Michael Kasperak

The case of Mike Kasperak differed from that of other transplant patients in the underlying cause of his heart disease. Kasperak, 54, was stricken with a severe viral inflammation of the heart (viral myocarditis) ten years ago. Recently the inflammation had not been active, but the heart had become enlarged, more scarred and fibrous. Kasperak (pronounced Ka-spair-ak) quit his job as a Cleveland steelworker and retired to East Palo Alto, Calif. After a November episode of heart failure, he was admitted to Stanford Medical Center on Jan. 5, in desperate plight. When Kasperak asked his wife, Feme, what she thought about a transplant, she gave what has fast become the standard answer of the Barnard era: "Go ahead--I want you alive with me."

In this case also, the eventual donor had no thought of her own death when she talked to her husband about heart transplants. Virginia Mae White, 43, had never had a serious illness as she celebrated the 22nd anniversary of her wedding to Charles W. ("Bill") White. Next evening, she had a massive brain hemorrhage and was taken to El Camino Hospital in Mountain View, only eight miles from Stanford. When her doctors said there was no hope, White asked whether there was any type of research going on relating to what had happened to his wife--"something where she could help."

Her neurosurgeon phoned Palo Alto, and White soon got a call from Dr. Norman E. Shumway Jr., pioneering head of Stanford's cardiovascular unit, a fellow resident with Cape Town's Dr. Barnard at the University of Minnesota and the developer of the heart-transplant technique first used by Barnard. Shumway asked about a possible transplant. White talked it over with his children, Judith, 18, and Richard, 12. He also consulted Virginia's mother. They all said yes.

Distributor Cap. When Mrs. White died, a team headed by Dr. William Angell removed her heart. Dr. Shumway did not have it perfused with blood, as had been done in South Africa, while Kasperak was prepared for the implant. He simply had it kept in a cold saline solution, at about 50DEGF. Kasperak, on a heart-lung machine, was cooled hardly at all. Applying experience gained from years of experimental surgery on animals, Dr. Shumway left in place two quadrantal areas of Kasperak's heart, with venae cavae and pulmonary veins attached--analogous to the distributor cap of a six-cylinder car with its spark plug leads. Then he cut this section away from Mrs. White's heart and tailored the remainder to fit.

There were many complications. Kasperak had worked in a fume-filled steel mill, had been a heavy smoker and, as a result, his lungs were leathery. They could not exchange enough oxygen to keep him going. So an incision was made in his throat and a tube inserted to supply oxygen more efficiently and to remove mucus. Kasperak's big chest was rigid; other organs showed little tendency to close in around the small heart, and the cavity filled with fluid. His liver and kidneys had been damaged by a shortage of oxygenated blood.

Scarcely more than a day after the transplant, Kasperak began to bleed into his gastrointestinal tract. Evidently the clotting mechanism in his blood had been knocked out by the failure of his liver to produce the necessary enzymes. His platelets (tiny disklike elements in the blood, which are important in clotting) plummeted from a normal count of 250,000 per cu. mm. to 4,000. This required heroic measures. Kasperak had to have blood transfusions, and to remove metabolic wastes from his body the surgeons punched another hole in him--through the abdominal wall, for peritoneal dialysis. This is a process in which a solution is pumped into the abdominal cavity to pick up waste substances that normally should be cleared by the kidneys and urine.

Kasperak rallied through most of the week. But then he suffered a serious setback. Because of his poor liver function, an excess of bilirubin (a by-product of hemoglobin, the oxygen-carrying protein in blood) began to build up in his system, and doctors scheduled another massive transfusion to remove impurities from his blood. Through it all, the one organ that consistently worked best was his acquired heart.

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