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The man who brought Jarvik and DeVries together was Dutch-born Surgeon and Medical Engineer Willem Kolff, 72, who calls himself "the oldest artificial organist." The founder of Utah's artificial-organ program got his start in the field by creating the first artificial kidney, a crude dialysis machine he pieced together from cellophane and other simple materials he found in Nazi-occupied Holland in the early 1940s. He designed his first artificial heart in 1957 when he was at the Cleveland Clinic. It sustained a dog for 1½ hr.
The heart that Barney Clark received thus represented more than a quarter of a century of research. Like Kolff's original device, it is powered by air, compressed by an external electric pump. Two 6-ft.-long air tubes, which emerge from beneath the rib cage, connect the heart to the pump and to emergency tanks of compressed air and other equipment, all of which are stored on a cart. Total weight of the awkward external system: 375 Ibs.
The cost of the heart: $9,050, plus $7,400 for the drive system. But Clark's equipment was donated by the manufacturer, Kolff Medical, Inc., and his doctors waived their fees. Had Clark done well enough to leave the hospital, he probably would have spent $2,700 to equip his home with ramps, wall outlets for air and other fittings. Then there was the hospital bill. At the time of Clark's death, it exceeded a whopping $200,000, to be paid by donations and U.M.C. endowment funds.
The cost, the 375-lb. encumbrance and the siege of postoperative ailments have all raised doubts about the use of artificial hearts. Said Dr. Michael DeBakey, the noted heart-transplant surgeon from Houston: "To be a success, the heart must restore the individual to normal life. If all it does is keep the patient alive, it has not succeeded." DeBakey and fellow Houston Transplant Expert Denton Cooley therefore favor transplants, which now offer recipients a 70% to 80% chance of surviving a year and a 42% chance of living five years. The best use of the mechanical heart, says Cooley, may be "to sustain a patient until a donor heart can be found."
Clark's experience will undoubtedly help doctors build a better heart. "We have learned more in a few months with Clark than in the past nine years with animals," says Larry Hastings, a U.M.C. heart-pump technician. Jarvik has already designed a portable drive system the size of a camera bag that can run the Utah heart for twelve hours. It may be ready by 1985. Researchers at the Cleveland Clinic, as well as Jarvik, are now working on hearts with implantable motors. In ten years, the only external apparatus needed by an artificial-heart patient may be a 5-lb. battery pack.
Yet even if these technological wonders occur, the costly artificial heart is sure to raise some difficult questions. "How much is life worth?" asks Dr. George Lundberg, editor of the Journal of the American Medical Association. "How much is one or more days of longer life worth? Is every life worth the same amount, and if not, why not?"