On this day in 1967: America's first heart transplant

Maddy Parameswaran travels back to 1967 to delve into the USA's first human heart transplant

5th December 2016

On 6 December 1967, Dr. Adrian Kantrowitz, a renowned cardiac surgeon and inventor, performed America’s first child heart transplant at the Mainmodes Medical Centre in Brooklyn, based on previous research by Dr. Norman Shumway and Dr. Richard Lower.  This occurred just three days after the world’s first heart transplant in Cape Town by the South African surgeon Christiaan Barnard. This was one of the world’s first heart transplants and thus ignited the medical community’s interest in human heart transplants, paving way to our modern-day methods.

Kantrowitz was primarily an inventor and was devoted to finding mechanical ways to help failing hearts. He soon realised, however, that only a human heart transplant would be the best option for those with irreparable damage. During the late 1950s, Shumway and Lower were performing transplants on dogs using ‘topical hypothermia’ and other innovative preservation and operative techniques. Kantrowitz built on their work and performed heart transplants on puppies as he rightly hypothesised that the chances of rejection would be lower in younger dogs as their immune systems would be more immature.

By 1966, he had performed over 400 canine transplants and had all the necessary technological and medical infrastructure ready to attempt a transplant.  However, the legal definition of death in the USA in the 1960s was still that of cardiac death and did not include brain death. This meant that the surgeons had to wait until the patient’s heart stopped beating to harvest the organ which lead to the heart being rendered useless most of the time as a lot of organ damage had already occurred. This had prevented an attempt in May 1966, a year and a half before Barnard’s attempt.

"By 1966, he had performed over 400 canine transplants and had all the necessary technological and medical infrastructure ready to attempt a transplant"

In November 1967, a baby was born with many cardiac congenital defects. A baby born without a brain was found as a donor and a transplant was attempted. However, the baby survived just six and a half hours… and the new heart failed. Kantrowitz attempted it again along with Shumway and Lower, this time from a brain-dead young female donor to a 58 year old man in 1968. Yet again, the patient passed away 14 days later due to heart failure.

These early efforts in heart transplantation gained interest in the medical community and resulted in 100 such procedures being attempted in the following year. However, the challenges of organ rejection and infection proved too great, resulting in bleak survival rates after surgery. Hence, most attempts (including Kantrowitz’s) were abandoned soon after, although he continued to be involved in discussions regarding transplantation. One of the issues raised by Kantrowitz was the criteria of death which proved to be a massive obstacle in harvesting appropriate organs. The criteria was subsequently changed in 1972 after an unsuccessful lawsuit against Lower when he took the heart of a brain dead patient in 1968.

Despite these failures, Kantrowitz’s work was carried on by Shumway, who continued relentlessly in his attempt to perfect cardiac transplantation. His team made some important contributions and were the first to introduce cyclosporin, an immunosuppressive drug, in 1980 thus making long term survival possible after surgery. For his contribution to the field of transplant research, he is now known as the “Father of Cardiac Transplantation”. At present, around 3,500 transplants are performed annually which can be attributed to the work of these pioneers.

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