Donation Life in Another Person’s Heartbeat

As far back as the centuries BC humans were of the mind that somehow transplantation was an achievable milestone. The first known description from 4th Century BC Chinese texts of a heart transplant was by a surgeon named Tsin Yue-Jen, they state he successfully switched the hearts of two soldiers, no reason was given for this operation but both survived. We have no proof of this amazing surgical advance by the Chinese or whether it was truly successful, however one man in 1967 was to become famous for performing just that operation, his daring work would lead the medical world on in pursuing the feat of heart transplantation. Years later the world would witness the implantation of artificial hearts and animal organs, all in an attempt to combat one of mans biggest killers, heart failure.

“It’s going to work!”

The first acknowledged successful transplant of a heart was not achieved until much further into the history books, when after much preparation Dr. Christiaan Barnard made the breakthrough. Denise Darvall, a 23 year old was to be the first ever heart donor after dying in a road traffic accident on 3rd December 1967, her 

recipient was Louis Washkansky who was told he was dying from heart failure.

Barnard decided that the time was right and gained permission from Denise’s father to go ahead with the operation. When her heart began to beat inside Washkansky’s chest Barnard shouted “It’s going to work!” This was by all accounts a successful transplant; however Washkansky died from pneumonia eighteen days later due to his compromised immune system that was being suppressed with azathioprine and hydrocortisone to stop his body from rejecting the new heart.

Even though this may seem to have ultimately been a failure it did not deter Barnard from persisting in his quest to perfect the heart transplant. It was only with the approval of the immunosuppressant cyclosporine in 1983 that an often lethal and experimental procedure would become routine.

The waiting game

Today the biggest obstacle facing patients needing heart transplants is no longer the risk of rejection or infection; it is simply that there just aren’t enough hearts available. According to the Transplant Activity Report 2010/11, 206 people needing a new heart joined the transplant list; there were 131 heart transplants and 126 donations.

As of the 26th January 2012 154 people were recorded on the active heart transplant list. Transplant patients in the UK rely solely on the general public to join the organ register and pledge to donate after their death, however current figures in March 2011 showed that only 17,751,795 people are on the UK Organ Donor Register which is only 29% of the UK population, unfortunately not everyone who is on the donor register will go on to be a suitable donor at death so this considerably cuts down the number of suitable donations made each year.

Sadly every year many people lose their fight for life whilst on the transplant list, during 2010, 19 people died waiting on the transplant list.


Bridging the gap

Artificial hearts are now being introduced to bridge the gap that many patients awaiting transplant face. This is not altogether a new technique; the first recipient of an experimental device was Haskell Carp, it was implanted by Dr Denton Cooley in 1969 at the St Luke’s Hospital, Houston, the patient survived for just 3 days. This did not deter other ambitious surgeons and in 1982 another artificial heart designed by Dr. Robert Jarvik, the Jarvik 7 was implanted by William DeVries, the recipient was a Seattle Dentist, Mr Barney Clark who volunteered simply because he wanted to make a contribution to medical science, he was fully aware he may not survive for long after the operation, however he survived for 112 days. The next recipient Bill Schroeder would survive for 620 days.

These early breakthroughs were another lifesaving gift to the heart transplant patient, and although the early attempts required huge pneumatic power sources and carried a high risk of infection, they paved the way for the future. Current devices include the AbioCor Replacement Heart and the SynCardia temporary Total Artificial Heart, over 950 implants of the SynCardia device account for more than 230 patient years of life. The longest a patient has been kept alive using the SynCardia is 1300 days and counting.

In August 2011 Mathew Green, 40 became the first UK person to receive a SynCardia device and be discharged from hospital, he has since been able to return to an almost normal life. Without this device it is almost certain he would not have survived the wait on the transplant list.

Reasons for Heart Transplant

There are many reasons for needing a heart transplant; cardiomyopathy, cardio vascular disease, congenital heart defects, coronary heart disease, heart attack and obesity are the leading causes.

In 2009 45,000 people under 75 died from cardio vascular disease making it the main cause of death in the under 75s. In the overall population it accounted for 1 in 3 deaths killing over 180,000 people in the UK. Coronary heart disease accounted for an estimated 1 in 5 male deaths and 1 in 8 female deaths killing 82,000 people in 2009.

Cardiomyopathy affects the heart muscle itself, causing a deterioration in the hearts ability to function normally, hypertrophic cardiomyopathy, is the most common cause of sudden cardiac death in young people, it is estimated that this condition affects 125,000 people in the UK.

Congenital heart disease is another contender for the cause of heart transplant. Hypoplastic left heart syndrome (HLHS), kills 95% of babies before they reach 1 month old if they do not receive treatment, before 1983 parents were told to take their babies home to die.

A prominent case in 1984 was that of Baby Fae, who after being born with this condition received the heart of a baboon, the procedure known as a xenotransplant was subject to ethical and legal debates and caused a media frenzy with some labelling the procedure unethical. Baby Fae died 21 days after the procedure of a kidney infection; however, her body had not rejected the heart.

The medical history books are filled with drastic and questionable attempts to save the lives of people with heart failure, animal transplants have so far been abandoned due to the failure to understand immunobiology and the risk of zoonotic infections and artificial hearts are only a temporary measure, however each year the transplant list adds yet more people to its pages. The best and last option definitely still is the ultimate gift from another human being, a heart donation.