Heritage Snapshot: Part 75

On Sunday, October 14, 1984, a premature baby girl was brought to Loma Linda University Medical Center. She had been born at Barstow Community Hospital on the High Desert of Southern California and was transferred soon after birth. Pediatric cardiologists and neonatologists found upon examination that she had been born with hypoplastic left-heart syndrome. After being presented with options, the mother chose to take the baby home to die. She was told she could bring the baby back at any time. Four days later, a pediatrician called and told her of Dr. Leonard Bailey’s research. Bailey had just returned from a family vacation and would talk to her about the possibility of an animal-heart transplant. The mother, accompanied by her own mother and a friend, returned to Loma Linda with the infant. The baby was hospitalized, and the three met with Bailey. For several hours he explained his research in detail, including his work with animals. The option of transferring the baby to the East for palliative surgery was discussed, but the mother rejected this option. Bailey told the group it was unlikely that a human heart would become available, because size-matched and tissue-compatible human-infant hearts were, for many reasons, extraordinarily rare and, in fact, probably had never before been sought. At the end of the session, the mother gave Bailey permission to begin preliminary testing, and then she left to discuss with the baby’s father the possibility of a transplant. Meanwhile, the baby was beginning to die from her heart malady and required intensive bedside care. Both parents returned the next day, and Bailey repeated the proposal in depth. He also told them he could give no guarantee of success, because this type of surgery had never before been attempted with a newborn human. During the next several days, the family had several opportunities to ask questions. It was the most exhaustive, comprehensive, informed consent ever achieved in the history of the institution. (Although not well known in the United States, Loma Linda University Medical Center was and still is the educational heart of the world-wide Seventh-day Adventist healthcare service that reaches into more than 50 countries with 125,000 employees in more than 500 medical institutions. The Loma Linda University Overseas Heart Surgery Team had performed more heart surgeries in more countries than had any other similar organization. As the only state-designated, level 1, regional trauma center for the four Inland Counties of Southern California, LLUMC was chosen by NASA to be the recovery hospital for space-shuttle astronauts if they should be injured during test-flight landings at Edwards Air Force Base.) On Monday, October 22, 1984, the Medical Center’s public relations office was told of weekend developments. The baby girl had almost died on her sixth day of life, was hospitalized on the cardio-thoracic surgery intensive-care unit—on life support—and was being tested as a possible candidate for an animal-heart transplant. The historic surgery was tentatively scheduled for the following Friday, October 26. The public relations office staff explained to the family their rights of privacy. Under California law (Civil Code Section 56.16), only limited, general information can be released about a patient’s condition unless the patient or his guardian agrees to release more information. The family decided to allow the Medical Center to release details of the surgery with the understanding that they would remain anonymous. During this meeting, they decided to call the patient by her middle name, Fae—Baby Fae. The name was meaningful. It was also the middle name of the baby’s mother, grandmother, and great-grandmother. In the Medical Center, security was beefed up. Strategic doors were rekeyed. Vacations were cancelled for all security personnel, and they began 16-hour shifts. Electronic surveillance was increased. The institution’s police-dog units went on call around the clock. Very few people knew what was happening, but many were curious. Why did employees, even physicians, have to show personal identification to get into certain areas of the Medical Center? Rumors spread that a VIP, or possibly a criminal, was hospitalized. It was a VIP—a five-pound heavyweight named Fae. One concern was the difference in blood groups of the potential donors and the recipient: common baboons are virtually all AB, A, or B types. The recipient was type O. Crossing the ABO barrier historically has been shunned. However, scattered reports of human kidney- and heart-transplant survival, despite ABO mismatching, were of some encouragement. The transplant team also felt that crossing the ABO barrier might be less significant than crossing the species barrier and that the baby’s immune system might fail to recognize it as being as significant as the species barrier. Should they proceed? All of the other tests were progressing nicely and showing a significant likeness between Baby Fae and one particular potential baboon donor. The team would be vulnerable to criticism if the risky transplant was not successful. The decision to proceed became a judgment call. This was, after all, a compassionate effort to save a baby’s life—and, maybe, eventually, the lives of many other babies. The Institutional Review Board had been following developments closely and was aware of the surgeon’s ongoing discussions with the baby’s family and of her condition. Final approval of the IRB was granted on October 24, two days before surgery.