Medicine: Transplants: An Anniversary Review

SURGERY'S most spectacular procedure, the transplant of a heart from one human being to another, marks its first anniversary this week. By the latest tally, 95 human hearts have been taken from newly dead donors and implanted in the chests of 93 patients (two of them got two apiece). Almost exactly half the recipients are still living, though some have received new hearts so recently that the likelihood of their survival cannot be judged, and another death is being reported almost daily. The world's record survivor has lived for just eleven months.

In the cold light of these figures, many questions arise. Were heart transplants begun prematurely? Have there been too many? Or too few? Did the mere existence of the procedure arouse false hope in patients for whom no donor heart could be found? Is it better to die after long hospitalization and distressing drug treatment, with a transplanted heart, than to die a little earlier with one's natural, inborn heart? What hope does the immediate future offer for longer and healthier survival?

The Me-Too Brigade. On the general answers to most of these questions, the heart surgeons are agreed, though they differ on details. No, say the surgeons emphatically, the beginning of transplants was not premature. The surgical technique had been worked out years earlier, in animals, by Stanford University's Dr. Norman E. Shumway Jr., with Dr. Richard R. Lower, who is now at the Medical College of Virginia. Both Shumway and Brooklyn's Dr. Adrian Kantrowitz had their scalpels poised when South Africa's Dr.

Christiaan N. Barnard performed the first operation. Though some criticized Barnard for haste, his Cape Town team was experienced in kidney transplants, and included specialists in most, if not all, of the ancillary medical fields.

Later, complains Cardiologist Irvine H. Page, a past president of the American Heart Association, the "circus trappings and glitter" surrounding the transplants set off a rush among surgeons to join "the me-too brigade." Many surgeons concede that by no means were all of the 36 medical centers in 16 countries that have tried transplants well-enough staffed or equipped to do so. Yet despite all the failures, Houston's Dr. Denton A. Cooley, who has transplanted more hearts than any other man, defends the operations. He points to what happened after early, unsuccessful attempts at heart-valve surgery in the 1920s: "Because of a few initial failures, no further surgery inside the heart was done for 20 years. Those years were lost, and the next efforts were relatively timid approaches. I believe it was a mistake to call a halt then."

Today heart-valve surgery is common, and is successful for nearly 90% of patients. Transplant of the heart may never approach that record, but Dr. Cooley is "glad that heart transplantation has not been abandoned."