History of heart transplant

I would like to start with my personal experience in heart transplant. In May 2002, I was working as a Senior Specialist Registrar in Cardiothoracic Surgery at the Mater Misercordiae Hospital. This is the only adult cardiac transplant centre in Ireland.

After a long day, we were preparing to go home, at that time; the heart transplant co-ordinator came to the operation theatre and informed us that there is a possible heart transplant tonight. The donor, 21 years old man, was involved in a road traffic accident, already brain dead. He was dependent on the breathing machine at Cork University Hospital. Within next hour we were informed that the donor was suitable for harvesting the heart, kidney and liver. In the mean time a suitable heart recipient was contacted. Harvesting time was fixed at mid night. The transplant coordinator was trying to organise a helicopter for our harvesting team. Due to stormy weather, it was not safe to fly with a helicopter. The Irish air force was contacted and soon they confirmed the availability of an aeroplane. I, along with two other team members flew to Cork, approximately 275 kilometres away from Dublin. We harvested the heart and flew back to Dublin. We were unable to land at the Dublin airport due to storm and we landed at the air force base some 40 kilometres away. Time was of essence for us because it is better to transplant as soon as possible after harvesting. If delayed there would be irreparable damage to the donor heart. We arrived at Mater hospital by an ambulance just after 2 am, where recipient team was ready to transplant. The transplant was successful and the patient left the hospital few days later.

Infants and children may need heart transplants as well as the adults. Infants and children with complex forms of congenital heart defects (most commonly hypoplastic left heart syndrome a condition where heart's lower left pumping chamber and the large artery that carries blood to the body are too small to support normal flow) and also with dilated cardiomyopathy (heart cavity is enlarged, stretched, weak and doesn't pump normally) may need heart transplant.

In simple term heart transplant means harvest of a healthy human heart from a suitable donor and transplant to a suitable recipient after removing the recipient's diseased heart.

46 years ago, Dr Christiaan Barnard achieved a milestone in the medical history. He performed the first human heart transplant at the Groote Schuur hospital in Capetown in South Africa on December 03, 1967. At that time, operations on heart were rarely performed because of risk of death. Heart transplant was unheard of and was unthinkable at that time. He took the heart of a 25-year-old female accident victim, Denise Darvall and transplanted it in to a 55 years old South African dentist named Louis Washkansky, who was suffering from fatal heart disease. “On Saturday, I was a surgeon in South Africa, very little known. On Monday I was world renowned”. Dr Barnard said after the first transplant. Asked to describe his feelings after the first transplant, Dr Barnard said, “Not very much. It was natural progression of open heart surgery. We did not think it was great event and there was no special feeling. I was happy when I saw the heart is beating again. We didn't stand up or cheer or something like that. I didn't even inform the hospital authority that I was going to do the operation.” Unfortunately the patient died 18 days later due to bilateral pneumonia.

3 days after the first transplant, the second human heart transplant using a human donor was performed on a child by Adrian Kantrowitz in Brooklyn, New York. The patient died within 24 hours due to rejection.

By 1971, 146 of the first 170 heart transplant patients had died, due to rejection of the new heart or infection. Most of the centres stopped transplant because of poor result. In 1974, the drug cyclosporin was discovered by Jean Borel from a poisonous Norwegian fungus, which helped to overcome body's rejection of the donor organs and protect the patient from infection. Subsequently heart transplants were more successful.

Currently heart transplantation is considered the gold standard therapy for end-stage heart failure refractory to medical treatment. Approximately 2500 heart transplants are performed yearly worldwide, but list of the candidates exceeds 50,000. Now-a-days having a heart transplant gives at least 10 years of healthy life. For some people, it is much longer.

Gordon McDonald, is the UK's longest surviving heart transplant patient. Another recipient Donald Arthur of New York was suffering from cardiomyopathy (enlarged heart) and was on heart transplant waiting list for three years. He was advised by the doctors that if he did not get a heart transplant within six months, he would die. How ever he was lucky enough to receive the heart transplant after a month in the Columbia Presbyterian Hospital (Recently Bill Clinton had a Coronary Artery Bypass Surgery in the same hospital), N.Y. Fifteen months after the transplant, Donald competed in the first of five New York city marathon. Since then he has completed a total of six marathons. After six years of transplantation, he was honoured to carry the 2002 Salt Lake City Winter Games “Olympic torch”

through the streets of N.Y.

In 1968 Australia's first human heart transplant was performed by Dr Windsor. Another Australian surgeon Dr Victor Peter Chang became worldwide news in 1984 because he developed the most successful programme with an impressive survival rate of 92 per cent after one year and 85 per cent survival rate after five years. He was responsible for developing Australia's National Heart Transplant Programme.

In India, Maimoona Beevi was the first patient on whom a heart transplant was performed in 1994 by Dr P Venugopal at the All India institute of Medical Science, New Delhi. After that, a pig heart was transplanted to human by another surgeon in 1996.

Since then less than 50 transplants were done in the entire country. The reasons for this number is lack of awareness among the public about organ donations, it results, benefits, social and religious stigma and financial burden.

Heart transplantation is now widely accepted b option for end-stage heart failure and complex congenital heart diseases. However, the annual number of transplants worldwide has remained relatively constant because of the limited donor availability.

Dr Md Habibe Millat, MBBS(Dhaka) FRCS(Edin) is a Senior Specialist Registrar of Cardiothoracic Surgery at St. James's Hospital, Dublin, Ireland