October 24, 2008

40 Years of Heart Transplants

FRIDAY, Oct. 24 (HealthDay News) -- When Dr. Edward Stinson assisted during the world's first heart transplant operation in 1968, he figured the procedure would go smoothly. It had, after all, worked well in tests on dogs.

But the aftermath was anything but reassuring. "We didn't know how organ rejection would manifest itself in a human, what the long-term complications would be," Stinson recalled. "But we knew it would work and evolve. I was confident it would evolve into a genuine therapy."

It has done that. While early patients tended not to survive very long with new hearts, doctors have managed to perfect the transplants to the point where they're fairly routine, if still rare due to the lack of availability of donor hearts.

Even children now get heart transplants and go on to live full lives. Just ask Lizzy Craze, a 26-year-old employee at the Web site Facebook who got a heart transplant in 1984 at the age of 2.

She remembers nothing about it now, but the handful of pills she must take every day for the rest of her life is an eternal reminder, as is her own attitude. "I'm pretty aware of the fact that I have a higher appreciation for being alive," she said. "I appreciate the little things in life."

Stinson and Craze will be among the surgeons and transplant survivors who will attend a symposium Friday at Stanford University in honor of the 40th anniversary of the first heart transplant. It was performed at Stanford Hospital in 1968 on a 54-year-old steelworker.

At the time, doctors could handle the logistics of the transplant itself. But patients often died of other conditions or their immune systems rejected the hearts.

The first patient died shortly after the surgery. "During the first year of our experience, I think we operated on nine patients, and two of them lived more than a year," said Stinson, now a retired Stanford University surgeon. "I don't think it was until the 19th or 20th patient that we had truly long-term survival."

Over time, new drugs increased the likelihood that the bodies of patients could adjust to their new hearts. Now, 86 percent to 87 percent of heart transplant patients live for a year; the five-year survival rate is almost three-fourths for men and more than two-thirds for women, according to the American Heart Association.

Heart transplants are generally performed on patients with untreatable, terminal heart disease, Stinson said, including those with clogged arteries or damaged heart muscle. While heart disease is very common, heart transplants are not. According to the American Heart Association, about 2,100 heart transplants are performed each year in the United States.

The lack of available donor hearts is the main challenge, Stinson said. The hearts must come from people who are still alive but brain dead.

In the early years, there was controversy over the concept of brain death, in which a person is declared essentially dead even though he or she is still technically alive, Stinson recalled. And some heart-transplant patients worried about getting hearts from people of the other gender or other races.

But those worries dissipated, he said.

Craze said her heart came from a young Utah girl who was in a car accident. Craze's own heart was losing elasticity, filling up with blood but unable to pump it out, she said.

"It was experimental to do it on someone of my size," she said. "The big question was that they didn't know if the heart would grow with the body."

It did. "I don't know," she said, "about being any other way."

More information

Learn more about heart transplants from the American Heart Association.

SOURCES: Edward Stinson, M.D., professor emeritus, cardiothoracic surgery, Stanford University, Palo Alto, Calif.; Lizzy Craze, Palo Alto, Calif.
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