One of the pediatric cardiologists at Loma Linda who’d seen Beauclair found Len Bailey and asked whether he was ready to do a cross-species transplant in a human. When Bailey said yes, the doctor told him he had just discharged a baby home to die. The family lived up in the high desert. He offered to have someone contact them to see if they had any interest. They called Teresa Beauclair, and she agreed to meet with Bailey.
Beauclair brought the baby back to Loma Linda. The father was unable to accompany them, but Teresa recorded the conversation with Bailey to share with him later. According to Beauclair, Bailey discussed his research and emphasized that doing this procedure on her baby, whom he referred to as Baby Fae, would be highly experimental. He told Beauclair he could promise nothing other than without a transplant Baby Fae would soon die. At first, it all sounded like mad science to Beauclair. But she felt she could trust Bailey, and in the end agreed to go ahead. Baby Fae was readmitted to Loma Linda hospital. Dr. Sandra Nehlsen-Cannarella, a respected immunologist at New York City’s Montefiore Medical Center, came to Loma Linda to screen the baboons for one compatible with Baby Fae. She found that the child carried no preformed antibodies to baboons, which meant that a hyperacute rejection was unlikely. This was a good sign. Nehlsen-Cannarella supported the operation. Teresa Beauclair, she said, was doing what any mother in similar circumstances would.
Baby Fae was operated on in room 3 of the Loma Linda University hospital on Friday, October 26, 1984. Bailey replaced the small, dark-haired, blue-eyed baby girl’s heart with one from a baboon. Baby Fae was twelve days old. At 11:35 a.m. her new heart began to beat spontaneously. Len Bailey called me later in the day to tell me about it. I warned him there was going to be a lot of publicity, but neither of us was prepared for what followed.
The transplant made front-page news in almost every daily newspaper in the United States. The surgery was news in London, Paris, Berlin, Tokyo, Hong Kong, Singapore, Cape Town, and Beijing. Television crews from the major American networks set up satellite trucks at the university. During the first week following the surgery, some 275 representatives of the world press traveled to Loma Linda. Reporters camped out by the hospital and in front of Len Bailey’s home.
Reaction to the news was mixed. In an editorial on Saturday, November 3, the San Diego Union said, “the great medical team at highly respected Loma Linda University Medical Center has demonstrated medical science at its best, which is to say it was willing to dare failure and controversy to save a life that would otherwise have been lost. And even if Baby Fae does not survive, she and her doctors will have advanced medical knowledge for the ultimate benefit of mankind.” That was how I felt. Joanne Jacobs, a columnist in the San Jose Mercury News, wrote that she was glad Baby Fae had been given a chance, even against desperate odds. “I wouldn’t want to live in a society that let its children die without a fight,” Jacobs wrote.
Not everyone was as generous. John Najarian, the chief of surgery at the University of Minnesota—who would have understood an undeveloped neonatal immune system, but who certainly knew little about Bailey’s research—said the operation was a mistake. “Everything we know indicates that the heart is going to fail,” Najarian said. “The operation will merely prolong the dying process.”
I fully expected the crush of press attention, and also the comments of others in the field, both pro and con. But I did not anticipate that picketers would appear at Loma Linda, vehemently protesting the use of an animal to save a human baby’s life. The animal-rights people seemed to consider Baby Fae’s life no more valuable than a baboon’s. Bailey received death threats. Soon the press turned on the parents. They reported that Teresa Beauclair was separated from the father and living a meager existence. They suggested that she lacked the judgment to make a medical decision. Beauclair talked about all of this later. “I may have been young and naive,” she said, “but I wasn’t dumb. I had feelings.”
The ethics of doing an operation that was experimental were also extensively questioned. This struck me as a complete misunderstanding of how medical progress is made. The fact is that every medical first is an experiment. Without experimental procedures medicine wouldn’t be a science and might still be in the hands of witch doctors and barbers.
Baby Fae did well at first. But she died at nine p.m. on November 15, 1984, at the end of her twentieth postoperative day. Though the exact causes of her death remain incompletely understood, rejection appears to have been a minor contributor. At a press conference the next day, Bailey was tired and drained. Up until then, others had handled the press conferences while Bailey was busy looking after Baby Fae. He had risked his reputation to try to save this child. Now he could only say what he believed. “To cherish the life of one child,” he said quietly, “is to value the lives of all. A rescue mission need not succeed to be brave.” He went on: “We don’t know for sure what happened. I am convinced that we did all we could.” Teresa later said, “The night that Stephanie died, I asked Dr. Bailey not to let this experience be wasted, and to keep going forward with it.”
That was not to be. I believed that Bailey should carry on. But he was finished with cross-species transplants. The protests and death threats were too much. Hate mail continued to pour in, and Bailey feared for his family’s safety. But there was one unexpected happy outcome. The intense coverage of Baby Fae raised awareness of the need for human infant donors. Within a week of Baby Fae’s operation, a two-year-old donor became available for eight-month-old Sara Remington, a Houston baby with inoperable end-stage heart failure. Denton Cooley, who had attempted a heart-lung transplantation in a two-month-old in 1968, operated on Remington on November 1, 1984. She lived for another thirteen years.
At a 1985 conference in London, I gave a talk on heart and heart-and-lung transplantation. During my lecture, I discussed the experience with Baby Fae. I was on a panel with Denton Cooley afterward. We were taking questions from the audience. Christiaan Barnard stood up, and in his broad South African accent said, “Professor Jamieson, I am surprised that you are supportive of the experiment with Baby Fae, which I consider irresponsible.”
I pointed out to Barnard that his first heart transplant could have been considered experimental, and that Baby Fae lived longer than his patient did in that case. The room erupted in applause. Barnard, who was used to being treated like royalty, looked displeased and sat down.
A little more than a year after Baby Fae’s operation, a brain-dead newborn baby who had suffered from asphyxia at birth in Northern California was offered as a donor to Loma Linda. Just three days earlier, a baby boy had been born there, weighing six pounds, with the same condition as Baby Fae—a hypoplastic heart. Bailey transplanted him with the donor heart on November 20, 1985. That child, known as Baby Moses, became the world’s first successful newborn heart transplant. I was delighted that Len Bailey could enjoy this achievement. Still, busloads of people opposed to Bailey’s latest experiment showed up to picket his house. Baby Moses, whose real name is Eddie Anguiano, is now in his thirties and lives with his family in Las Vegas, Nevada, where he works in one of the hotels. Sometimes an experiment becomes a human life.
Baby Moses was the first of many babies and children whose lives were saved with heart transplants at Loma Linda. Success bred more success, as infant donors continued to increase for the program. Len Bailey had paved the way for a wave of infant heart transplants. By 2011, more than fifteen hundred children under the age of one had been transplanted around the world. Survival rates in children are now the same as those in adults. Bailey, after being publicly pilloried over Baby Fae, is now regarded as a true medical pioneer.
Christiaan Barnard and I were often invited to speak at the same meetings. He talked about heart transplantation, and I talked about cyclosporin and heart-and-lung transplantation. Barnard was a celebrity wherever he went. On several occasions, I heard him end his talk by announcing that he was retiring and that this was the last speech he was ever going to give. This always produc
ed a standing ovation. The last time we were together was at a meeting in Tampa, Florida, in January 1984. He’d retired from active practice the year before but remained a fixture on the lecture circuit. As usual, he ended his talk by saying it was his farewell speech—which was met with the usual adulation. I felt like I’d lived through this one too many times, and afterward I approached him, trying to look both surprised and dismayed. “I’m sorry to hear that this was your last speech, Chris,” I said. “But since it was, can I have your slides?”
A meeting in 1984. Bottom row (left to right), Christiaan Barnard, Me, Richard Lower, Bruce Reitz. Back row (middle), Robert Jarvik, designer of the Jarvik artificial heart.
Barnard’s jaw dropped.
“Er, well, Stuart, I’ll send them to you,” he said.
I never received them.
Barnard was replaced as head of the Department of Cardiothoracic Surgery in Cape Town by Bruno Reichart, a surgeon from Munich who rejuvenated the surgical and transplant programs. I’d never liked Barnard, whom I thought was not a good representative for heart transplantation. Reveling in his reputation as a handsome playboy, Barnard had married a series of ever-younger women. He became obsessed with youthfulness and the search for “anti-aging” cures. He signed on as a spokesman for an expensive skin cream that was supposed to get rid of wrinkles. I was always careful about talking to Shumway about Barnard, who had cheated him out of being the first to transplant a heart. But one time, when Shumway was sitting in my office at Stanford, I mentioned what seemed to be Barnard’s fear of getting old.
“Did you hear Barnard is promoting an anti-wrinkle skin cream?” I said.
“Yes,” Shumway said. “I tried it on my scrotum, and it doesn’t work.”
I was involved in founding the International Heart Transplantation Society, when these operations were still considered experimental, and before the advent of lung transplantation. In 1980 Dr. Michael Hess, a cardiologist working with Dick Lower in Virginia, suggested we hold a preliminary meeting at the American Heart Association scientific sessions scheduled in Miami in December. Representatives from nearly a dozen cardiac centers showed up, including one contingent all the way from Oslo, Norway. This was encouraging, as only Stanford and two other centers had active programs. This was before the development of cyclosporin and many hospitals and most health insurers considered heart transplantation a waste of resources. The evidence that transplantation was an effective treatment for heart failure was still unpersuasive. Most operations were financed privately or under special arrangements.
Another planning meeting was held the following year in Chicago. I reported that Stanford now had a one-year survival rate for heart transplants of 70 percent. Again, this was before we were using cyclosporin. Nobody else was doing as well, and most cardiac centers were still not doing transplants at all. The board of trustees of the Massachusetts General Hospital had elected not to support cardiac transplantation, and this decision was defended by the New England Journal of Medicine. The secretary of Health and Human Services decided not to pay for heart transplants under Medicare. All of which made the idea of a heart transplant society seem off point. But we decided to go ahead, renaming the group the International Heart Transplantation Society to broaden the base. We talked about publishing a journal and set up a national registry to track transplants in the US.
Our first formal meeting was in San Francisco in March 1981. About fifty people showed up, including Norman Shumway, Ed Stinson, and Phil Oyer. Shumway was elected the honorary president. The first issue of the journal Heart Transplantation came out that summer in 1981. It included a paper in which I reviewed the Stanford experience, including the first eleven patients to have been treated with cyclosporin. I closed on an optimistic note, writing that improved immunosuppressive drugs such as cyclosporin would likely result in greater use of cardiac transplantation. I took over as the fourth president of the society and served a two-year term from 1986 to 1988. By this time the journal was widely read, and the registry had become a valuable resource. The Journal of Heart Transplantation was in due course renamed The Journal of Heart and Lung Transplantation.
By the end of the 1980s, the experiment was over. Transplantation of the heart and the lungs had been accepted as valuable procedures and were routinely done to save the lives of dying people with heart and lung disease throughout the world. Cyclosporin and the Stanford experience had made the difference.
CHAPTER EIGHTEEN
ON MY OWN IN A COLD PLACE
The University of Minnesota was a storied institution to me, the cradle of heart surgery. Spanning the banks of the Mississippi River in Minneapolis, the university had been a hotbed of innovation in a frigid location. Under its legendary chief of surgery Owen H. Wangensteen, pioneers like John Lewis and Walt Lillehei had flourished at Minnesota, and they, in turn, had nurtured the generation of surgeons that included Matt Paneth, Christiaan Barnard, and Norman Shumway. The University of Minnesota served as a mecca for those who wanted to develop the field. No aspiring cardiac surgeon could afford not to spend some time in Minnesota. Between 1951 and 1967, Walt Lillehei alone trained more than 150 surgeons from around the world. For me this professional family tree was personal: it was the close relationship between Paneth and Shumway that had brought me to Stanford and to the summit of the transplant world.
But Minnesota’s stature in the field of cardiac surgery had fallen. When Wangensteen retired in 1967, after nearly four decades as the chief of surgery, Walt Lillehei applied for the job. Everyone expected him to get it. But Lillehei was regarded by the university administration as a brilliant surgeon with nonexistent management skills. The selection committee instead looked beyond Minnesota, hiring a kidney-transplant surgeon from San Francisco named John Najarian.
Wangensteen didn’t approve and warned the dean of the medical school that under Najarian Minnesota would enter a dry spell during which its top cardiac surgeons would likely leave, including Lillehei. And that’s what happened. Lillehei was swamped with attractive offers from around the country, and not long after Najarian’s arrival he accepted a job as chief of surgery and chairman at the New York Hospital-Cornell Medical Center—taking many of the senior cardiac surgeons with him.
Lillehei’s departure in late 1967 was acrimonious. Lillehei believed that the equipment in his lab belonged to him, and he informed Najarian he’d be taking it to New York. Najarian said the equipment belonged to the university and that he’d decide what Lillehei could have and what would have to stay. On the Saturday night before he left, Lillehei and a small crew arrived at his lab after dark in three rented trucks. They took everything, leaving behind only a single rose in the middle of the floor.
After that there had then been a succession of cardiac chiefs under Najarian as the program fell apart. By 1980, private heart surgeons in the Twin Cities were doing more heart surgery than the university, the place where it all started.
In early 1984, Shumway talked to me about what had happened in Minnesota. To my surprise he asked if I would consider becoming the next cardiac chief there. Although I was happy at Stanford, I was intrigued. The rich history at Minnesota appealed to me. But I was wary. Stanford was the best heart-surgery center in the world. I ran its laboratory and transplant program. Why go to Minnesota, which had fallen off the map? Shumway thought that the situation at Minnesota could be reversed with new leadership and urged me to at least think about it. I said I would, but the more I did the less interested I was. One thing I loved about California was the warm climate, which was so like what I’d grown up with in Africa. Minnesota was unspeakably cold and dark for many months of the year, a frozen outpost that made London look like a sunny paradise. I finally told Shumway I didn’t want to go. He let the matter drop.
Several months later Shumway was scheduled to speak at the Transplantation Society conference in Minneapolis. A few days ahead of the meeting, Shumway told me he couldn’t go and asked me to take his place. I didn’t think anything of
it, as he did this all the time. I always felt awkward giving a lecture to a few hundred people who had come to hear Shumway, but I was used to it. It was August, a pleasant time in Minnesota, and I told Shumway I’d be happy to stand in for him.
“By the way,” he said, as though it was an afterthought, “when you’re there, why don’t you take a look at the job at the university?” I’d been outmaneuvered.
I gave the meeting’s opening plenary speech, a notable honor. I still remembered going to a meeting of the society in The Hague as a student, and again to the one in Jerusalem a few years later. I’d been in awe of the surgeons who attended back then. Now they were colleagues. My lecture was well received. Afterward, I visited the university. The campus was lush and lovely in late summer. Students were out lolling on the lawns or throwing Frisbees, and joggers ran along the river roads that flanked the Mississippi, which flowed powerfully at the bottom of a wooded gorge. The Minneapolis skyline punctuated the horizon just beyond the Washington Avenue bridge that connected the campuses on either side of the river, and from which the poet John Berryman had famously leaped to his death in 1972. I had a nice tour and went home thinking perhaps I should reconsider making a move to Minnesota.
A couple of months later, the American College of Surgeons held its annual meeting in San Francisco. Najarian was there, and he came down to Stanford to talk to me about the Minnesota job. I didn’t know what to make of him. He was huge, a bear of a man. He had a deep voice and a bad hair transplant. Najarian had played football at the University of California, Berkeley. What I couldn’t look away from were his huge, fat hands. I found it hard to believe he was a surgeon. He wore a gaudy gold Rolex watch, the sort of thing nobody in Shumway’s group went in for. But he politely asked me to think again about Minnesota, and I promised him I would.
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