|CURRICULUM IN CARDIOLOGY - HISTORY OF MEDICINE
|Year : 2016 | Volume
| Issue : 2 | Page : 120-125
The story of heart transplantation: From cape town to cape comorin
Aakshi Kalra1, Sandeep Seth2, Milind Padmaker Hote3, Balram Airan3
1 Institute of Economic Growth, Delhi University, New Delhi, India
2 Department of Cardiology, AIIMS, New Delhi, India
3 Department of CTVS, AIIMS, New Delhi, India
|Date of Web Publication||7-Oct-2016|
Institute of Economic Growth, Delhi University, New Delhi
Source of Support: None, Conflict of Interest: None
Norman Shumway is widely regarded as the father of heart transplantation although the world's first adult human heart transplant was performed by Christiaan Barnard, on December 3, 1967, at the Groote Schuur Hospital in Cape Town, South Africa. Adrian Kantrowitz performed the world's first pediatric heart transplant on December 6, 1967 and Norman Shumway performed the first adult heart transplant in the United States on January 6, 1968, at the Stanford University Hospital. In India, PK Sen attempted the first heart transplant in humans soon after Christaan Barnaard but the first and subsequent patients died. The first successful heart transplant in India was by Dr. P Venugopal in 1994 at AIIMS, New Delhi. This was followed soon after by Dr. KM Cherian who also did the first pediatric and first heart lung transplant in India.
Keywords: History, heart transplant, India, P Venugopal, KM Cherian, Barnard
|How to cite this article:|
Kalra A, Seth S, Hote MP, Airan B. The story of heart transplantation: From cape town to cape comorin. J Pract Cardiovasc Sci 2016;2:120-5
|How to cite this URL:|
Kalra A, Seth S, Hote MP, Airan B. The story of heart transplantation: From cape town to cape comorin. J Pract Cardiovasc Sci [serial online] 2016 [cited 2021 Jul 31];2:120-5. Available from: https://www.j-pcs.org/text.asp?2016/2/2/120/191525
| Introduction|| |
“That's all we ever really wanted in the end. It would have been great to be first, but, finally, what always mattered most was that we'd find a way to help people live a little longer so that they could be with those they loved, and do the things they cared about, for a little longer. It was a very simple hope, but we did it. That seems the best memento of all. I'm happy to make an anniversary of that fact.”
Human instincts acknowledge “being first”in every sphere from science to the arts. History too distinctively remembers individuals who did it (any invention/discovery or achievement) for the first time. There is always a phenomenal history behind every first doing, sometimes unsung or unheard. This article intends to bring together the history of the heart transplant, both the global and Indian perspective. It discusses a series of events across the years, which framed the current platform for heart transplant surgeries and the pioneers behind and on the scenes. The story has been built upon tireless efforts and sacrifices.
The world's first heart transplant was applauded and gained attention at once. Simultaneous similar attempts were made in different parts of the world. Initial endeavors were not successful which can be attributed to the less understood biology of cardiac transplantation at that time.
| the Initial Attempts|| |
In the 1890s, Alexis Carrel began experiments with vascular anastomosis. He also tried the initial heart transplants by connecting the carotid arteries of dogs to the donor aortas.,, In the 1930s, at Mayo Clinic, Mann and his team also tried similar kinds of surgical implants. The first major step came from Russia when Demikhov managed to do transplants in dogs with an end-to-end aorta anastomosis. In 1951, Marcus and his team reported on their experiments with heterotopic heart transplants from Chicago.,,,,,,,,,,
The increase in pace in research came with the reports of orthotopic heart transplant experiments in dogs from Lower and Shumway's group. Their dogs survived for up to 21 days.,,,,,
The transformation phase in the history of terminally ill patients was brought in the period of the 1960s. That era saw a magnificent medical achievement both from the perspective of patients and doctors worldwide, opening the avenues for a better tomorrow. The first transplant was animal to the human heart and eventually human to human heart replacement was performed.
| on Animals|| |
The first animal (chimpanzee) to human heart transplant in the world was performed by James Hardy at the University of Mississippi Medical Center in Jackson on January 23, 1964. James Hardy had chosen a patient with the extensive vascular disease with amputations of both legs, who was semicomatose and was dying. However, the chimpanzee heart was not large enough to support the circulation and failed soon after [Figure 1].
The next famous attempt at xenotransplant was by Bailey in 1983 when he attempted to transplant a baboon heart to an infant girl, known as “Baby Fae.” The surgery was technically successful, but there was an acute rejection, and the girl died 20 days later.
| Unveiling the Story of “ditgaanwerk:” Story behind Closed Doors|| |
The inclination for replacing the failing heart with another had been intriguing many surgeons around the globe around the same period. Christiaan Barnard was the first surgeon to perform human-to-human heart transplant surgery in South Africa on 3rd December 1967. A book titled “100 Headlines That Changed the World” includes the first transplant story of Washkansky under the heading of “Man with a new heart.” However, the relentless work had been undergoing much before that monumental day; it had become like a race to be the “ first.”
There has been pioneering work of surgeons who deserve appropriate recognition. Many surgeons, including Barnard, Richard Lower, Adrian Kantrowitz, and Shumway, were in the race to do a heart transplant for the first time.,,,
While Lower, Shumway, and Kantrowitz made preparations to conduct the first heart transplant, they got delayed due to disagreements over legal and medical issues over cardiac death versus brain death. During this period, Barnard conducted the first successful human transplantation in South Africa on December 3, 1967. Adrian Kantrowitz subsequently conducted a transplant on December 6, 1967, Shumway on January 6, 1968, and Lower in May of 1968.
The story started at the University of Minnesota, where Shumway and Barnard were peers and the latter closely understanding the work of the former. The race to be the first was driving Barnard within. He performed his first successful kidney transplant in South Africa to understand transplant immunology and geared for a heart transplant. Both awaited the major components of transplant procedure – a recipient and a donor so that the first transplant could be planned. On September 14, 1967, Louis Washkansky who was a grocer by profession got admitted in the Groote Schuur Hospital in Cape Town, South Africa. Chief cardiologist Dr. Velva Schrire was aware of Barnard's interests and recommended Washkansky as the appropriate case for transplant. The patient was already suffering with diabetes and heart ailment. He seemed to be the apt recipient of the heart transplant, which raised hopes to find a donor before the situation worsened. However, the dawn came upon finding a donor on December 2, 1967, when Denise was declared brain dead. She was brought to the hospital after a road mishap. Within theaters A and B where both were operated, it was finalized with mutual consent to consider them for the first ever attempt [Figure 2].
Darvall (Father of Denise) had said upon agreeing for the transplant:
“If you can't save my daughter,
You must try and save this man.”
| The first Surgery|| |
On December 3, 1967, Barnard performed the world's first successful heart transplant. The initial recovery after surgery was good, but subsequently he worsened and was treated for a possible rejection the medical condition being actually a severe pneumonia. He succumbed on the 18th postoperative day. The second transplant patient lived for 19 months and died of severe coronary artery disease. At this point, many countries in the world over started doing heart transplants but with most patients dying soon and a 1 year survival of only 11%, very few centers continued to do heart transplants. Ten heart transplants were performed at Groote Schuur Hospital and the longest lived for 23 years.
| After The first Transplant|| |
After the first transplant, surgeons all around the world started doing the transplant, focusing on the surgery but not trying to understand the transplant immunology. Most of the one hundred patients died, and heart transplant fell into disrepute with most centers stop transplanting. Only Shumway's team continued. They worked on transplant immunology, transplant infections, efforts to improve the donor pool, improvements in organ preservation and heart biopsies, and looked at advances in drugs to prevent rejection. They were the first at Stanford to introduce cyclosporine in the late 1980s.
When Shumway restarted heart transplants, the success rates were good, and before he retired, he had overseen more than 800 transplants [Figure 3].,,,,
Lower worked initially with Shumway and later left for Virginia. He performed his first transplant in May 1968. He also developed the technique of sending teams for heart harvesting to remote areas, thus reducing the need to shift the donor to the recipient hospital [Figure 4].
| Indian Scenario|| |
India holds an important place in this field. Dr. Profulla Kumar Sen became the first surgeon in India to do a heart transplant at KEM Hospital in Mumbai. He performed the world's 6th heart transplant, but his work was hampered in those early days of cardiac transplantation by the absence of a law on brain death. Unfortunately, the right heart ballooned within 15 min of coming off bypass and the patient died within 3 h. He attempted another transplant months later but that patient also died within 14 h with severe pulmonary hypertension. There were no further attempts for a long time due to the absence of a law of brain death [Figure 5].
The next era of the heart transplant in India started with the law on brain death following which on August 3, 1994, the first successful heart transplant in India was done at AIIMS by Dr. P Venogopal [Figure 6].
“Legislation of brain death materialized in 1994 but the Bill had been introduced in Parliament 7 years back and we knew it was a matter of time before it was passed,” said Dr. P Venugopal. “So we had been working on the transplant program for the past 3 years.” On August 3, 1994, when they got a donor - a woman in her mid-30s who was brain dead, and whose relatives were willing to donate her heart – they had a recipient ready at AIIMS, New Delhi. “Since the donor's blood group was B + ve and the recipient was AB + ve (universal recipient) there was no problem,” said Dr. Venugopal. The recipient lived for about 14 years.
The transplant team at the AIIMS lead by Dr. Balram Airan continued the work after Dr. Venugopal retired, led by Dr. BalramAiran and had completed 47 transplants by 2016 [Figure 7].
Further, down South, Dr. KM Cherian was also waiting to do a heart transplant. He got his chance in 1995 at Madras Medical Mission [Figure 8].
A 30-year-old Hemalatha Soundarrajan was knocked down while crossing the road near Pallavaram. She was declared brain dead at the hospital. Her husband was willing to donate her heart. Cherian was contacted. Cherian then scoured private hospitals in Chennai, Cochin, Trivandrum, and even Hyderabad looking for a suitable recipient. Finally, he found the recipient in Chennai. General Hospital: Maimoon Beevi, 38, from Tambaram, with dilated cardiomyopathy and had been waiting for a donor heart. The surgery was successful. Vijaya Hospital provided Beevi with immunosuppressant drugs for the 1st year free of cost. A friend of Dr. Cherian from Bahrain footed the bill for the next year. All her subsequent investigations were also done free of cost.
However, after this great start, both in North and South India, there was a lull. From 1994 till date, India has done only 250 heart transplants. The numbers were far and few in the initial years as few centers were doing heart transplants due to the costs involved, as well as the lack of donors. Of late, the numbers are picking up with both an increase in the number of centers involved in heart transplant programs, as well as increase in a number of donors following an active interest by various NGOs. [Table 1] lists some of the high points of heart transplantation in India and around the world.
| Conclusion|| |
In India, a number of transplants have been low and very few centers have picked up this technique. Over 250 transplants have been done in India so far. Thereafter, the technique is now gradually spreading to more centers across India with major centers in Delhi, Chennai, Kochi, and Hyderabad. With time, the numbers should increase.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Seth S, Kalra A, Singh B. Cardiac Transplantation - Current Status and Challenges in India. Cardiology Update, Cardiology Society Meeting, Bangalore; 2013.
Patterson C, Patterson KB. The history of heart transplantation. Am J Med Sci 1997;314:190-7.
Carrel A, Guthrie CC. The transplantation of veins and organs. Am Med 1905;10:1101-2.
Mann FC, Priestley JT, Markowitz J, Yater WM. Transplantation of the intact mammalian heart. Arch Surg 1933;26:219-24.
Shumacker HB Jr. A surgeon to remember: Notes about Vladimir Demikhov. Ann Thorac Surg 1994;58:1196-8.
Cooper DK. Experimental development of cardiac transplantation. Br Med J 1968;4:174-81.
Marcus E, Wong SN, Luisada AA. Homologous heart grafts; Transplantation of the heart in dogs. Surg Forum 1951;1:212-7.
Warden HE, Cohen M, Read RC, Lillehei CW. Controlled cross circulation for open intracardiac surgery: Physiologic studies and results of creation and closure of ventricular septal defects. J Thorac Surg 1954;28:331-41.
Neptune WB, Cookson BA, Bailey CP, Appler R, Rajkowski F. Complete homologous heart transplantation. AMA Arch Surg 1953;66:174-8.
Marcus E, Wong SN, Luisada AA. Homologous heart grafts. I. Technique of interim parabiotic perfusion. II. Transplantation of the heart in dogs. AMA Arch Surg 1953;66:179-91.
Harrison JH, Merrill JP, Murray JE. Renal homotransplantation in identical twins. Surg Forum 1956;6:432-6.
Webb WR, Howard HS. Cardio-Pulmonary transplantation. Surg Forum 1957;8:313-7.
Webb WR, Howard HS, Neely WA. Practical methods of homologous cardiac transplantation. J Thorac Surg 1959;37:361-6.
Cass MH, Brock R. Heart excision and replacement. Guys Hosp Rep 1959;108:285-90.
Lower RR, Shumway NE. Tissue transplantation. Studies on orthotopic homotransplantation of the canine heart. Surg Forum 1960;11:18-9.
Lower RR, Stofer RC, Shumway NE. Homovital transplantation of the heart. J Thorac Cardiovasc Surg 1961;41:196-204.
Willman VL, Cooper T, Cian LG, Hanlon CR. Auto-transplantation of the canine heart. Surg Gynecol Obstet 1962;115:299-302.
Hurley EJ, Dong E Jr., Stofer RC, Shumway NE. Isotopic replacement of the totally excised canine heart. J Surg Res 1962;2:90-4.
Reemtsma K, Williamson WE Jr., Iglesias F, Pena E, Sayegh SF, Creech O Jr. Studies in homologous canine heart transplantation: prolongation of survival with a folic acid antagonist. Surgery 1962;52:127-33.
Blumenstock DA, Hechtman HB, Collins JA, Jaretzki A 3rd
, Hosbein JD, Zingg W, et al.
Prolonged survival of orthotopic homotransplants of the heart in animals treated with methotrexate. J Thorac Cardiovasc Surg 1963;46:616-25.
Hardy JD, Kurrus FD, Chavez CM, Neely WA, Eraslan S, Turner MD, et al.
Heart transplantation in man. developmental studies and report of a case. JAMA 1964;188:1132-40.
Bailey LL, Nehlsen-Cannarella SL, Concepcion W, Jolley WB. Baboon-to-human cardiac xenotransplantation in a neonate. JAMA 1985;254:3321-9.
Barnard CN. The operation. A human cardiac transplant: An interim report of a successful operation performed at Groote Schuur Hospital, Cape Town. S Afr Med J 1967;41:1271-4.
Barnard CN, Wolpowitz A, Losman JG. Heterotopic cardiac transplantation with a xenograft for assistance of the left heart in cardiogenic shock after cardiopulmonary bypass. S Afr Med J 1977;52:1035-8.
Kantrowitz A, Haller JD, Joos H, Cerruti MM, Carstensen HE. Transplantation of the heart in an infant and an adult. Am J Cardiol 1968;22:782-90.
Stinson EB, Dong E Jr., Schroeder JS, Harrison DC, Shumway NE. Initial clinical experience with heart transplantation. Am J Cardiol 1968;22:791-803.
Griepp RB, Stinson EB, Dong E Jr., Clark DA, Shumway NE. Acute rejection of the allogrfted human heart. Ann Thorac Surg 1971;12:113-26.
Clark DA, Schroeder JS, Griepp RB, Stinson EB, Dong E, Shumway NE, et al.
Cardiac transplantation in man. Review of first three years' experience. Am J Med 1973;54:563-76.
Caves PK, Stinson EB, Graham AF, Billingham ME, Grehl TM, Shumway NE. Percutaneous transvenous endomyocardial biopsy. JAMA 1973;225:288-91.
Green CJ, Allison AC. Extensive prolongation of rabbit kidney allograft survival after short-term cyclosporin-A treatment. Lancet 1978;1:1182-3.
Venugopal P. The first successful heart transplant in India. Natl Med J India 1994;7:213-5.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
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