Cooper Union forum; 10; Fall 1970

From the Great Hall of the Cooper Union in New York City. National Educational radio presents a lecture entitled transplantation and medical devices. This lecture was recorded for broadcast by station WNYC. Now to introduce the speaker. Here is the chairman of the Cooper Union forum series Dr. Johnson a Fairchild we are very honored this evening. To have one of the most famous. Dr. Adrian Kaberle who served or. Who not only teaches direct surgery. But with his team. Has done some of the first French was. In this metropolitan area. I would like to tell you a great deal about.

You is a very biased Lords charming. But you know what. He's devoting his life to trying to push. You. Forward. He was I was almost going to say I'm not only a surveyor you know. It's a terrible thing the surveyor's of not only a teacher but he's a scholar of. He is not just a surgeon here's a job of attempting. Through his imagination of his brain to push. The fields of surgery and. Medical care of people a step farther along a lot. He has faced many problems obviously. Both

of them are wrong. He has. Faced many intricate problems as far as I know. Doctors can't prove it. Probably the greatest medical. Philosopher and practitioner. In this whole area. We are very proud of the light that he could take the time to come and talk to us. Budget carefully. But. Sure. It'll. Be. Ladies and gentlemen.

Mr. Fairchild I I want to thank you for that most of. The gracious introduction. I'm kind of sorry my mother wasn't here. How. Many of the things that you said weren't true. One thing is true is that I am a surgeon and I. Have been interested in diseases of the heart. For all of my professional career. And. Lived through really the development of this whole field of heart surgery because when I went to medical school. Which really wasn't very long ago about 20 years ago. There were there was no such thing as heart surgery. And this whole field developed during the lives of all of us in this room.

And it has been a very exciting. Here and The History of Medicine. And I think will continue to be a very exciting only because it is one. That is Diseases of the heart is one of the areas which is of great concern. To those of us who are interested in the have been interested in the health of the people. One of the. Greatest teachers in surgery that ever lived was a man by the name of Theodore Bill Roth and he lived in the latter part of the 19th century in Vienna. And started the school of surgery in Vienna which became world famous. And in the generation of surgeons that just preceded mine the thing to do to become a surgeon was to go to Vienna. And the reason for that was that Bill Roth and his students developed many of

the surgical procedures which we use today. And this was in the 18th 70s and 80s in the period just after the development of anesthesia. Prior to this surgeons were limited in the amount of. Operative procedures that they could do because it was a very difficult and dangerous thing to operate on a patient without anesthesia. And it was even more difficult on the patient. With the development of anesthesia Of course it then became possible to do very careful and slow and deliberate operating procedures. And so it then the whole field and developed developed very rapidly. And Bill Ross was well known in his time. He was a great friend of Brahms. They used to power around in the coffee houses in Vienna. Apparently they were rather well-known

Boulevard De Beers. It is written in his biography that when he and Brahms would walk together down the boulevards. They were greeted by their first names by the ladies of the night. So apparently these boys got around. Though Arthur always complained that he couldn't write music as well as Brahms and Brahms would complain that he couldn't operate as well as Bill Roth is my fact though Roth did write a piece of music and he sent it to his friend Brahms to criticize it and to help him and because Brahms thought so well of the author. He tore it up and threw it away. I guess he didn't think he was really a great musician. Nevertheless he was truly a very great surgeon. And during the latter part of his career as the professor and the end of

one of his students came to him one day and said Professor Bill Roth now that we have developed all of the surgical procedures that can be done in the abdomen Perhaps we should think about operating someplace else in the body maybe even in the chest or even on the heart. And it was then that Bill Roth turned to his student and said the words that have now become in the shrine over the door of the American College of Cardiology something to the effect that young man anyone who would be so stupid as to want to operate on the human heart should be thrown out of the medical profession. And this. From of very great man. Dominated the thinking in surgery and in medicine for 50 years. And there was a good reason for Bill Roth to say this he wasn't doing this out of being an obstinate man.

He did this because they had had experience they had there were surgeons who had tried to open the chest of a patient under anesthesia and operate on the heart. And all of these patients died. They didn't understand in those days about how to support the ventilation of a patient when the chest is open because as soon as you open the chest if you don't do anything about it the lungs collapse. The patient is not able to breathe and so obviously if you touch the heart the heart will stop. And so after having two or three experiences like this it was Bill Ross feeling that no surgeon should try anything as rash as trying to operate on the human heart. It wasn't until the under the understanding of the breathing apparatus was delineated that it then became possible. To operate on the heart. And this is only been in the last 20 or 30 years. And the first great surgeons who did any kind of surgical procedures on the human

heart are most of the men are alive today people like Robert Gross and Boston Dr. Clarence Crawford of Stockholm of the Karolinska Institute in Stockholm that's the very famous hospital and Stockholm which is supported by the Swedish government Dr Blaylock who is professor of surgery at Johns Hopkins. These men not more than 20 years ago began the whole area of heart surgery. Today. There are about 30000 children a year that are born in this country with some sort of heart defect and the vast majority of these can be very successfully treated with one or another of the surgical procedures that we use in a routine fashion. Love I when I say the vast majority I think about 90 percent. Of diseases that these children are born with they aren't really diseases they

are deformities that they are born with inside of their heart. And as I say these can be very successfully corrected. And I don't mean improved I mean cured. If you take something for instance such as a pagan ductus which is an abnormal connection between two of the main arteries in the heart. That remains open into a very small percentage of children. These children have a very limited life expectancy and all they have to do is to go in and put a string around this abnormal connection and tie it off and you convert these children from children with a very limited life expectancy into perfectly normal children. The same is true of other defects inside of the hardware such as atrial septal defect and this is an abnormal hole in the heart between two of the main chambers of the heart and if one goes in and nearly So is this whole lot. Again you convert these children

from. Children with a very limited life expectancy into children with a perfectly normal life expectancy. There are another. 60000 patients a year who develop. Problems with within their heart associated with rheumatic fever. This is usually involves one or another of four valves in the heart there are normally four valves in the heart which are called the tricuspid valve the polemic about the micro valve and the aortic valve and rheumatic fever most commonly attacks the mitral valve and also of the aortic valve. It very rarely involves the tricuspid valve or the PO Monica. But these this is usually a disease of young adults. And their valves become so distorted that they again have a very limited life expectancy. And surgeons now are able to go

in and either repair these valves or take them out and put a new plastic dousing. And although the plastic valves that we use today are by no means the best that can possibly be developed I'm sure that they will be improved. They are far better than the valves that the patients have. That is the diseased and distorted valves that these patients have. So that's another 60000 patients a year. There are another 10000 patients a year who develop a peculiar disease known as Stokes Adams disease this is an interesting problem. Originally described by two Scottish physicians Mr. Stokes in Mr. Adams and they noticed in a group of their patients that they apparently would be going along perfectly well and then suddenly for no reason at all their heart would stop. And you can understand how this could be embarrassing.

Fortunately most of the time their heart would start up again within a minute or a minute and a half and they would recover. And if you would take their pulse if you take their pulse before their heart is perfectly alright and if you take a pulse after its pressure and it took them a long time to understand what was happening and what has happened apparently was. There is a system inside of the heart which distributes the stimulus that is there is a stimulus which is generated in a portion of the heart which then is distributed to the heart muscle and commands the heart muscle to contract so that the patient then has a heart beat. And if there is involvement with this stimulated if there is some way of through a disease process which is usually arteriosclerosis. If there is a block so is that this stimulus cannot be distributed to the heart muscle. Why then the heart muscle just sits there and waits until something happens

and then in the meantime no one no heart no blood is being circulated and so that the patient's brain is deprived of oxygenated blood. And if you deprive a human patient of oxygenated blood for more than 15 seconds he becomes unconscious. And if you do it. If there isn't enough blood supply to the brain for more than three or four minutes there is irreversible changes in the patient's brain. And even then if the heart does start up again the brain is destroyed and so that you have then lost the patient. Well stocks Adams disease as I say attacks about 10000 patients a year. And. If after the diagnosis is made that is after the first attack what usually happens is a patient goes along or right then will suddenly become unconscious and fall down after the first attack. Previous to the modern era of heart surgery 50 percent of these patients were dead in one year and 80 percent were dead in two years.

In the last 10 years or so heart surgeons have developed a small electronic device called a cardiac pacemaker which we are able to put in under the skin and run two wires to the heart. And this little iconic device. Keeps track of the heartbeat each heartbeat one after the other. And if a heartbeat doesn't come along within one second it will generate its own stimulus and will stimulate the heart muscle to contract so that the patient then will continue to have stimuli brought to the heart by this artificial means. And now. If we lose a patient who has Stokes Adam's disease we have to explain to our colleagues why we lost the patient. And this is progress. So that you can see great progress has been made. With the development of devices known as as pump oxygen nadirs which are artificial hearts in the true sense in that they will take over the function of the heart not only of

the heart but of the heart and the lungs of a patient. You can put a patient on this machine and I support his circulation and during this period of time you can get inside of the heart and make all these kinds of repairs that I've been talking about. So that really the accomplishments in the past 15 or 20 years have been astounding. And when one looks at the field of heart surgery one usually thinks of it as an explosive field because of all of these great accomplishments and they are truly great accomplishments. But. If you look at the problem from a statistical point of view this year one thousand seventy one million of our fellow citizens will die from some form of disease of the heart or great vessels. 1 million 54 percent of the deaths in this country are due to

these to heart disease. Half of the people half of the people in this room. I think it's the staff. I wouldn't be so sure I have been wrong before. But that's a very staggering number one out of two people who die will die from this disease so that you can say that what we have accomplished as great as it is is trivial compared to what we have yet to do. Times are difficult in the world today. And we in medical research. Have our difficulties to Paramount about among the difficulties that we have however is a shortage of research funds. In the past several years research funds that had been available to medical research workers in the United States

have been very generous and it is because of this generosity of the of the federal government through the National Institutes of Health. That we in this country have developed the best medical research system in the world. Why not. But nowadays the pressures from money of course are very great. Our country faces very great problems. The war in Vietnam the problems of the urban community the problems of education all of these are competing for much needed dollars and not much is being said about medical research. Just a few weeks ago two astronauts were sent to the surface of the moon and stayed there for a few hours and brought back big chunks of dirt which was an astounding accomplishment that cost three hundred and thirty million dollars.

This year the National Heart Institute will have. 10 million dollars for new projects and exploring methods of treating heart disease in this country. This is an appalling thing. I think that too. That the problems of heart disease the problems of education the problems of the race relations and the problems of our city cities are far more important than sending guys to the moon no matter how handsome these guys are. Sure. And. At any rate we share these problems with the rest of you and I make this play only that you should understand that this is a again a great problem and we must have medical research funds if we are going to make any progress in these areas. Now what kind of progress is possible. I've

described to you methods of repairing congenital heart disease that is heart disease problems that children are born with we have good methods for doing this. We have good methods. Or at least acceptable methods for repairing valuer diseases of the heart. We have good surgical methods now. For approaching diseases of the car Neri arteries which are the small arteries that supply the heart muscle itself. But the great problem that we face is the problem of diseases of the heart muscle per se we have no method of of repairing or replacing the heart muscle itself. And we have therefore got to explore methods of doing this. If one takes a mechanistic point of view about what the heart is it is a pump. It is said to be the side of the soul. And the organ of love. I don't

know much about the soul but as far as love is concerned we in Brooklyn think that there are better organs for that. But it most certainly is a pump. And one could reproduce the pumping of function of the heart. One thing that you could do is to make a mechanical heart and we have done experiments in which we have made mechanical hearts over the past five years or so and these hearts mechanical hearts are fashioned out of plastics which we know are acceptable in the body such as silicone rubber fiberglass and some newer plastics known as Teflon and Dacron. And these are very tough and very good plastics to make things out of and are well accepted in the tissues so that there is no rejection problem. And it is possible then to make pumps out of this of these kinds of materials and we have

made Thompson and have done experiments in animals where we have removed the animal's heart and replaced it but this kind of a mechanical pump and we've done about a hundred and fifty such experiments over the past five years and I'm sorry to have to report to you that the longest survivor that we have ever gotten with such a device is about 40 hours. That is there are all sorts of problems that you run into when you do try and replace an organ such as a heart with a mechanical gadget. Even though we can measure the amount of blood flow that you want to push around and you can push the blood around with this mechanical pump at the right speed and at the correct quantities and at the right pressure is because all of these things we can measure and adjust it so that it will do this kind of thing. We get into all kinds of more subtle and more difficult problems for one thing the blood is not simply a fluid it is a living tissue and one has got to handle the

blood very gently and we don't have surfaces that well. I had a little blood quite gently enough as yet we can do it for a few hours. Well as I say 40 hours is the longest time that we've ever had an animal there have been other groups around the country that have been doing experimental work with artificial hearts. And the longest time that I know of any device is a patient that was operated on by Dr. Cooley who put a mechanical heart into a patient because he was facing a very difficult problem and that in the operating room and that this patient only survived for 16 hours. And I think that what Dr. COOLEY pointed out is that humans are much more rugged and therefore better experimental subjects than are animals but whatever it is in survival time is measured in terms of hours and not in terms of days or weeks. In addition to the obvious problems such as handling the blood blood gently and getting a surface which will.

Prevent the blood from applying because you see if you take blood out of the body. Ordinarily it will clot immediately and if you expose blood to an abnormal surface it will clot mediately. We don't have a surface as yet which will totally prevent blood from clotting and this is a very serious problem. There is another problem and that is a problem of control. What you do is to set this pump the pump the blood at the right and a velocity and at a pressure that you think is correct. And it is unreasonable to suppose that this is the correct pressure and flow for this animal for the rest of his work. Well it is. It will last for the rest of his life. But that may be very long. And so we have got to develop devices that will get information back from the body as to whether or not the blood flow is adequate whether or not the pressures are adequate. You know there are all sorts of things that control one's heart rate for instance.

I know that if. I'm walking down the street and I see a good looking blonde my heart will tend to speed up a few beats per minute and unless you can make a gadget that will do that the whole thing isn't worthwhile. So that you have to have a device which is going to respond to this kind of stimulus as well. So that it's a very complicated problem it is not simply a problem of making a pump that will push blood around it adequately. Right. But I pump that will respond to the needs of the body. So as far as a total artificial heart is concerned it seems to us in our laboratory at least that this is something which is not in the immediate future but rather is something like 10 or 15 years away. We then have got to face the problem some other way. There must be some other

approach that we can explore. Now another possibility is that one does not really have to replace the heart geographically. Of course there is the possibility of transplanting a heart and this I'll discuss in just a few moments. But if one looks again at it from a mechanistic point of view a diseased heart doesn't destroy the individual the way the same way that a diseased appendix destroys the individual a diseased appendix is the site of an infection. It involves tissues that are around it a large inflammatory mass will form. If this mass then bursts it will develop a curtain itis. And this will destroy the patient that is it destroys the patient by destroying more and more tissue. A diseased heart destroys the patient because it is not capable of doing the job of pumping the blood in it to the quantities which are demanded by the body. So that it is conceivable that one could

make an extra pump that is not to replace the heart geographically leave it in place and just put an extra pump in to carry the load of pumping the blood around to the bottom. After all a sick old diseased heart if it isn't good for anything else has a certain amount of sentimental value and it might be nice to to keep it if you could. So we did a whole series of experiments in which we explored the possibility of putting in an extra heart which we call an auxiliary ventricle. First we did these and in dogs and over a period of about eight years we did something like 500 experiments in dogs and finally demonstrated that it was indeed possible to do this to put in a mechanical device which is not very large as big as a small transistor radio. And without removing the patient's or the dog's heart and

have it take over about 50 percent of the work of pushing the blood around in the body one could elect tronics late tie this to the original part the natural part and since the natural heart would speed up or slow down in response to the needs of the body then the gadget would speed up and slow down as well you see because it's tied into the electrocardiogram electric light and is electrically time by the natural heart so it has that advantage that has another advantage in that it doesn't have to be functioning all of the time because if it is if it's not functioning it's just sitting there. And then the original heart has to do all the work and you could have this thing functioning or not functioning by turning it off from the outside without too much difficulty. The longest time that we had one of these devices. In a dog I was for 17 months and we had a whole series of animals in which we had this gadget functioning for months and even years. So we felt then that it was reasonable to try this

in a small series of patients in whom the problem that they were facing was gave them really no other alternative. That is a group of patients who had longstanding severe heart disease where everything had been tried and were in imminently facing death. One patient that we did this in was a 64 year old woman who came to the hospital because she had had three major heart attacks and with each heart attack a certain part of her heart muscle was destroyed and replaced by a scar and she therefore had less and less heart muscle left to pump the blood around. And she was in congestive heart failure which is the term that doctors used to describe the fact that her heart was not capable of pushing the blood around in adequate quantities. Now. You know that there are essentially two

groups of doctors there are doctors which are called internist who work with pills and things and surgeons who like to do something about the disease. The internist saw this patient and it made a very good diagnosis in that they and they knew that this patient had had previous heart attacks and had destroyed a significant part of their muscle and they could pretty well get a pretty good idea of this from the electrocardiogram and from the X-ray tests that they did. And they do have methods of treating the congestive heart failure which is a method of encouraging that. What happens when you have congestive heart failure is that fluid tends to collect in your tissues because the heart is not capable of pushing the blood around so that the fluid tends to leak out of the blood vessels into the tissues and the patients the belle of. What used to be

called Roxy. But this is actually such a collection of fluid in the tissues. Well they have a very exotic roots and herbs that they can use to squeeze these tissues dry. And they used this in this patient and they were able to get rid of about 40 pounds of water over a period of a few weeks. But then she very quickly collected this fluid back again. And they tried to do this again and they did it for three or four times until finally the patient had reached a point where she would no longer respond to this kind of treatment. Now in addition to the fact that she had had three previous heart attacks. She had rather severe diabetes some of longstanding of about 40 years that she had had diabetes and in also because the diabetes was so severe it involved the nerves of her lower half of her body so that she was paralyzed from her waist down. And actually had been in bed for two or three years prior to our seeing her. She also

had diabetic involvement of her kidneys a disease which is no known as can steal Wilson's disease and she because she had been in bed for all of this long period of time she developed a chronic infections in both of her kidneys she had chronic pollen affright us as well. She also had diabetic involvement of the retina of our eye both eyes and she was partially blind and she had two or three other minor illnesses. But the thing that was killing this patient. Was. What was the fact. That this poor woman's heart was no longer capable of pushing the blood around in her body. So we discussed. The possibility of putting in this mechanical heart. Into this patient both with her physicians and with her family and with herself and she was alert and understood the

problems and understood what she was facing and she herself made the decision that. You know she just didn't want to live this way and if this offered her any opportunity of improvement why she wanted to try it. And so we did. Had we operated on this patient and for a period of time she did remarkably well she recovered from the operation we put in this mechanical device. Able to get her out of bed wheelchair she was out up and around visiting with her family. And as a matter of fact did. As I said quite remarkably well. This was very adequately reported in the newspapers and I'm sure that some of you will remember a few years ago when we did this operation in Brooklyn about the same time Dr. DeBakey my rather well-known heart surgeon in Houston Texas did a similar operation and both of our patients were and did pretty well for a period of time.

So well that my children had already chosen the hotel that we were going to stay at in Stockholm. But this like so many dreams was shattered one night about three weeks after the operation when we were called to the hospital because a patient had suddenly become comatose and we all came back and did what we could but unfortunately we lost the patient the next day. And on examination we found that even though we had had this exhaustive experience in dogs and had done what we felt all that was necessary to solve the problem of forming clots inside of this device. Actually she formed a small clot in one corner of this pump and this clot broke off and went to her brain and destroyed her. So. This is been our experience than with a total mechanical heart which has

not worked out real well. A partial mechanical heart intended for permanent implantation which I think worked out reasonably well we actually did this operation in two patients not in one and both of the experiences were about the same. Dr. DeBakey has done a similar operation in three or four patients and again with only limited success. We feel that we need a much greater effort research effort to develop newer materials and newer methods of supplying power to such a device. Before this can become a realistic possibility. But here I don't think that this is 10 or 15 years off. I think this is something that is only a couple of years off if we can get enough money to do the research. We have had some experience with a another kind of artificial heart.

Which we have designed for only for temporary years. There are about 600000 patients a year that develop heart attacks in this country and are brought to the hospital. Of these 600000 patients who develop these acute heart attacks. About 15 or 20 percent of them also develop shock. That is their heart has been suddenly damaged. And is not capable of doing the job. And then these patients will go into shock and if they develop shock along with them our cardio infarction with along with their heart attack. Then the mortality in this problem is horrendous and we're not talking about a small number of patients. If 600000 patients a year develop my cardio infarction and 20 percent of them develop shock which is about the number that's one hundred twenty five thousand people a year and this hundred twenty five thousand people are

not elderly people. There are people in the Middle Ages in the prime of their life. And who are in the very productive and capable of doing a socially useful job. Yeah. Then more if they develop this. The shock syndrome along with a heart attack. Their mortality then goes up to something like 90 percent. That is nine out of 10 of these patients will die. And there isn't anything that any doctor can do about that. Because what the problem is is that this sudden suddenly a portion of their heart muscle has been destroyed and a whole load of pumping the blood is thrown on what heart muscle is left. And if there isn't enough heart muscle left to push the blood around why then the patient's going to shock and they die. So we did any series of experiments with a very simple pump a pump that is placed on the end of us of tube a flexible to which we can put in through a small

vessel in the leg. We can make a one inch incision in there like and put it in there and push it up into the blood vessel which will go right up behind the heart. And in this area it will act as a pump and we can take over the load of pushing the blood around with this device. And again we did a long series of experiments in dogs and we found again that we could take over a very significant part of the work of pushing the blood around in the body with this kind of a pump. So we then again. Set out to do this in a series of patients whom the medical people had done all that they could for. And whom they felt now they were most certainly going to lose. So that these were the sickest patients that we could get and we have used this device now in 30 patients and of these 30 patients they divide themselves into two groups. There is one group who had such massive damage

that so much of the heart muscle of the steroid that one could not. Recruit any of these patients and we lost every one of them. But that was about one third about 10 of these 30 patients were in that group. The remaining 20 patients we were able to pull everyone of these patients out of shock. Stabilize them and send them back to the medical people. And a very significant percentage of these patients with subsequently sent home. So that we feel now of patients who we are capable of surviving that we can we can salvage about 50 percent of these patients that isn't it isn't brilliant. We can solve every problem. And as I say there are one group of patients which we now can recognize which really you cannot do anything for sure of repricing their heart because their heart is so totally damaged that it is not possible to retrieve it. But the interesting thing is not that we lost a group of patients but that we were able to salvage a very

significant number of these patients whose heart really was not that only damaged but only required support for a comparatively short time anywhere anywhere from three or four hours to about 15 hours. And if you support these patients for this period of time you can pull them out of shock stabilize them and send them home. And these were patients which up until now. Would have most certainly died. So that here and this is truly an artificial healer this artificial device is has a very immediate usefulness and we are now in the process of disseminating this it has now become commercially available so is that doctors all over the country now have become very much interested in this kind of device. And I think that in a year or so this will be generally available because it's a very simple device to use for the surgery. This is and it is very simple. It is done in bad you don't have to take the patient to the operating room and it is usually done under local

anesthesia or no anesthesia because most of these patients are comatose when we get them. And they can be done by reasonably trained surgeons and physicians without too much difficulty. So here that is a mechanical device which has very immediate usefulness in in the present time. So then finally one has got to come to the possibility of that group of patients for which there is no salvage short of. Literally replacing their horns. And as you know in the recent two years or so it has become very fashionable to do heart transplants. This wasn't so when we first started doing experiments and heart transplants about 0 6 again 6 or 7 years ago. This is when our Surgical Research Laboratory became a very active in all of these areas

because it was then possible to get research support from the government and it was possible to concentrate the efforts of a very bright young people on trying to do something constructive about problems which we were concerned about. And there were only three laboratories in the country in 1962 963 that were involved in experimental methods of doing heart transplantation. There was Dr. Shumway as a laboratory in Palm Alto and it really is Dr. Shumway who deserves the credit for doing this because it is he and his coworker Dr. Richard Lowery who worked out the surgical technique that made it possible to do a heart transplant in animals. There was Dr. Shumway laboratory in Palo Alto and in San Francisco just south of San Francisco. Then Dr. Lowery who had been working with Shumway set up his laboratory at the University of Virginia and our own laboratory here in Brooklyn New

York. And we all know. From 1962 to 1965 accumulated a rather extensive experience with doing this kind of surgical procedure in animals and there were several things that had come out of this out of this experience. Number one. It became obvious that the surgical procedure was perfectly feasible and all of us could now I had developed teams that could do this in dogs with about 95 percent assurance that you could take the heart out of one item and put it in another animal and had this animal at least recover from the anesthesia and a walk around for a few days at least. That was one thing that became obvious. Then the second thing was that in a small group of animals it was possible to control a rejection problem so is that one could get long term survivors. And we have in our laboratory

at the present time two dogs one dog that has survived now for over three and a half years following a heart transplant in another dog about two years following a heart transplant and had a rather extensive series over it in about 300 dogs we had 20 percent of them that would survive for more than three months. That is it is perfectly true that we lost 80 percent of these animals within the first three months from this rejection problem. But. In those days nobody knew whether or not the rejection problem would be more difficult. Or less difficult to control in humans. We had developed a surgical procedure to the point that we could do it with great confidence. We had developed techniques for removing the heart from a dead animal and reviving the heart and putting it again in such a way so that it would take over the circulation and we had developed techniques for

him for recognizing the rejection problem in the heart and in a small percentage 20 percent of controlling the injection problem for at least a reasonable period of time anywhere from three months to a year or more. So then it became obvious when we would meet the three of us since we were the only three involved in this whole effort at that time. And talk about this and it became obvious among all of us that this had to be done in humans before you would know whether the rejection problem was more difficult or less difficult than in animals. And about that time Dr. Barnard came and visited all of our laboratories and he was well known to us he was a well known heart surgeon he is a brilliant surgeon. He's young and aggressive and very handsome and long before he became.

Known to Gina Lollobrigida we knew him very well when he came and visited our laboratories and he set up the fourth laboratory in Cape Town in South Africa and it became perfectly obvious that we all knew that it was now a matter of time before this had to be done in humans and actually although certainly Dr. Barnard deserves credit for having done this first. The rest of us also prepared to do it essentially was done simultaneously and this is very true in science when something is ready to be done. It is frequently done simultaneously in three or four centers at it at the same time so that also although Dr. Barnard operation preceded my operation by three days and Dr. Shumway has followed my operation by two weeks it was all done essentially at the same time. And following that as I say it then became very fashionable and many surgeons including Dr. Denton Cooley and I did the Bacchae and Dr. Lowell

High who is of one of the really surgical pioneers in this country in our own city here in New York also did a series of these cases and by this time which is now a little over two years now just about two years just about two years since the first heart transplants were done. A series of about a hundred and forty some odd patients have been done. And the interesting thing is that the long term survivors in humans is 20 percent. That is exactly the same as a week as it was in the dogs. So. You can see that we have problems. I think however. That this is a very realistic possibility. And that this can be developed and that this that the moral and ethical problems which do exist and I admit they exist. There are

moral problems and there are ethical problems. But the fact of the matter is again from a mechanistic point of view from the point of view of people who are alive. It doesn't make any sense to bury a patient with perfectly good organs it isn't going to do him any good. And as far as the soul is concerned I don't think the soul is in his kidneys or his liver or his thyroid gland or his heart for that matter so that it is perfectly reasonable to take a perfectly good heart. And put it into a patient who really needs this to stabilize what is not reasonable is that we do not have a good method really good enough methods of controlling the rejection problem. And the rejection problem is not an easy problem to control. It is one of the basic abilities that all of us have that permit us to survive. It is.

A basic requirement to survive what it is is the ability of our body to recognize that some living foreign material is inside of us and sets about destroying it. We are constantly being exposed to all sorts of bacteria and all sorts of viruses and if we did not have the ability to recognize these as foreign material and have the ability to destroy these infections would have destroyed us millions of years ago so that the system for our recognizing and destroying foreign living tissue is exquisitely developed in our body. And it is a an interim goal and necessary part of us and we have therefore got to learn more about precisely how this works. And controlling it again exquisitely not on a broad way not suppressing all of the immune reaction that a patient has because then you suppress his ability to to defend himself against infection and what you've

got to do then is to develop an exquisitely sophisticated method of controlling his ability to reject heart tissue. That's all. And lave him with the ability to reject bacteria and viruses and diseases of all sorts. So then I have described to you. A little of the history of the development of heart surgery. Some of the problems associated with developing mechanical hearts of all sorts mechanical hearts of which the. There is I think a very exciting future. And the possibility of transplants and the difficulties that we are having with these transplant procedures all of these things. We must find more and more and more must learn more about. And the way we will learn more about it is that if the people of this country decide.

That there are more important things to do with our among. Then fighting a war in Vietnam. Or sending men to the moon of the ear with things. You've heard of Dr Adrian Kantrowitz speaking on the topic transplantation and medical devices this was one of the 1970 series of lectures recorded at the great hall of the Cooper Union in New York City by station WNYC. The chairman for the Cooper Union was Johnson a Fairchild. This program was distributed by the national educational radio network.