Transplants Heart Assist Devices and the Future

Heart transplantation is the gold standard surgical treatment for patients with advanced heart failure. Unfortunately, there is a worldwide scarcity of donors for heart transplants. Over the past ten years, the number of heart transplants performed in the United States has remained relatively stable at between twenty-five hundred and thirty-five hundred annually. If there were enough donor organs, it is estimated that more than fifteen thousand, and perhaps as many as thirty thousand, heart transplants would be done each year. Patients of any age could theoretically undergo a heart transplant, but because of the scarcity of donors and a somewhat higher rate of complications after surgery, patients more than sixty-five years of age are generally not eligible.

The History of Heart Transplants

The technique for transplanting the heart and lungs did not rely exclusively on the heart-lung machine. The first transplantation was reported in 1905 by Drs. Alexis Carrel and Charles Guthrie. While at the University of Chicago, the pair implanted the heart of a small dog into the neck of a larger dog by joining the heart of the smaller dog to the jugular vein and carotid artery of the larger animal. The animal's blood was not antico-agulated, and the experiment ended about two hours after circulation was established because of a blood clot in the cavities of the transplanted heart.

In 1950, Dr. Vladimir Demikhov, the great Soviet surgical researcher, described more than twenty different techniques for heart transplantation and published various techniques for heart and lung transplantation. He was even able to remove an animal's own heart and replace it with the heart from another animal before the heart-lung machine was developed. This was accomplished by placing the donor heart above the dog's own heart, and then with a series of tubes and connectors, rerouting the blood until he had the donor heart functioning in the appropriate position and the other heart removed. One of his dogs climbed the steps of the Kremlin on the sixth postoperative day but died shortly afterwards of rejection.

By 1960, Drs. Richard Lauer and Norman Shumway in the United States had established the foundation for heart transplantation as it is performed today.

Their method had also been used by Sir Russell Brock in England and Demikhov in the Soviet Union but became popular only after Lauer and Shumway reported it publicly. Shortly thereafter, Dr. James Hardy at the University of Mississippi attempted the first human heart transplantation. Because no human donor organ was available at the time, a large chimpanzee's heart was used. It was unable to support the circulation.

The first human-to-human heart transplant occurred December 3, 1967, at Groote Schuur Hospital in Capetown, South Africa. A surgical team headed by Dr. Christiaan Barnard transplanted the heart of a donor, who had been certified dead after there was no heart activity for five minutes, into a fifty-four-year-old man named Louis Washkansky, whose heart had been irreparably dam aged by repeated heart attacks. This first transplant captivated the world's imagination, and Barnard's name quickly became one of the most recognizable names in medicine. Interestingly, Barnard himself did not think the operation was revolutionary. Not a single picture was taken during the entire procedure. In a recent interview, Barnard talked about the conditions that led to the first transplant:

"Heart transplantation was successful because it was virtually just another heart operation. We had experience in major heart surgery. We knew how to prepare a patient for it. We know how to care for a patient during such an operation and how to care for the patient postoperatively. All we had to do was work out the surgical technique

Dr. Christiaan Barnard earned worldwide fame when he performed the first human-to-human heart transplant in South Africa in 1967.

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