Transplants: Why Blaiberg Died

• Share

(2 of 3)

Sensitized Animals. The billions of lymph cells in Blaiberg's blood and other tissues began trying to destroy the alien heart as soon as it was implanted. To counter this intolerance, the physicians on Barnard's team at Groote Schuur Hospital tried to suppress lymphocyte (and therefore antibody) production with drugs: azathioprine (Imuran) and a steroid of the cortisone family. Later, they resorted to a third weapon, antilymphocyte globulin (ALG), extracted from the blood of animals that have been sensitized to react against human lymph cells.

Blaiberg did well for six months, then had an episode of hepatitis. He also had a bout with pneumonia, because the immunosuppressive drugs that had weakened his defenses against the implanted heart had lowered the barriers against invading microbes. Using antibiotics and delicately juggling his doses of suppressive drugs, the doctors pulled Blaiberg through and kept him going for another year, which was marked by only occasional setbacks.

Nonetheless, the process of graft rejection was proceeding inexorably. Lymph cells with their attached antibodies were attacking cells in the transplanted heart muscle and in the heart's own blood vessels, causing inflammation, swelling and formation of scar tissue. By this month, the heart muscle had been so damaged that it was in nro better shape than Blaiberg's own heart had been 18 months earlier. It could no longer pump enough blood to his lungs to pick up oxygen for his body's needs, or to his kidneys to sustain their vital filtering function. As a result, these organs had also deteriorated.

Surgeon Marius Barnard (Christiaan's brother) signed a certificate listing the cause of Blaiberg's death as "heart failure brought about by failure of the kidneys, and pneumonia." Christiaan Barnard was quick to point out that there had been no sudden crisis of rejection like those observed in some other transplant patients; the process had been as slow as it had been relentless. Although there might have been time to find another heart donor, Barnard concluded that the condition of Blaiberg's other organs had so declined that another transplant would be futile.