Heart Surgery: Were Transplants Premature?

Criticism and caution about heart transplants have been welling up for weeks. So, as Capetown Surgeon Christiaan N. Barnard began his second U.S. tour, he tackled the issue headon. Barnard chose the title "Was Human Cardiac Transplantation Premature?" for his presentation to the American College of Cardiology in San Francisco. Emphatically, he said that it was not.

Other opinions varied widely. Most sensible and restrained was a report by the Board on Medicine of the National Academy of Sciences. Investigational transplants are now "appropriate" in man, said the board, but surgical teams with insufficient experience and facilities should not be permitted to attempt them. It thereupon laid down a set of guidelines. But even in hindsight, they were guidelines that had already been observed by Barnard and the two U.S. teams that have transplanted hearts.

Fearsome Specter. More drastic were the objections of a few eminent cardiologists at the San Francisco meeting. New Orleans' Dr. George E. Burch, the college's new president, joined Los Angeles' Dr. Eliot Corday and Manhattan's Dr. Simon Dack in calling for at least a three-month moratorium on heart transplants. The college's outgoing president, Philadelphia's Dr. William Likoff, announced a conference of leading physicians, lawyers and theologians, to be held late this month in Bethesda, Md., to discuss the legal, ethical and practical aspects of transplants. And then there is the resolution, proposed to the Senate by Minnesota Democrat Walter F. Mondale, to set up a presidential commission to study and evaluate scientific research in medicine. In some surgeons' minds, Mondale's proposal has blurred into the fearsome specter of having a commission decide on each individual transplant and establish the death of the donor before the transplant team can be called in.

Asked whether he would observe the proposed moratorium, Barnard answered with an unhesitating "No, I would not." If other surgeons wished to, he suggested, that was their business. He insisted that he was guided by his own conscience, based on principles as old as the Hippocratic oath—that the physician must do everything in his power to save life, to restore health, and at the very least to alleviate suffering. Barnard conceded that in the case of Louis Washkansky he did not save life. But "in the case of Dr. Philip Blaiberg, I can say unhesitatingly that we have alleviated suffering. This man is now up and around, able to shave himself, and to feed himself sitting up—things that he could not do before."

Self-Appointed Critics. Any further restrictions on surgeons seemed unnecessary and unwise to Barnard. The death of a heart donor is already certified by the most experienced neurosurgeons and neurologists, he said. As for the radical nature of the operation, Barnard felt that the decision to remove a dying man's heart "may not be as difficult as the decision to remove a young woman's breast because of a lump."