to use the artificial heart, developed by Argentine-born Dr. Domingo Liotta, was made on the spur of the moment. "It was an act of desperation," Cooley admitted. "I was concerned, of course, because this had never been done before. But we had to put up one Sputnik to start the space program, and we had to start here some place."

The desperate moments began even before the controversial heart started pumping life back into Karp, 47, a printing estimator from Skokie, 111. Cooley warned Karp that if his badly damaged heart proved to be beyond repair, it might become necessary to use the experimental plastic device. Because the artificial heart is believed to cause serious damage to the blood if left in the body for too long, Cooley, along with Karp's family, issued a nationwide appeal for a human heart to replace it as quickly as possible. It was a starkly explicit appeal,calling for a person "with irreversible brain damage, good cardiac function and O-positive blood."

One potential donor, en route to the hospital by ambulance from Cleveland, Texas, died of a blood clot just a few blocks away; complications prevented use of her heart. Then Dr. Robert Lennon, a Lawrence, Mass, anesthesiologist, called Cooley to say that he had a suitable donor. Mrs. Barbara Ewan, who had suffered fatal brain damage, was considered medically dead (complete absence of brain waves for a period of 48 hours) when she arrived in Houston, but her heart had been kept beating with injections of stimulants. She suffered cardiac arrest just eight blocks from the medical center, and was re ceiving heart massage when she arrived.

Even before Karp died, rumors began surfacing that the artificial heart (technically known as an orthotopic cardiac prosthesis) had been developed at least partially with funds assigned to a DeBakey research team and that it had been used without adequate testing and without DeBakey's knowledge or permission. The National Heart Institute has asked DeBakey and Cooley if federal funds were used in the development of the device. If so, said Dr. Theodore Cooper, NHI's director, its use was subject to federal guidelines covering human experimentation. He explained that these guidelines stipulate that "if experiments are going to be carried out on man, every effort must be made to ensure that the experiment is safely conceived, that the procedure is done with the informed consent of the patient, and that scientific and ethical matters involved be reviewed by scientists and physicians at the hospital not themselves involved in the experiments."

Some of DeBakey's associates implied that the artificial heart used by Cooley and Liotta had been developed almost entirely by DeBakey's federally funded research team. "It's the same damn heart we've been working on for years," said one of them. Though Cooley is not a member of the team, Liotta is. In this case, DeBakey's permission--and that of a special medical review board--should have been received before the heart was used.

DeBakey, 60, a pioneering open-heart surgeon, is president of the Baylor University College of Medicine; Cooley, 49, is a member of the faculty. The two Texans have scrupulously avoided public battles, but their subordinates have been less inhibited. Those loyal to DeBakey, for example, have fostered the impression that Cooley has performed some of his 20 heart transplants prematurely. Cooley's lieutenants, on the other hand, dismiss this as professional jealousy; they point out that Cooley performed his first transplant three months before DeBakey did. DeBakey's associates also expressed concern about the purely experimental status of artificial hearts. The Baylor heart was reportedly tested in calves at least four times. The animals died on the operating table or shortly after the implantation. One survived for three days. Large-scale damage to the blood cells--one of the chief obstacles to the use of artificial hearts*--was cited as a contributing factor in the calves' deaths. Medical authorities, however, carefully refused to speculate whether any damage might have been done to Karp by similar "traumatization" of his blood cells.

Experience Needed. Cooley, for his part, remained unruffled. He claimed that the artificial heart used in Karp was developed entirely with funds from the Texas Heart Institute and other private sources. But he was cautious in appraising its usefulness. "We have demonstrated that a mechanical device will support the body," he declared after Karp's death. "But we've got to get more experience. It can only be used in a person who is at the brink of death or in a person who has already died, as, in effect, Mr. Karp had. He was completely dependent on the mechanical heart-lung, so that if it had been disconnected he would have been dead. That was the only justification for doing something as radical as this."

Originally, Cooley had estimated that the patient might be able to live as long as a month with the artificial heart. When the question was repeated later in the week, however, his reply was more circumspect. "I don't know," he said. "This is a human being we're working with." As a result of the furor provoked by the Karp case and the still unresolved questions of procedure and ethics, heart surgeons are likely to be extremely hesitant before they try to duplicate Dr. Cooley's desperate act.

* One measure of the gravity of the problem is the fact that the NHI is spending some $6,000,000 to study the cause of such damage and to develope blood-compatible materials for artificial hearts.

This file is automatically generated by a robot program, so reader's discretion is required.