Transplants: Why Some Survive

One of five surviving heart-transplant patients, 62-year-old John Stuckwish, died in Houston last week, seven days after Dr. Denton A. Cooley sutured a homicide victim's heart into his chest.

But the other four were alive and fighting strongly for survival at week's end.

Four and a half months after surgery, South Africa's Philip Blaiberg, 58, was confidently planning to swim again, come summer. In Houston, Everett C.

Thomas, 47, continued to improve at an amazing rate. Frederick West, 45, felt well enough to play chess with his doctors at London's National Heart Hospital. And in Paris, Dominican Father Damien Boulogne, 56, who received his new heart on May 12, progressed so encouragingly that his doctors switched him from intravenous to almost completely oral medication.

Why have they survived while ten have not? Although a transplant patient's normal rejection of foreign tis sue can spell failure and death, so far no heart recipient seems to have undergone such rejection. To forestall this immunological reaction, some of the transplant teams administered heavy doses of a drug called Imuran and cortisone-like hormones. Herein lay a second danger. Overdoses could render the patient's body incapable of controlling infection; apparently this happened in the case of Louis Washkansky, the world's first transplant recipient.

Dying Organs. By far the most common cause of death among heart- transplant patients has been the overall state of their health before surgery. In most cases, the transplanted heart has not failed its recipient. But in at least five of the ten who died, lungs, liver, kidneys or brain, damaged severely as a result of the patient's longstanding heart disease, failed to keep pace with the strong transplanted heart or were beyond any chance of recovery. "Almost invariably," says one pioneer in treatment of transplants, "the patient considered suitable for a transplant can be characterized as a few islands of viable tissue in a sea of dead or dying cells."

Thus almost anyone sick enough to qualify for a heart transplant may already be too sick to survive. Conversly, anyone well enough to survive may not be sick enough to qualify for the still highly experimental surgery.

As a result, standards for deciding who should receive transplants are changing. Some renowned heart specialists are focusing their search for recipients on younger, relatively healthier men. Stanford University's Norman E. Shumway Jr., who has performed two transplants on patients who failed to survive, puts it this way: "We aren't going to do any more transplants in dying patients whose lungs, kidneys and other organs have accommodated themselves to a failing heart." To adopt such an approach, heart transplanters will require the elusive solution of another problem: how to tell when a prospective recipient's other organs have crossed the line between possible recovery and irreversible damage.