Transplants: Beyond the Heart

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Just two months ago, when Dr. Christiaan Barnard remarked that he would not hesitate to remove a still-beating heart for transplantation if the donor had suffered indisputable "brain death," the suggestion still seemed shocking to many surgeons. Since then, heart transplants have become increasingly common and the criteria of brain death generally agreed upon. Thus, gathering last week in Manhattan, most of the world's transplant surgeons accepted the idea of a beating-heart transplant with Barnardian aplomb.

Concurring completely was Houston's Dr. Denton A. Cooley, who has seven recipients surviving. The only note of caution was sounded by Mississippi's Dr. James D. Hardy,*who said that it might take a while to persuade certain segments of the public that the procedure is morally permissible.

Lung Failures. With some 2,000 kidney, 30 liver and more than 40 heart grafts now logged in surgery's annals, the second international congress of the Transplantation Society turned its attention to two main problems: how to extend the variety of transplantable organs, and how to improve the survival chances of all grafts of whatever kind.

Most candidates for heart transplants have been ill so long that they have suffered deterioration of many other vital organs, notably the lungs. So, Stanford University's Dr. Norman E. Shumway Jr. suggested, it would be a good thing to transplant at least one lung, or a large part of it, along with a heart. Nine transplants of lungs, or lobes of lungs, have failed. The tenth, performed a fortnight ago by Dr. Arthur Beall of Dr. Michael DeBakey's team in Houston, was doing well last week.

Since the pancreas manufactures insulin essential for the utilization of sugar and other carbohydrates, the patients most likely to need a transplanted pancreas are victims of the severe juvenile form of diabetes. The pancreas, said Minneapolis' Dr. Richard C. Lillehei, is so inaccessible that it is the only major organ that is harder to get out of the donor than to put into the recipient. He has made three grafts of an entire pancreas, with the patient surviving 41 months in the most successful case. Be cause all three died of infection rather than rejection of the graft, Lillehei declared confidently: "We know enough to justify going ahead, and in a few years pancreas transplants may be as common as kidney transplants."

Transplantation of the cartilage that surrounds the bone in joints would offer hope to vast numbers of victims of arthritis and other joint diseases. And, said Glasgow's Dr. Thomas Gibson, there would be no rejection problem, because cartilage is bloodless. But cartilage by itself is not enough. In animals, joints have been reconstructed successfully with cartilage left adhering to a delicately sculptured layer of bone, though Gibson is not yet ready to try that approach in man.

When the transplant experts tackled the rejection problem, they quickly agreed that all early drugs designed to suppress the body's immune reaction to foreign protein were bad. Since they blocked off the production of disease-fighting antibodies indiscriminately, said London's Sir Peter Medawar, they left the transplant patient easy prey to infectious crises caused by the commonest microbes that healthy people carry around all the time.