The Hearts of the Matter

By Claudia Wallis

The countdown started around midnight at Baltimore's University of Maryland Hospital. At that hour doctors began the delicate task of removing the heart and lungs from a 32-year-old victim of a car accident declared brain dead several hours earlier. Working swiftly, they excised the organs, chilled them to 45 degrees F and transported them across town to Johns Hopkins Hospital. Clinton House, 28, a refrigeration mechanic whose lungs were ravaged by cystic fibrosis, had been summoned from his home and was being wheeled into the operating room. He had waited a year for this moment. In a room ten yards away, doctors prepared John Couch, 38, of Yardley, Pa., who was suffering from advanced heart disease.

Over the next seven hours, the two teams worked briskly, removing House's stricken lungs and his functional heart, leaving what Surgeon Bruce Reitz later described as a "very dramatic cavity" in his chest. The doctors had decided it was simpler and safer to replace both the heart and lungs rather than the lungs alone. As Reitz's team began implanting the heart and lungs taken from the accident victim, House's heart was rushed into the next room, where Surgeon William Baumgartner sutured it piggyback over Couch's own ailing heart. By 10 a.m. the exhausted physicians had completed their tasks and made American medical history. It marked the first time in the U.S. that a living individual had donated his heart, in what is termed a "domino donor" organ exchange. Officials at London's Harefield Hospital revealed last week that Dr. Magdi Yacoub had actually been first to use the domino approach there in April.

At week's end both patients were sitting up in chairs, and House had even enjoyed his first post-op hamburger. House had been happy to serve as both organ donor and recipient, said his mother Joyce Plesic. "He said if someone could help him, he should help someone else." Couch's wife Peggy said she was pleased that her husband might have a chance to meet the man who gave him his heart. Doctors say that get-together may occur this week.

For House, the transplant was a last resort in a lifelong battle with cystic fibrosis. CF victims produce abnormally thick, sticky mucus and other secretions that block normal lung function and interfere with digestion. Babies born with CF used to die in early childhood, but today more than half reach their early 20s, thanks to a battery of drugs that control lung infections, aid digestion and limit secretions. Still, few survive beyond the age of 30. House's lungs were "just about gone," according to his father, and for three years he had used an oxygen tank while he installed air- conditioning equipment.

Some 250 heart-lung transplants have been performed in the U.S. since 1981; two-thirds of the patients survived the first year, and 25% have lived more than five years. Surgeons in England have demonstrated that the procedure can work well on CF patients. One woman there has survived for 20 months with a new heart and lungs. "She is living a reasonably normal life, working at a library," reports Biochemist Robert Beall of the Cystic Fibrosis Foundation in Bethesda, Md. Before surgery, he says, the woman "had to be carried from bed to bathtub." Especially encouraging is the fact that the woman's new lungs have not been affected by cystic fibrosis.

CF patients may soon benefit from a new procedure in which just the lungs + are transplanted. "It's sort of a heart-lung, hold the heart," says Dr. Joel Cooper of Toronto General Hospital, who developed the operation. For some patients, he observes, "a heart-lung transplant is fantastic, but why transplant the heart if it is not needed? Why subject the patient to the additional risks?" Since November three patients, none afflicted with CF, have had the operation. "All have gone home, and all are performing spectacularly," he says.

Experts on cystic fibrosis agree, however, that such surgical wonders are of limited use. Although 500 to 1,000 CF victims die each year, many of them suffer from diabetes, kidney failure and other complications that make them ineligible for transplants. A shortage of lung donors poses an even greater problem. "This is not a panacea for cystic fibrosis," says Beall. He and others think the best hope lies in deciphering the genetic basis of the disease. Researchers at St. Mary's Hospital in London believe they have located the responsible gene on human chromosome No. 7. The finding should lead to a precise biochemical understanding of CF and, in turn, better drug treatments. That, of course, could someday eliminate the need for surgical heroics.

With reporting by Dick Thompson/Baltimore