One Miracle, Many Doubts

A feat of heart surgery sharpens the debate over benefits and costs

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The dying heart was an I ugly yellowish color when Dr. William DeVries finally cut it loose, tore it out of the Mercurochrome-stained chest cavity, and put it to one side. For the next three hours, while a nearby heart-lung bypass machine kept the unconscious patient alive—and while a tape in the background eerily played Mendelssohn and Vivaldi—DeVries' sure hands carefully stitched into place a grapefruit-size gadget made of aluminum and polyurethane. At 12:50 p.m. last Monday, the Jarvik-7 artificial heart newly sewn inside William J. Schroeder began beating steadily, 70 beats to the minute. When Schroeder opened his eyes 3½ hours later in the intensive-care unit, DeVries bent over his patient and whispered assurances, "The operation is all through. You did really well. Everything is perfect."

So, for only the second time in history, a human heart had been permanently replaced by a machine. Like a landing on the moon or a close-up photograph of Saturn's rings, it was an event that seized the world's imagination, arousing once again a sense of shuddering awe at the incredible powers of technology, a sense that almost anything is possible, almost anything that can be imagined can be done.

Though nobody could predict how long the aging and diabetic Schroeder would survive—his only predecessor, Dr. Barney Clark, died after a courageous 112-day struggle last year—he was reported at week's end to be doing "beautifully" (see following story). But even if Schroeder dies soon, there will be more such operations, and even more complicated ones, in the near future.

The Humana Hospital Audubon in Louisville, where the operation took place, has received permission from the Food and Drug Administration to perform another five artificial-heart implants. One candidate is now in the hospital for evaluation, but will most likely be turned down. At the same time, two Southern girls are scheduled for complex variations of organ replacements this month. Cynthia Bratcher, 6, of Scottsville, Ky., will be taken to Birmingham for an operation that will install a second heart inside her. Meanwhile, Mary Cheatham, 17, of Fort Worth, will go to Pittsburgh for simultaneous transplanting of heart and liver. (The first recipient of such a double transplant, Stormie Jones, 7, of Cumby, Texas, is still doing well after ten months.)

In what should be a time for congratulations and rejoicing, it may seem carping to raise questions about the value of such spectacular operations, yet that is exactly what a number of medical experts were doing last week. They did so because they feel serious doubts about the whole course of high-technology medicine doubts about cost, ethics, efficiency and simple justice.

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