On December 3, 1967, shocking news arrived from South Africa: a Cape Town surgeon, Dr. Christiaan Barnard, had performed the first human heart transplant. Probably no operation in history had ever generated so much publicity. In my professional circles, the excitement was particularly intense. At the time, I was a professor of surgery at Houston’s Baylor University College of Medicine and a cardiovascular surgeon at Texas Children’s Hospital and St. Luke’s Episcopal Hospital, which were the bases for my newly created Texas Heart Institute. Like many of my colleagues, I had long regarded heart transplantation as the next necessary development in our field, and I was envious of Chris’s success. The day after the story broke, I sent him a telegram: “Congratulations on your first transplant, Chris. I will be reporting my first hundred soon.”
Chris’s patient, Louis Washkansky, died after eighteen days, but Chris was not discouraged and soon performed another transplant, with similar results. Within a short time, a couple of other surgeons in the United States followed suit, and their patients, too, died within days. Dr. Michael DeBakey, the chairman of the Department of Surgery at Baylor, appointed a committee to explore establishing a heart transplant program at Baylor-affiliated Methodist Hospital. He did not include me, even though I was by then the most experienced heart surgeon in the world. This slight wasn’t unintentional, nor was it altogether unexpected. Mike was a difficult man, and though we had had many professional successes in the sixteen years we had worked together, by the late sixties our relationship had, for a variety of reasons, deteriorated significantly.
Under these circumstances, I didn’t feel that I had to get Mike’s approval to proceed independently. I asked my surgical associates Grady Hallman and Robert Bloodwell, who worked with me at St. Luke’s and Texas Children’s, to be part of my team. I let them know that I was planning to do a transplant at the first opportunity.
On May 2, 1968, I was in Shreveport, Louisiana, giving a talk to the medical society there. Just before my presentation, reporters asked whether I was planning to do a heart transplant. I answered, truthfully, that I had no “immediate plans.” A couple of hours later, I got a call from Robert. “Boss, I think we’ve got a donor,” he told me. “A fifteen-year-old girl who shot herself in the head with a .22 pistol after arguing with her nineteen-year-old husband. Her brain waves have been flat for several hours, and I have permission to take her heart.” I immediately chartered a plane and returned to Houston.
As I was flying home, I thought of Everett Thomas, a 47-year-old accountant whose heart had been severely damaged by rheumatic fever. He’d had two heart attacks and two strokes. Three of his heart valves needed to be replaced. Mr. Thomas had come to Houston from Phoenix after hearing of my successful record with valve replacement. He had been bedridden for six weeks, and his prognosis was bleak. We had already planned to do a triple valve replacement, but the odds were greatly against his surviving the procedure. Nonetheless, he and his wife had decided to go ahead with the surgery, so we had scheduled it for the morning of May 3. When I got back to the hospital, I asked the Thomases an important question. If, during his valve replacement operation, it became clear that Mr. Thomas could not survive, would they consent to my placing our donor’s heart in his body? They agreed.
Shortly before midnight, members of my team transferred the donor from the municipal Ben Taub Hospital emergency room to an operating room at St. Luke’s. (There was a peculiar and fortuitous coincidence at work here: six years earlier, I had operated on the donor for a coarctation, or narrowing, of the aorta. That condition had left her with a permanently enlarged heart, which would be better able to handle the circulation of a large man.) Mr. Thomas was in an adjacent operating room. Once I saw the inside of his heart, I knew that it could not be repaired. The valves were more heavily calcified than I’d expected, and the septum was also involved. A transplant was the only recourse.
The procedure went smoothly; it took me only 35 minutes of pump time to do the transplant. But I wasn’t certain the new heart would regain function. When we removed the vascular clamps, the heart went into ventricular fibrillation, and I asked for the defibrillator paddles. After a single electrical jolt, the heart began a regular beat. I felt as if I had witnessed a miracle. (Mr. Thomas survived with his new heart for nearly seven months.)
Soon after, the wire services spread the story around the world. Mike DeBakey received the news when he arrived at Methodist that morning. He was so upset that he canceled his scheduled surgery and spent the morning sequestered in his office. Not surprisingly, our rift, which was already painful for me, widened even more.
In 1948, when Michael DeBakey joined Baylor, he was known not only for his talent as a surgeon but also for his connections with federal agencies that were granting large sums of money for medical research. He was an extremely hard worker; he slept little and basically spent his life at the medical school and Methodist Hospital. After I arrived at Baylor, in 1951, I soon learned that he was much feared by his trainees. When a surgical assistant did not meet Mike’s standards, he would denounce that assistant loudly and send him from the operating room like a schoolboy to the principal’s office.
During the first few years that Mike and I worked together, we got along well, and Mike’s tireless promotion of our work established Baylor as a leading center for vascular surgery. But soon, though Baylor’s golden age was just beginning, my relationship with Mike started to wane. Over the next few years, he began to treat me as a rival rather than a colleague. He excluded me from projects I was well qualified to engage in; he tried to claim Baylor’s ownership of innovations I had created on my own time; and he made sure that his patients always took priority over mine. There didn’t seem to be room for me at Methodist anymore.
So in 1954 and 1955 I moved my surgical practice to Texas Children’s and St. Luke’s. (Though I maintained my faculty position at Baylor.) It was at St. Luke’s that I performed the heart transplant on Everett Thomas in May 1968, and over the next few months I performed nine more such procedures. Each operation was a success on its own terms, but by the end of the year only one of my first ten patients was still alive. Most had died of infections they were unable to fight off because of the immunosuppressant drugs we had to give them to prevent their bodies from rejecting their new hearts.
One possible solution to this problem was a total artificial heart, also known as a TAH, which would not be subject to tissue rejection. Some of the initial work on the TAH was done in the fifties by Dr. Domingo Liotta, an Argentinean surgeon. In 1961 Mike offered Domingo a surgical fellowship at Baylor, a position that Domingo thought would allow him to develop his TAH. In fact, Mike was more interested in developing a workable partial artificial heart, or left ventricular assist device, a more modest pump that could provide temporary support for patients who developed potentially reversible cardiac failure after heart surgery.
In December 1968 a frustrated Domingo came to my basement office at St. Luke’s. He asked whether I would be willing to work with him on the TAH. I was, but I made clear that we would use the TAH only in an emergency, as a bridge to transplantation. It would be used to keep the patient alive until a suitable donor heart could be found. Neither of us felt a need to ask Mike’s permission to proceed. After all, he’d already said he wanted nothing to do with Domingo’s TAH project. However, we would need to fabricate a new heart to keep our TAH from being confused with any device Domingo had been working on at Baylor.
By the end of March 1969, Domingo and I had performed extensive bench tests on our artificial heart and had implanted it in seven calves, the last of which survived for 44 hours. We believed that our TAH was ready for human use in a desperate situation.
I had several patients who were awaiting cardiac transplantation at St. Luke’s. Among them was 47-year-old Haskell Karp, a printing estimator from Skokie, Illinois, who had diffuse atherosclerotic disease that affected all of his major coronary arteries. He’d already had several heart attacks, which had left much of his heart tissue scarred and useless, and he had severe angina and complete heart block, for which he had received a pacemaker. In early 1969 his condition had begun to deteriorate rapidly, and he was referred to me for a transplant.
After nearly a month in the hospital, Mr. Karp was losing hope. His breathing was becoming more labored, and he could hardly even brush his hair. On April 3 I told him that the only option, other than a transplant, was to remove a wedge of tissue from his diseased left ventricle, thereby decreasing its size and allowing it to pump more efficiently. I explained that his heart had so much diseased tissue, he had only a 30 percent chance of surviving the operation. If the procedure failed, the only way to save his life would be to implant the TAH until he could receive a new heart. Mr. Karp and his wife agreed to the plan.
The operation was to be done the next day, which happened to be Good Friday. Mr. Karp was wheeled into the surgical ward. He was pale, sweaty, and breathing with difficulty. His blood pressure had fallen to half its normal level. My patient was about to die.
When I opened Mr. Karp’s chest, I saw that the inside wall of his heart had been almost entirely replaced by fibrous tissue. It was amazing that this heart had been keeping him alive at all. I had to remove about 35 percent of the left ventricle—a much larger portion than anticipated. When the clamps were released to let blood back into the heart, it beat erratically. We tried for more than fifteen minutes to restore a regular rhythm with electric shocks and manual massage but were unsuccessful. I’d reached a crucial point in the procedure. Was I going to let Mr. Karp die on the operating table or try to save his life by whatever means? I decided to proceed with our contingency plan.
Implanting the artificial heart was an arduous task. The TAH was so stiff that a normal surgical needle was barely sharp enough to do the job. Still, I was able to do the whole procedure, including the wedge operation, in less than two hours of pump time. As the TAH was turned on and began to fill with blood, my team members and I held our breath. A few of us were silently praying. We were immediately relieved when it began to pump blood, almost like a natural heart.
Minutes later, Mr. Karp regained consciousness, responded to verbal commands, and moved his hands and feet. After the breathing tube was removed from his throat, he was able to speak a few words. Mainly, he just smiled.
Soon afterward, I called Willem Kolff, one of the pioneers in artificial heart research, to tell him about the operation. Willem, who was vacationing at Zion National Park at the time, told me, “Denton, you need to beware of Mike DeBakey’s reaction.” He said that he would ask some of his Navajo friends at the park to do a ritual dance to protect Domingo and me. “I’m afraid you’re going to need it,” he added. He later told me that the Indian dance went on for more than two hours.
After a frantic search for a donor heart for Mr. Karp, one became available, and on April 7, three days after the TAH surgery, I transplanted it into his body. But as was so often the case in those days, the new heart didn’t keep him alive for very long due to the large doses of immunosuppressant drugs he had received. He soon developed acute pneumonia in his right lung. His compromised immune system couldn’t fight the infection, and he died just 32 hours after the transplant.
News of the TAH implant led to my complete break with Mike, who was irate that I had not requested his permission to do the procedure. In a newspaper interview, he claimed that the operation was a “stunt” that had no useful research purpose. According to Mike, the only reason I had performed the operation was because I wanted to be the first.
The controversy that ensued centered on whether the TAH was the product of Baylor research, funded by the National Heart Institute, as Mike was claiming, or whether it had been created with private funds. If it had been developed under NHI auspices, I would have needed to get Mike’s and the NHI’s permission before I could use it. But because Domingo and I had funded our device privately, the only criteria governing its use were medical ethics and the patient’s willingness to receive it.
Mike immediately launched a major attack against me. He embarked on an aggressive international campaign to have the medical profession chastise me. With the help of his two sisters, medical writers at Baylor, he prepared a package of documents indicating that I had exceeded my medical authority and had used “his” device without permission. He sent these documents to almost every major department of surgery in the United States and Europe. A package was even mailed to one of Mr. Karp’s sons.
As a result of Mike’s accusations, a number of investigations were launched. Ultimately, the investigatory committees of the NHI and the American College of Surgeons agreed that in a situation as desperate as the Karp case, any physician should feel obligated to take whatever reasonable steps might save the patient’s life. Both committees issued only mild censures. Baylor’s investigation was led by a panel of faculty members that Mike had handpicked; not surprisingly, I received a censure for not requesting permission from the Baylor Committee on Research Involving Human Beings. Soon after, I resigned from the faculty.
In the months after the TAH implant, I called Mike several times and left messages but never got a response. In fact, Mike did not speak to me again until after we’d both retired from the operating room nearly forty years later.
During those years, TAH technology didn’t progress as much as I might have hoped. It wasn’t until 1981—twelve years after I operated on Haskell Karp—that I performed the world’s second TAH implant, again as a bridge to a transplant. Like Mr. Karp, the patient died of infection soon after receiving a donor heart. Even today, three decades later, the TAH is used infrequently.
I have never regretted using the TAH to prolong Mr. Karp’s life. He came to me because he’d heard of my surgical reputation, and he was so sick that no other surgeon was willing to try to save him. When I think about those days, I see his face—framed by the dark-rimmed glasses he always wore—and am reminded of the trust and hope he put in me and in medical science.