Heart's Ease

The elderly man walking along the seafront, enjoying the autumn sun, looked more like a campaigning politician than a heart patient. He stopped often to shake hands with passers-by and to chuck babies under the chin. At home between constitutionals, he ate so heartily that he put on two pounds last week. It was true that every other day he dropped into the hospital for a checkup, and he was taking about 30 pills a day. But Cape Town Dentist Philip Blaiberg, 58, was in far better shape than he had been before he received his heart transplant. The daily bulletins on his condition monotonously reported "excellent progress."

Those 30 pills included antacids and vitamins and, more important, digitalis to strengthen the action of his new heart and two drugs to suppress the immune mechanism by which Blaiberg's body might reject the graft: azathioprine (Imuran) and the hormone prednisone. The doctors at Groote Schuur Hos pital were cautiously reducing the doses of immunosuppressives--his moonfaced appearance was a sign of cortisonism--and they hoped soon to be able to cut down his checkup visits to one a week. Blaiberg was writing a diary for daily newspaper syndication, and his wife Eileen, fresh from a crash course in photography, supplied intimate, at-home pictures.

Virtually everyone involved in the transplant was on the move. Blaiberg expected soon to go to a seaside cottage south of Cape Town, and was talking about a 1969 visit to Europe. Surgeon Christiaan N. Barnard was in Europe again with brother Marius, and pondering an invitation to Moscow. Dorothy Haupt, widow of the donor of Blaiberg's heart, accepted a trip to Buenos Aires for TV appearances, with $1,000 added.

Against the day when Barnard would do his next transplant, the South African National Film Board made plans to shoot the operation in color. Its asking price for world rights is $1,400,000.

What role was played in the death of Louis Washkansky, the world's first heart-transplant recipient, by the patient's immune mechanism and the at tempts made to suppress it? After studying microscopic sections of the transplanted heart, Dr. Barnard said they showed only minimal evidence of rejection. But on the basis of a similar set of heart-tissue samples, a distinguished transplant team at London's Hammersmith Hospital, headed by Surgeon William J. Dempster, said that it found signs of "a moderately severe rejection reaction--more than just minimal." American pathologists who saw Barnard's slides were divided in their judgments. However the reaction is graded, its cause is still debatable. Some authorities blame nature's immune mechanism; others, the heavy doses of radiation given to Washkansky in the hope of subduing the reaction. Although the South African doctors insist that Washkansky died of pneumonia, they admit that they may have overtreated him with both radiation and immunosuppressive drugs. They have been careful not to make such a mistake with Philip Blaiberg.

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