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Among the several courses open to them to try to blunt the rejection mechanism, Washkansky's doctors chose to use two drugs, azathioprine (Imuran) and cortisone, plus radiation. At first, to avoid moving their patient, they administered gamma rays with an emergency cobalt-60 unit, somewhat resembling a dentist's X-ray machine, rigged up in his room. After four days, when Washy was waving at photographers and joshing with doctors and nurses, he was considered strong enough to stand a quarter-mile trundle to the regular radiation treatment center. At week's end, when his white-blood-cell count rose, the doctors still had more drugs in reserve to beat back the rejection mechanism, and they stepped up his cobalt-60 treatments. Washkansky's liver shrank to nearer normal size; Denise's heart and his kidneys worked so well together that he lost 20 Ibs. of edema fluid.
Double Chill. While South Africa was proudly rejoicing, the U.S. transplant team was just beginning. In wintry Brooklyn, Dr. Kantrowitz had put his team on full alert at about the same time as Dr. Barnard was alerting his. His 19-day-old patient, the intended heart-transplant recipient, had been born blue. The child was a victim of severe tricuspid atresia—constriction, to the point of almost total closure, of the three-leafed valve that normally regulates the flow of blood from the right auricle to the right ventricle on its way to the lungs for oxygenation. There is no way to correct this condition surgically, and its victims live no more than a few weeks. Justification for a transplant was clear.
The problem was to find a donor. Maimonides sent telegrams to 500 hospitals across the U.S., asking to be notified of the birth of an anencephalic baby (with a malformed head and virtually no brain) or one with such severe brain injury that it could not long survive. There are a thousand or more such cases every year in the U.S., but long days passed before Dr. Kantrowitz got the word that he was awaiting. It came from Philadelphia's Jefferson Hospital: an anencephalic boy was born there the day after Washkansky's surgery. Dr. Kantrowitz talked with the parents, whom he described, in broad understatement, as "intelligent and understanding." They agreed to let Kantrowitz take their baby to Brooklyn to die, and to transplant his heart.
He died at 4:20 a.m. Wednesday, across the room from the recipient baby, who was being kept alive in a respirator that supplied him almost 100% oxygen. Since heart-lung machines are impractical for such small infants, the 22-man transplant team chilled the dead baby's body to retard damage to the heart. The doctors had already begun cooling the recipient baby in a water bath to 59 °F. After 40 minutes, they were ready to cut. One group excised the dead baby's heart while another excised the recipient's. In a mere 30 minutes Dr. Kantrowitz was able to join the aorta, the great veins and pulmonary arteries. From skin to skin, the operation took 2¼ hours.