Four Hearts

In an unprecedented flurry of daring surgery, four human hearts were transplanted last week: two in Europe, two in the U.S., bringing the world total of such operations to ten.

PARIS

French surgeons had to wait for months--not only for a suitable donor and recipient but also for their government to decide when a dead man is dead. At last the Cabinet ruled that a donor is dead when his electroencephalogram (brainwave recording) has shown no activity and he has had no reflexes for several hours. Scarcely was this decision taken when Donor Michel Gyppaz, 23, died of head injuries at Paris' ancient, crumbling Hopital de la Pitie.

The recipient was Truck Driver Clovis Roblain, 66, forced to retire last July by progressive heart failure and a crippling heart attack. Chief surgeon was Dr. Christian Cabrol, 42, on the faculty of the University of Paris since age 26, and a specialist in artificial-heart research. An hour after the operation, Roblain's blood pressure dived to near zero. Emergency measures restored it to near normal, but Roblain remained in a coma until his death 51 hours after the operation. The autopsy showed that many formerly immobile blood clots, set free by the unwontedly strong pumping action of the new heart, had traveled to his lungs and blocked circulation there.

STANFORD

Joseph Rizor, 40, a carpenter from Salinas, Calif., became the second heart-transplant subject for Stanford University's pioneering Dr. Norman E. Shumway Jr. The victim of three heart attacks within seven years, Rizor had been longing for a transplant since he heard of Dr. Christiaan N. Barnard's first operation in Cape Town last December. "At first," says his wife Eileen, "I was shocked by the idea. But time and the knowledge of how desperately my husband wanted the operation made me realize that it might be his only chance to live." When a brain-injured donor, a man of 43, died in Stanford Medical Center, Shumway implanted the heart in a 41-hour operation. (The donor's kidneys were used in two other transplants.)

Although Rizor had the advantage of relative youth, his long-standing heart disease had impaired his lung function, and after the operation he still needed artificial respiration, by way of an oxygen tube cut into his windpipe. Rizor's new heart was doing a fine job of pumping more blood, but the blood was not taking up enough oxygen. Explained Shumway: "This change in circulation has confused his lungs to some extent. The problem is whether there can be a satisfactory adjustment to the new heart. Liver and kidney functions are fine--in other words, all systems are 'go' except for the lungs."

HOUSTON

Everett C. Thomas, 47, a Phoenix, Ariz., accountant, was in St. Luke's Episcopal Hospital in Houston waiting for Dr. Denton A. Cooley to replace three valves in his heart, all damaged by rheumatic fever beginning 15 years ago. A donor heart became available after Kathleen Martin, 15, shot herself in the head during a quarrel with her 18-year-old husband. By extraordinary coincidence, Dr. Cooley had operated on her in 1962 because a narrowing of her aorta was restricting the outflow from her heart, which was becoming enlarged to meet its extra work load.

When Kathleen Martin died, Dr. Cooley opened Thomas' chest and found such widespread calcification that valve replacement would do little good; a transplant was far preferable. So once again he held Kathleen Martin's heart in his hands, this time to implant it in Thomas' chest. The fact that it was al ready enlarged was now an asset. Dr. Cooley, one of the world's most dexterous cardiac surgeons, especially noted for his success in correcting heart defects in small infants--even the new born--breezed through the adult transplant in three hours, clipping about one-third off the average time.

Although Cooley used the basic Shumway technique of leaving in place part of the recipient's heart shaped like a distributor cap (TIME, Jan. 19), he was careful also to leave in the donat ed heart a bundle of nerve fibers called the sino-auricular node. This is the heart's normal pacemaker. When Thomas' condition remained good at week's end--so good that he was able to embrace his wife--Cooley said: "The reason for the success, so far, may be the inclusion of the complete conductive mechanism with the transplant."

LONDON

Britain's first heart donor was an Irish construction worker who died in a South London hospital after a fall from a scaffold. Chief surgeon in this case was Donald Nixon Ross, 45, who was born in South Africa and was a medical school contemporary of Dr. Barnard's at the University of Cape Town. The recipient was Frederick West, 45, a contractor who had been in the hospital 20 times in little more than a year. He could not walk across a room without disabling pain.

Neurosurgeons operated in vain to save Donor Patrick Ryan, 26, who had broken his skull. When his EEG had been flat for six hours, he was pronounced dead by four groups of doctors, none of whom were involved in the proposed transplant. The Ross surgical team at Britain's National Heart Hospital used the Shumway technique in an operation that ran 61 hours.

Although West's progress was encouragingly uneventful, some British doctors criticized the surgeons for "joining in a race with undesirable gold-rush characteristics." Not so, retorted Surgeon Ross. The operation was "morally correct," and justified because West had no alternative but death, and knew the risk he was taking.

In Cape Town, meanwhile, Dentist Philip Blaiberg, 58, the only long-term heart-transplant survivor (Dr. Barnard's second patient), was gaining strength with every passing day and having to fight against gaining too much weight. Tanned from sunning on his balcony and from strolls on Cape Town's sea front, he was paying only two visits a week to Groote Schuur Hospital for checks on his heart and dosage of immunosuppressive drugs. Blaiberg has retrained muscles that in pre-transplant days were too weak to work the stick shift of his car; last week he drove in and out of Groote Schuur with the aplomb of a professional driver.

Four Parts

An eleven-year-old boy from Loma Linda, Calif., died last week of auto-accident injuries. Within the day, his kidneys were transplanted into two men, an extract from his spleen was injected into a leukemia patient, and surgeons used some of his skin as grafts for a severely burned woman.

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