Grim Lessons At Hospital No. 6

To most of the world, the Chernobyl nuclear accident was a disaster of terrifying proportions. But for the specialists struggling to save lives at Moscow Hospital No. 6, the mishap created a kind of medical classroom--a unique if horrific opportunity to learn how to cope with large-scale exposure to deadly radiation. So far, the lessons have been sobering. "This incident has demonstrated our very limited ability to respond to nuclear accidents," says Dr. Robert Gale, 40, a bone-marrow-transplant expert from UCLA who helped Soviet counterparts treat Chernobyl victims. "If we are very hard pressed to deal with 300 cases, it should be evident how inadequate our response would be in a thermonuclear war."

Gale, with two UCLA colleagues, Paul Terasaki and Dr. Richard Champlin, and Israeli Specialist Yair Reisner, worked with Soviet doctors under what he called "battlefield" conditions. In all, 299 people, most of them fire fighters and plantworkers, were hospitalized after exposure to estimated levels of radiation that ranged from 100 rads to more than 800 rads. In normal circumstances a person is exposed to about one-tenth of a rad per year. "Those in the lower-dose range will have modest and reversible damage," Gale says. Many of the 299 fell into this category. But 35 patients were exposed to doses exceeding 800 rads and were listed in "grave condition." Nineteen of them were chosen either for transplants of bone marrow from donors or for more experimental transplants of liver tissue from fetuses. At week's end eleven of the 35 had died, including six who had apparently undergone transplants.

The operations were needed because massive radiation destroys vulnerable bone-marrow tissue. The vital substance acts as the body's production center for blood cells that carry oxygen, help to cause clotting and provide immunity against disease. Victims of damaged marrow can die within weeks of severe anemia, hemorrhaging and infection. To transplant the tissue, physicians use a syringe to draw out healthy marrow--usually from a donor's hipbone--and inject it into the patient's bloodstream. The marrow cells make their way naturally to the interior regions of bones. For the procedure to succeed, the tissue of the donor and the patient must match exactly, or the donated cells must be treated to make them compatible. In Moscow, all the donors were siblings or parents of the victims. Still, rejection can occur. And even when a transplant takes, the recipient may die of infection or other injuries caused by the radiation.

The doctors' toughest job was screening out those victims who might recover without the risky operation as well as those too ill to benefit. Of the patients selected for transplants, some had received such a heavy dose of radiation that their white blood cells, which are needed to match tissues, had already been destroyed. That forced the doctors to use the liver tissue from fetuses, which is also a source of blood cells and is less likely to be rejected In future nuclear accidents, Gale suggested, blood samples should be taken from all victims within 48 hours so that they will be available for tissue typing.

The physicians faced other painful problems. The sister of one patient, ) saying she was afraid of anesthesia, reportedly refused to be a donor. That left doctors with no choice but to search elsewhere for the critically needed tissue.

Gale is a somewhat controversial figure. Some colleagues at UCLA privately complain that the talented researcher is prone to self-promotion. Gale has also received a written reprimand from the National Institutes of Health for failing to get proper approval before performing experimental procedures on cancer patients. For his efforts last week, however, Gale was personally thanked by Soviet Leader Mikhail Gorbachev, first in the Soviet leader's televised speech to his nation and again in a meeting in Gorbachev's office. That marked a rare tribute to a foreigner by a country that prides itself on being self-sufficient.