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Once from an Ape. So far, surgeons have thought of three possible replacements for an incurably failing heart: an animal's heart, another human heart, and a completely artificial heart. The animal heart has been used only once, in a case that illuminated both sides of the surgeon's dilemma. At the University of Mississippi Medical Center, Dr. James D. Hardy had, on three occasions, a patient dying of brain injuries who would have been a suitable donor—but he had no recipient. Twice, when he had potential recipients of a transplant, he had no human donors. One candidate to receive a transplant, who seemed to be dying after a heart attack, bewildered the surgeons by getting well enough to go home. When the other was undeniably dying from progressive failure of his heart, Dr. Hardy gave him a chimpanzee's heart. The ape's heart was too small for the big man, and it failed within two hours. No other animals' hearts have been seriously considered for transplantation into man, despite the poetic appeal of a lion's heart. And even apes' hearts are too scarce to supply the predictable demand.
Fail-Safe Protection. Since animals seem of little help, surgeons have been forced back on human sources. Here, Stanford University's Dr. Norman E. Shumway could offer reassurance from many years of experimental surgery on dogs. A nagging question had been: What about the heart's nerve connections, since these cannot be reestablished in transplant surgery? Dr. Shumway's answer: It doesn't matter. Like practically everything else in nature, the heart has fail-safe protection. It has an internal, independent, electrical "ignition systern" to trigger its beats. This system speeds up in response to outside nervous stimulation (excitement) to meet the body's resulting greater demands for blood and oxygen. But even with no external nerve connections, it responds to excitement in essentially the same fashion through the action of adrenal hormones.
Dr. Shumway also introduced a refinement of technique in heart transplants used by both Dr. Barnard and Dr. Kantrowitz last week. In animal surgery, it had been customary to remove the entire heart. This meant severing and later rejoining not only the two great arteries, but also two great veins returning spent blood to the heart and four veins returning oxygenated blood from the lungs. By leaving in place parts of the walls of the upper heart chambers (auricles or atria) to which these six veins return, Dr. Shumway eliminated an enormous amount of delicate suturing in sensitive areas, and cut the operating time virtually in half.
Other People's Cigarettes. Shumway and Lillehei, like many of today's foremost surgeons and professors of surgery, absorbed much of what they know of the technique and exploratory spirit of their calling from the University of Minnesota's great (and lately retired, at 68) Dr. Owen H. Wangensteen. So did Christiaan Barnard, who was at Minnesota in 1953-1955. Barnard, the son of a Dutch Reformed minister, had always wanted to be a doctor. His father, on a cash income of $56 a month, gave three of his four sons a university education.