NOVA: NEW ORGANS FOR OLD: PIONEERS OF SURGERY (TV)
Summary
One in this series of science documentaries. This documentary details the history of modern organ transplantation, particularly heart transplants. With advances in heart surgery, by 1966 surgeons took up the challenge of completely replacing the heart itself. Many advocated the use of artificial hearts, but others researched the possibility of performing a heart transplant, replacing an abnormal heart with a healthy one. Early historical attempts at transplantation were minor and often unsuccessful. French surgeon Alexis Carrel performed revolutionary organ transplantation experiments on animals in the early 20th Century, although they always ended in failure. During World War II, war surgeons tried to determine how to tend to extensively burned soldiers, and British doctor Peter Medawar tried to devise a way to perform a new kind of skin graft, using skin from a relative or cadaver to prevent the patients from dying from infection. The patients all rejected the new skin, and Dr. Medawar discovered that it was due to their immune system rejecting the skin as a foreign body. The same held true for any of the body’s other organ systems as well. Many others wounded during wartime suffered kidney failure, and Medawar’s findings made it seemingly impossible to replace them with functioning kidneys. A team of surgeons met at Peter Bent Brigham Hospital in Boston to try to work around this problem. Most of their experiments with kidney transplantation ended in death by tissue rejection, but a couple of patients survived, sparking the team’s hopes. They kept patients alive during surgery via an “artificial kidney” device invented by Dutch doctor Willem Kolff, which could perform a crude yet effective means of dialysis. In addition to the team in Boston, two French teams of surgeons were also attempting to find a way around kidney rejection, using organs from prisoners on death row. The only notable successful skin transplants took place between identical twins, and in 1954 a man named Richard Herrick approached the team at Boston, dying of renal disease. His twin brother Ronald offered to donate his kidney, and the team believed it would be successful since there would be no immunological barriers between the twins. The operation proved to be a success, much to the excitement of the Boston team. Soon more sets of identical twins arrived and they too were treated with the transplantation technique. In 1956, Edith Helm became the first recipient of a kidney transplant to successfully give birth. Upon further research, Dr. Medawar discovered that newborn animals could readily accept grafts from other animals without immunological consequences. This phenomenon was known as “immunological tolerance,” but there was no way of inducing it except by radiation to suppress the immune system, and doctors were reluctant to use it due to the terrible side-effects it would entail. Another method was discovered based on anti-cancer drugs derived from mustard gas, which could be used to control white blood cell count. In 1959, it was discovered that the drug azathioprene could be used to suppress the immune response, and doctors hoped that it could be used for successful transplantation. Early experiments with dogs proved to be promising, and by 1963 performed a transplant which resulted in a patient who lived for over a year afterward. In short order, tissue typing and better means of organ preservation increased the chances of survival for kidney operations. In 1964, surgeons tried to apply these principles to other organs, such as the liver and, more notably, the heart. Heart surgery was inherently more risky than other kinds of organ operations. However, by that time considerable progress had been made in the field of heart surgery. Two surgeons, Norman Shumway and Christiaan Barnard, pioneered the notion of the heart transplant. A major challenge was finding donor hearts, and by 1967 both Shumway and Dr. Adrian Kantrowitz each individually waited for donors for their individual patients. However, Dr. Barnard performed the first successful transplant in Cape Town, South Africa on December 3rd, 1967, using a heart taken from a woman fatally injured in an automobile accident to give to patient Loius Washkansky. Dr. Barnard quickly achieved celebrity status for his accomplishment, although Dr. Kantrowitz performed one only a few days after Dr. Barnard’s procedure. American surgeons were annoyed that a South African was becoming famous for building upon experimentation done almost entirely in the United States. Washkansky remained alive for eighteen days before succumbing to the side-effects of the immunosuppressant drugs given to him. Dr. Kantrowitz’s patient died after only six hours, and soon Dr. Shumway made his own attempt, but his patient died after fifteen days. Dr. Barnard made his second attempt at a heart transplant, watched carefully by international media. This second patient lived for over a year, adding to the credibility of viable heart transplants. Patients sprang up from all over the world, hoping to receive the new operation. In May 1968 at the Methodist Hospital in Houston Texas, Dr. Michael DeBakey and his apprentice Denton Cooley started to move into heart transplantation. Soon patients from across the country sought DeBakey and Cooley’s help, and they gained notoriety similar to Dr. Barnard’s. Soon Houston became a leading center for heart transplantation around the world while Dr. Barnard adjusted to his international fame. Soon the transplant patients began to die off, either due to tissue rejection or reactions to the drugs. This prompted criticism about the future of heart transplantation, particularly leveled at Dr. Barnard. Other surgeons felt that the field was moving too quickly without fully addressing the tissue rejection problem, thus endangering patients. However, heart transplantations continued unimpeded, although the surgeons also tried to address the problem of keeping the patients alive while waiting for a donor heart. Cooley’s eagerness to move forward with transplantation led to conflict with DeBakey. In 1969, Cooley used an experimental artificial heart to keep a gravely ill patient alive until a real heart could be found, making it the first time that an artificial heart was successfully implanted into a human being. A donor heart was not found in time, and the patient died. DeBakey was furious that Cooley had performed the operation without the hospital’s permission. Cooley resigned from the hospital and cut off communication with DeBakey. By March 1971 only 24 of the 170 recipients of heart transplants worldwide remained alive. Cooley and others believed that they could do no more with the procedure, and that they had reached a dead end. Dr. Shumway continued his work, assembling a team to focus on solving the problem of tissue rejection.
Details
- NETWORK: PBS
- DATE: September 20, 1988 9:00 PM
- RUNNING TIME: 0:58:27
- COLOR/B&W: Color
- CATALOG ID: B:44652
- GENRE: Public affairs/documentaries
- SUBJECT HEADING: Public affairs/documentaries
- SERIES RUN: PBS - TV series, 1974-
- COMMERCIALS: N/A
CREDITS
- Paula S. Apsell … Executive Producer
- John Palfreman … Producer, Director, Writer
- Roger Limb … Music by
- Daniel Kane … Music by
- Mason Daring … Theme Music by
- Martin Brody … Theme Music by
- Will Lyman … Narrator
- Roy Calne … Interviewee
- Joseph Murray … Interviewee
- Francis Moore … Interviewee
- Willem Kolff … Interviewee
- Charles Dubost … Interviewee
- Edith Helm … Interviewee
- Wanda Foster … Interviewee
- Denis Melrose … Interviewee
- Adrian Kantrowitz … Interviewee
- James Hardy … Interviewee
- Christiaan Barnard … Interviewee
- Norman Shumway … Interviewee
- Alexis Carrel
- Denton Cooley
- Michael E. DeBakey
- Louis Fierro
- Donald Gould
- Richard Herrick
- Ronald Herrick
- Rene Kuss
- Peter Medawar
- John Merrill
- Louis Washkansky