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In general, the obstacle to using animal organs is that the human body quickly rejects foreign tissue. What gave Leonard Bailey hope of better results was the advent of the wonder-drug cyclosporine. Developed by Sandoz Ltd. in Switzerland, cyclosporine inhibits organ rejection by partly suppressing the immune system. It is considered safer than earlier drugs used for this purpose because it is less likely to destroy the body's ability to fight infection. Since its first use in the U.S. in 1979 it has revolutionized transplant surgery, raising the one-year survival rate of heart recipients from 65% in the 1970s to 80%. Bailey believed that by focusing on the treatment of newborns, whose immune systems are not yet fully developed, he could further reduce the risks of rejection. Says he: "A newborn is a gracious host."
Yet even as Baby Fae seemed to be demonstrating Bailey's point, critics charged that xenografts are still too uncertain and that other treatments should have been considered. Dr. Moneim Fadali, a cardiovascular surgeon at the University of California, Los Angeles, was one of several physicians to suggest that the decision to use an animal organ may have been "a matter of bravado" and that a human heart "would have offered the child a better chance of survival." Loma Linda Surgeon David Hinshaw explained that he and his colleagues believed that the hope of finding a compatible human heart in time to save the dying Fae was "almost nonexistent." Indeed, infant hearts are so seldom available that transplants into very young children are rarely attempted.
Ironically, the heart of a two-month-old infant was available the day of Fae's operation. Transplant coordinators from the Regional Organ Procurement Agency at UCLA called Loma Linda hospital to offer the infant's kidneys (the heart was not discussed because Loma Linda does not have a human-heart-transplant program). When word of the potential human donor became public last week, Loma Linda officials explained that the call from the procurement agency had come after the baboon heart was implanted, that the heart of a two-month-old might have been too big for Fae, and that it would have taken too long to complete compatibility testing. Eventually hospital officials admitted that they simply had not considered the possibility of a human donor.
That admission raised the larger question of whether Baby Fae's parents had been properly advised of possible alternatives to the baboon heart. "If they didn't even look for potential life-saving alternatives, what does this mean in terms of the 'informed consent' of the parents?" asked Michael Giannelli, science adviser for the Fund for Animals. According to Minnesota Surgeon Najarian, Baby Fae's doctors should have recommended a form of corrective surgery for hypoplastic heart developed by Dr. William Norwood, chief of cardiac surgery at Children's Hospital of Philadelphia. Norwood's procedure, which is practiced at only a few U.S. hospitals, involves a rerouting of blood through the heart so that the right ventricle takes over the pumping function normally performed by the left ventricle. Norwood says that of 100 infants he has treated, 40 have survived; the oldest is now four. But, he admits, the procedure "is not a trivial business and if one intends to have serious impact on this disease, numerous alternatives have to be explored."
As the week wore on and the questions continued, Bailey retreated into silence, and other doctors were delegated to meet the press. "He is totally absorbed in nursing this child," explained Surgeon Hinshaw. "He is not a publicity seeker, and he is very sensitive about this." The pressure on Bailey and his colleagues drew understanding from another surgeon who knows what it is like to have microphones continually thrust at his face. "I really have sympathy with what they're going through," said Dr. William DeVries, who had been Barney Clark's surgeon.
For his part, Bailey found it hard to understand why people would question a procedure that was saving the life of a dying infant. "If you had the opportunity to see this baby and her mother together, and see this baby in the best shape she's ever been, you would see the propriety of what we are doing," he said.