50 years of heart transplants
Ivan Sychev, Geektimes
On December 3, 1967, a successful heart transplant operation took place for the first time in South Africa. The heart of 25-year-old Denise Darval, who died in a car accident, was transplanted to 55-year-old Louis Vashkansky. He lived only 18 days, but died not because of rejection by the body of the heart or the failure of a new organ, but from bilateral pneumonia. The second patient of the same cardiac surgeon lived more than a year and a half, the third – more than twenty.
For fifty years, a heart transplant operation has not been considered a fantasy. Let's remember thanks to whom people get a second chance at life.
The surgeon monitors the patient's vital signs
after a 23-hour heart transplant operation
The origin of transplantology
By the beginning of the XX century, the first successful organ transplantation operations, including human ones, had already been carried out in the world. In 1905, in the Czech Republic, the doctor Eduard Cirm used the cornea of both eyes of an 11-year-old child to transplant a 45-year-old man. As a result, one eye could not be saved, and the second continued to see for 12 years until the patient's death. The cornea does not have blood vessels, most often it takes root, but the most important issue in this case can be considered the preservation of donor material.
This problem was solved by a Russian ophthalmologist surgeon Vladimir Filatov: he started transplanting the corneas of corpses, and kept the material for the operation for 1-2 days after the death of the donor at a temperature of 2-4 degrees above zero in a humid chamber. The first successful operation of this kind took place in 1931. In addition, Filatov, together with designer A. Marcinkovsky, developed tools that posed less danger to the lens and increased the efficiency of the operation.
"Odessa is my only lighthouse,
There are fights with and without a mat,
And if you get your eye knocked out in Odessa
Then this eye will fix you Filatov."
Odessa lights up the lights, E. Agranovich
Ophthalmologist Vladimir Filatov at work
The next important stage in transplantology was kidney transplantation. In Russia I experimented in this direction Evgeny Chernyakhovsky. This surgeon performed 554 operations on abdominal organs, heart and blood vessels only in 1903-1904. Since 1907, he experimented with kidney transplantation on animals, as he said in 1913: "We succeeded in kidney transplantation experiments, vascular patency was restored, but then the kidneys gangrenized." In the 1920s, he continued experimenting with his student By Yuri Voronoi.
Yuri Voronoi in 1930 at the III All-Union Congress of Physiologists presented a dog with a kidney transplanted to her neck, which had been functioning for more than six months by that time. In 1933, Voronoi performed the world's first human kidney transplant from a deceased donor. Although the blood groups of the donor and recipient did not match, the surgeon took a risk. The organ was transplanted to the hip, and it began to function. The patient lived for two days. An important discovery of Yuri Voronoi was the very possibility of using a cadaveric kidney – an organ taken a few hours after a person's death. He found that such a kidney "comes to life" after transplantation and can function, as he wrote in the Italian scientific journal "Vinerva Chigdisa" in 1934.
Yuri Voronoi denied the possibility of using a kidney, an important organ, from a living person: "It is impossible to cause a known disability to a healthy person by cutting out the organ necessary for transplantation for problematic patient rescue." But today such operations are carried out, and the first successful was the kidney transplant of one twin brother to the second on December 23, 1954. Richard Herrick, with an organ that used to work in the body of his twin brother Ronald, lived for nine years, married a nurse who took care of him during the Christmas holidays, and became the father of two daughters. In 1990 , a doctor Joseph Murray, who carried out this operation, received the Nobel Prize.
Immunobiological factors remained an important issue, organs could be rejected by recipients. In the case of twin brothers, suppression of immunity was not required, but this was an exception to the rule. In 1959, after a transplant operation from a posthumous donor who was not a relative of the patient, body irradiation was used to suppress immunity – the result was 27 years of life after a kidney transplant operation.
Our immune system protects the body from foreign cells, which can be both an infection and a foreign organ. The development of immunosuppressors has opened a new era of transplantology. Patients take medications to avoid rejection. The side effect of such drugs is obvious: the weakening of immunity reduces the body's ability to resist infections.
Brothers Richard and Ronald Herrick
The first heart transplants
One of the founders of transplantology is considered a Soviet and Russian scientist Vladimir Demikhov. He conducted many experiments that influenced medical science. In 1937, a dog with a mechanical device in the form of a pump with an electric motor instead of a heart lived for two and a half hours.
Vladimir Demikhov transplanted lungs, heart, liver to dogs, proving the fundamental possibility of such operations. In 1946, he transplanted a second heart to the dog, and later completely replaced the heart and lungs. In 1954, he introduced a two–headed dog - transplanted the head with the neck and front paws of a puppy to an adult shepherd. He repeated this experiment twenty times, the record in which was a month of the life of such a creature. His 1960 book "Transplantation of Vital Organs in an experiment" became the world's first monograph on transplantation.
Vladimir Demikhov and the dog with two hearts
In the 1960s, a race between several surgeons began. American Surgeon Norman Shumway from the Stanford Clinic successfully performed heart transplants to dogs, some of which lived up to a year and a half. He created a method by which heart transplantation is carried out today: he did not remove the heart completely, but left the upper part of the atrium together with large veins, which significantly reduced the time spent on the operation and its complexity. Norman was waiting for an opportunity to perform surgery on a human. – he needed donors.
Ahead of Norman Shumway Christian Barnard, an old friend from the University of Minnesota. Barnard used the achievements of Vladimir Demikhov, Norman Shumway and Richard Lower. The surgeon studied in the USA, and in 1960 and 1963 came to the USSR to Vladimir Demikhov.
The recipient was 55-year-old Louis Vashkansky, who was admitted to Groot-Schur Hospital, South Africa after three heart attacks. He agreed to the operation, because in any case he had several weeks to live. There were problems with the donor: the political regime of South Africa did not allow the use of the heart of blacks. Earlier, because of this, there was a scandal related to Barnard himself - he transplanted a kidney of a black citizen to a white one. He was accused of experimenting on blacks. People of the same race as Louis Vashkansky were only 20% of the population. Even less – with a suitable blood type. An accident on the road, as a result of which a 25-year-old employee of the bank, Denise Darval, died, gave Vashkansky a chance for survival.
Louis Washkansky and Denise Darval
Denise's father agreed to the operation: "If you can't save my daughter, you have to try to save this man."
The operation took place on December 3, 1967 and lasted about five hours. In the process, it was noticed that the girl's heart is much smaller than the recipient's heart, but it still began to function. A few days later, Louis Vashkansky was able to get out of bed, he ate, smiled, journalists constantly came to him. He lived for 18 days, after which he died of pneumonia, enhanced by suppression of the immune system to prevent organ rejection.
The next operation was more successful – Philip Bleiberg lived for more than a year and a half. Dirk van Zyl lived for 24 years after surgery in 1971. By December 1968, a year after the first operation, about 100 heart transplants were performed worldwide.
Christian Bernard and his patient Louis Vashkansky
In the USSR, the first heart transplant was performed much later, in 1987. There were no donor centers in the USSR. Valery Shumakov spent all twenty years after the operation in South Africa, together with his colleagues, trying to prove that brain death is the death of a person, and that in this case it should become a sufficient reason for the removal of organs to save other lives. In 1987, common sense prevailed, and brain death began to be taken for death in the USSR.
On March 12, 1987, twenty-five-year-old Alexandra Shalkova with cardiomyopathy became the first patient in the USSR to undergo a heart transplant. The girl has lived for more than eight years. "I think she could live today. But Shura once did not take the prescribed pill on time to suppress the rejection reaction. She was ruined by the usual carelessness. Unfortunately, this happens. Not every human body can accept an implanted organ," Valery Shumakov said.
Surgeon Valery Shumakov and patient Alexandra Shalkova,
examination after heart transplantation
One of the most famous patients of the Shumakov Research Institute of Transplantology and Artificial Organs was Vladimir Patokin, who received a second heart in February 1992. At that time, Patokin was 40 years old, and in 2012 he celebrated the twentieth anniversary of the operation. He received a donor organ from a 27-year-old man. Already on the day of the operation, Vladimir Patokin was able to sit on the bed and walk on his feet. A year and a half later, he took part in the World Transplant Games in Canada, and in 1994 he received a bronze medal in the 50-meter breaststroke at a competition among people with a transplanted heart in Finland.
Vladimir Patokin, 2012. RIA News/Sergey Kuznetsov
One of the main enemies of transplantologists is the time that needs to be spent on finding the right donor and on the operation itself. Thanks to Vladimir Demikhov's experiments and further developments in the field of artificial heart creation, patients can wait for a transplant for a long time today. Today there is, for example, a SynCardia Freedom Portable Driver device on the market, a portable device that completely replaces the heart – although you have to carry it in a backpack. Such devices are still undergoing clinical trials and are not used everywhere.
When performing operations, artificial blood circulation devices – autojectors are used. The first such devices were designed in 1926 in the USSR by scientists By Sergey Bryukhonenko and Sergey Chechulin. They experimented on dogs, but for the first time such a device for open-heart surgery was used in 1952 in the USA. It was the Dodrill-GMR cardiopulmonary bypass machine, which the surgeon Forest Dewey Dodrill himself developed together with General Motors. In the USSR , he performed the first operation with artificial blood circulation Alexander Vishnevsky in 1957.
25-year-old Stan Larkin
passed with a pump in a backpack for 17 months
Heart transplantation operations have raised new questions for the scientific community and people – religious, ethical and legal. People mistakenly attribute emotions to the heart and often treat death more positively than such interference in life, the "game of God". In the legislations of different countries, the moment of complete cardiac arrest of a person was taken for death. For Christian Barnard, this definition was at least strange: he was a cardiac surgeon and in the course of operations, in this case, deliberately killed and then resurrected his patients. The laws, for example, did not allow taking the hearts of newborn babies without a brain, who lived no more than two days, and using them to save the lives of other newborns. In order for heart transplantation to become an almost routine operation today, changes in legislation and the introduction of donor registration systems were required.
Heart transplant today
For half a century, patients have been receiving the hearts of deceased people thanks to advances in the field of transplantation. In Russia, 120 heart transplants were performed in 2014, and 200 in 2016. For comparison: 3,191 heart transplant operations were performed in the USA in 2016. According to Sergey Gauthier, the chief freelance specialist of the Ministry of Health of Russia on transplantology, director of the Scientific Center for Transplantology and Artificial Organs named after V. Shumakov, in Russia this indicator needs to be raised to at least a thousand per year.
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