History of Heart Transplantation

Cambridge and Oxford Heart Transplantation Organisation

References:
Braunwald, Heart disease textbook 5th ed.

There are several mentions of heart transplantation in ancient mythology and biblical reference, but it was the pioneering work of Alexis Carrel at the beginning of the 20th century that made organ transplants a real possibility.

The next reported heart transplantations were those of Mann at the Mayo Clinic in 1933. These dog heart transplants were able to function until the onset of rejection at eight days.

After these experiments, there was a 20-year period without progress until the late 1940s. S.V.P. Demikhov, a Russian surgeon, then initiated a series of ingenious experiments on the technical feasibility of both intra thoracic heart transplants as well as heart lung transplantation, although his work was not reported in the West until 1962.

With the advent of techniques for successful heart surgery in the 1950s, major attention was finally given to heart transplantation.

Various experiments using either hypothermia (low temperature) and circulatory arrest or the early cardiopulmonary bypass machines permitted a number of ingenious laboratory studies to be performed.

The currently-used surgical technique for heart transplantation originated with the work of Lower & Shumway in 1959, but the first human heart transplantation was performed by Christian Barnard in Cape town, South Africa, in December 1967.

This transplant triggered a great amount of interest at other centres around the world, with 170 transplants by 65 surgical teams performed between December 1967 and March 1971. However, with only 15 per cent of patients surviving a year after the procedure, enthusiasm for heart transplantation waned by the end of 1971.

Widespread application of heart transplantation depended on development of better immunosuppressive therapy. This came with the discovery of the drug Cyclosporin.

The rapid development and introduction of this compound to clinical transplantation resulted in superior results. Later on many drugs and methods were used in heart transplantation, including FK506, ATG, OKT3, MMS and body radiation.