Transplants: Shumway's Way

Much of the glamor has rubbed off heart-transplant surgery since Dr. Christiaan Barnard's historic operation eight years ago this week in Cape Town. Discouraged by the generally low survival rate of patients, many of the surgeons who performed the early heart transplants have now abandoned the technique. There is one notable exception: Dr. Norman E. Shumway of Stanford University School of Medicine, the man who developed the technique used by Barnard. Shumway, 52, is allergic to publicity but recently broke a three-year silence on his transplant record. At a meeting of the American Heart Association in Anaheim, Calif., his team reported that it has been performing an average of one heart transplant per month since 1968, and that 33 of its 95 patients are alive today. This record of success far exceeds that of any other surgical team; of the 191 patients round the world known to have undergone transplant operations outside of Stanford, only 18 are still living.

Shumway's 33 surviving transplant patients* owe their lives to several innovative changes in postoperative care. The Stanford doctors routinely administer drugs that stimulate the heart for the first few days after the transplant. Explains Dr. Edward B. Stinson, head of the surgery team: "We noticed that a transplanted heart functions at a lower than normal rate of output right after surgery." The Stanford group also routinely performs heart biopsies after surgery, looking for any clinical clue that the body's immune system may be rejecting the new heart. By slipping a biopsy catheter into the right ventricle via the jugular vein, doctors snip a piece of tissue, then compare it with a sample taken at the time of the original operation. If the biopsied tissue shows inflammation--a sign of rejection--the doctors temporarily increase the dosage of drugs that suppress the immune system after transplant surgery.

Ready for Jogging. Because these drugs decrease the body's resistance, the patient becomes highly susceptible to infection. The Stanford group has a remedy for that too. "We throw a whole array of antibiotics at the patient as soon as we suspect something," says Dr. Sharon Hunt, a member of the postoperative care team. "Once we have ascertained the exact nature of the infection, we withdraw those that are not needed."

Soon after surgery, the doctors order a special physical-fitness program that includes jogging, calisthenics and other forms of vigorous exercise. This tends to counter a side effect of one type of immunosuppressive drug: demineralization of the bones. One patient, a professional bowler who will shortly be discharged from Stanford, has been given free rein to resume his career; another is careening about Palo Alto these days on a ten-speed bike.

Word of the remarkable transplant record at Stanford has spread through the medical world. The group has already received requests for advice and information from teams of cardiologists in England and Russia. Says Stinson: "Around the world there is a serious renaissance of interest in heart transplants."

* Two of whom received second transplants after their bodies rejected the first.

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