Heritage Snapshot: Part 76

Meanwhile, sophisticated, time-consuming immunological tests were employed to help choose the best tissue-matched donor. Dr. Leonard Bailey’s research had discovered that some baboons are more closely tissue-matched to some humans than are other humans. The longest test, the mixed-lymphocyte culture, took six days, but the transplant team was determined not to rush into surgery without having vital information. At midnight, Thursday, October 25, Baby Fae almost died. She was already on maximum life support and was almost taken to surgery before the tests were completed. Decisions were being made on an hour-by-hour basis. At 4 a.m., Friday, October 26, Sandra Nehlsen-Cannarella, Ph.D., the project’s chief immunologist, received results from the mixed-lymphocyte culture. Dr. Nehlsen-Cannarella, who at the time was director of transplant immunology at Montefiore Medical Center and the Hospital of Albert Einstein College of Medicine in New York, had been one of the project’s external scientific consultants. She had studied in London for three years in the 1970s at England’s prestigious National Institute for Medical Research, where she was assistant to 1960 Nobel laureate and world-renowned immunologist Sir Peter B. Medawar. She had been invited to join Loma Linda’s transplant team for this surgery. By this time, Baby Fae had stabilized enough to proceed with surgery on schedule. At 6:30 a.m., she was taken by her support team into the second-floor surgery suite—and into the pages of medical history. Heart surgery is a symphony of cooperation and teamwork. At first, the atmosphere is quite casual. The patient is moved under giant lights. All the instruments and supplies that might possibly be needed are set up. The heart/lung machine is primed. The patient is placed under general anesthesia, and the surgery field is prepared. When all is ready, the surgeons scrub and gown. Team members chat informally. But as time passes, the atmosphere changes. It seems like a countdown. The surgery team works its way through a long series of preoperative procedures. As the time for surgery approaches, team members move into place. The patient’s temperature, blood pressure, respiration, and heart rate are monitored carefully. As this information is announced, it is often accompanied by the word “sir.” The team works with precision and technical detail in getting a patient on and off the heart/lung machine. One fact is obvious: these people have been here before. Baby Fae’s anesthesiologist, Robert D. Martin, M.D., administered her anesthesia with extreme caution because of her weak condition. The baby could have died at any moment under the best of conditions. Her body temperature was carefully lowered to 18° C (66° Fahrenheit). This procedure, called deep hypothermia, was done to reduce her metabolic rate and drastically slow her body functions, as in a state of hibernation. This is standard practice in infant heart surgery. It allowed the transplant team to stop Baby Fae’s circulation for one hour and 10 minutes. Implanting the new heart, about the size of a large walnut and weighing about one ounce, took approximately an hour. During the warming procedure, Baby Fae’s brand-new, perfectly formed heart started beating on its own at 11:35 a.m. It was a reassuringly strong and regular beat. A feeling of awe prevailed. The heart could have been rejected in minutes, but it wasn’t. The only initial problem was a brief tachycardia episode—or rapid heartbeat—and that subsided on its own. Baby Fae’s new heart did not require support from stimulating agents. During surgery, Baby Fae’s mother walked slowly through the lobby with Chaplain Bill Hinton. She looked anxious but hopeful. After several hours in the surgery suite, Baby Fae was returned to her intensive-care room for recovery. Her mother hurried with the chaplain to see her little one. The concern was gone from her eyes. Her face was beaming with anticipation and gratitude. Her baby had been pulled from the brink of certain death and given a fighting chance to overcome overwhelming odds. The new heart was beating 130 times a minute: 7,800 times an hour. Her anesthesiologist later reported that the surgery was the smoothest heart operation he had ever worked on. Baby Fae looked pink and healthy. She never before had looked so well. Her nurses later claimed that she recovered better than many regular pediatric cardiac-surgery patients do. Most people had sincere questions. Would the heart grow with the baby? (Animal research already published and experience with human kidney and liver transplants suggested that it would. The transplanted organ comes under the influence of the growth factors of the recipient.) Would she need another transplant when she was older? (It was hoped not; however, that could be a possibility. At least human hearts are more readily available in older age groups). The main question asked by the scientific community was regarding the parents’ informed consent: Did they really understand their daughter’s condition and did they fully understand the options for her care?