Making Progress

Scampering and wagging her tail, the brown and white dog on the movie screen seemed nothing more than a picture of normal canine happiness. But to the meeting of the American College of Surgeons, the happy-go-lucky mutt was of signal significance. Within her chest was another dog's heart, transplanted by Dr. Richard R. Lower of the Medical College of Virginia more than a year before. She and another pup had not only survived with substitute hearts, but they were able to function normally--even to the extent, in the brown and white dog's case, of bearing a litter of puppies.

No one has yet transplanted a human heart. Nonetheless, physicians at the conference heard reports of progress in the transplantation of other human organs. Although measured in mere weeks, one of the most significant reports was that of three successful liver transplants made on three infant girls in Denver. Performed by an imaginative and daring transplant team led by Dr. Thomas Starzl at the University of Colorado Medical Center, all three operations involved the replacement of a diseased liver that was deemed incurable. Until recently, 34 days had been Starzl's record for survival after a liver transplant. Two of Starzl's tiny patients have now survived for more than eleven weeks. The third has been sustained for five weeks.

Dr. Starzl lessened the chances of adverse immune reaction by using healthy organs from children--much the same age and size as the patients--who had died of some cause other than a liver disease. Before implantation, the donated liver was matched for tissue and blood cells. To further assure a reasonable chance of success, Starzl and his colleagues gave their young patients injections of azathioprine (Imuran), prednisone and antilymphocyte globulin--all of which help to suppress immune reactions. The antilymphocyte globulin, newly developed from the blood of horses that have reacted to human tissue, is already helping to improve the chances (now estimated at 65%) of successful kidney transplantation as well.

Saving the Bleeders. In another series of experiments on animals, a Boston City Hospital team sponsored by the Harvard Medical School reported the possibility of spleen transplantation to save the lives of hemophilia victims. Hemophiliacs suffer from the lack of a blood-clotting substance called AHF. As a result, an otherwise manageable cut can become a source of quick death. At present, when a severe onset of hemorrhaging occurs, hemophilia victims can be saved from bleeding to death by injections of AHF extracted and concentrated from a healthy person's blood. But the process is costly, and the relief temporary.

It is known that the spleen is somehow involved in the production of AHF, but just how is not yet clear. Experimenting with pigs, the Boston City Hospital surgeons found that a normal spleen begins to produce more AHF when perfused with the blood of a hemophiliac. To one of the surgeons, Dr. John C. Norman, this suggests the possibility of transplanting a normal spleen into a hemophiliac, so that his abnormal blood might stimulate the new spleen into plentiful production of AHF.

Surgically, such an operation would be far simpler than transplanting a heart, liver or even a kidney. But Dr. Norman emphasized that further experimentation--with dogs--must be conducted before spleen transplantation is attempted on a human being. Then, in all probability, a donor's spleen will be enclosed in a plastic bag, hooked up to a hemophiliac's circulating system and hung externally on his arm until it is certain that the method works.

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