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Show Family Weekly/ march 22, 1970 Problems and Their Promise could benefit from such radical surgery—but not until science finds the perplexing problems By Dr. ARTHUR S. FREFSE All the information, including the pulses of its own to confuse the com- patient’s age and specific physical and puter, In these cases, a larger com- health data, added up to some 50 different factors, which were then put through a computer to find their relationship to one another. The team discovered that the more mature patients and those better able to cope with anxiety and stress had a better chance of survival. ; The patients involved were not heart->ansplant cases, however, but there is no reason at ell to think there will be significant differences between them and Dr. Paley’s subjects, who underwent beth open- and closed-heart surgery. These findings show that there are more than physical problems involved in the survival of these patients, and cardiac surgecns may, before long, routinely request psychological tests before surgery. Dr. Paley explains that his team had zeroed in on a new facet of heart surgery. He adds that they have a method which, “if it proves out, may provide a very valuable tool and may puter must be coupled to Bickford’s. Thelargeroneis so programmed that it can “subtract” any spurious signals and show only those emanating from thebrain. The scientist foresees the possibility of a day when these larger computerswill be set up at key points throughout the nation and information fed into them through telephone ines fromthearea’s hospitais. Finai decision of the momentof death will then be centrally controlled: Gne of the major difficulties in heart transplants has been getting the right donorand the right recipient in the same place at the same time, for at this time most surgeons will not use a heart more than an Dr. Barnard prevent failures—even explain fail- ures we don’t understand on a physical basis.” The brain is also involved in the success of transplants. Dr. Reginald Bickford, professor of neurosciences at the University of California, has described the brain as the “organ of personality, the body’s most sensitive organ.” He believes that here is where the scientists must look for evidence of the exact moment of death. This is important in deciding when surgeons canlegally and ethically transfer the heart from the donor. Transplants have created new definitions of death, one of which says that the brain activity ceases althoughtie heart maybestill beating. Dr. Bickford devised a small analog computer which, attached by electrodes to the scalp, will “tick” as long as the living brain waves continue. When the clicking stops, brain activity will have ended and death occurred, In this way, a donated heart can be taken for transplantation before deterioration has had a chance to set in. In some cases, however, the heart itself may generate electrical im- plicated tests on animals indicates that heart-valve nerves act as sensors to measure the blood flow so that the brain can properly regulate the working of the heart. Another of the major stumbling blocks in this new surgery has been the problem of rejection, the body’s system for eliminating foreign material, whether it is microscopic bacteria or transplanted hearts, After the first transplant by Dr. Christiaan Barnard oi Louis Washkeusky in December, 1967, cobalt irradiation and massive doses of immunosup- omy, also has turned to animals to learn more about heart transpiants. He has found that heart valves are not just passive doors which open and close according to the pressure of the blood. On the contrary, they contain nerves which communicate with the brain. He believes that nerve regeneration may go onvery rapidly in transplanted hearts, and this may be of use to the surgeon who performs heart transplants. Furthermore, evidence from com- geon, has been the only doctor to try the natural process of rejection. ar artificial heart in a human being. The use of this device has been professionally questioned, and its use for terminal sufferers like Will Gray is still a matter of doubt, It may be = way of tiding the person over until Washkansky succumbed to pneumo- a transplant is ready, but many prob- nia 18 days later because the postoperative treatment weakened his lems are involved—clot formation, lack of a reliable long-term power source, and others. Dr. Cooley summed up transplants in this way: “The initiai experience with cardiac transplantation has been encouraging. In fact, nothing has been encountered which was not anticipated from the outset. The rey markable prolongation of life and resteration of good cardiac output has been most encouragingand somewhat beyond expectation. “In the future, the challenge remains with the prevention of rejection. Once this and other obstacles are overcome by the immunologists, then cardiac transplantation will hold greater promise.” In short, it’s likely that in the ble future heart will spell “life” to innumerable suffering human beings—but not without first overcoming some major obstacles, both inside and out of the pressive drugs were used to prevent defenses againstinfection. The use of irradiation and anti-rejection drugs was stopped. Irradiation is again being utilized, but of a radically different type. It represents another new hope for jong-term snccess. Instead of irradiating the heart or the whole body, nuclear power has now been pinpointed to knock out the specific hourafter the donor’s death. A new portable unit has been developed; in it, animal hearts have been safely preserved for more than 14 hours. This would make possible, for example, the use of a donor heart from a person who died in Los Angeles, for someone in Washington, D.C. At Tulane University, Dr. Terence H.Williams, professor of neuroanat- likelihoo? of rejection (the first successful kidney transplant was between identical twins with their perfectly similar tissues). In heart transplantation, a dozen or more factors are now checked for similarity, and these are being increased nearly every month. Houston’s Dr. Denton A. Cooley, world-famous heart-transplant sur- cause of rejection. The chief villain in this drama of the body’s rejection is presently believed to be white blood cells, the small lymphocytes. Blood or lymph from either artery or lymph vessel is sidetracked through plastic tube, which winds around a radiation source (a sort of mini atomic pile) before it carries those body fluids back to a vein. The latest suggestion has been to use a simple plastic bracelet which would contain the radiation source; thus the flow could be continued as long es neressary, destroying the small lymphocytes which are especially sensitive to radiation—all with. out anything more elaborate than having the patient wear a bracelet and a smallplastic tube. The immunosuppressive drugs that have been used to control rejection have been steadily improved, and new ones are being steadily developed. The aim is to control the rejection mechanism without weakening the patient’s resistance to infection. Tissue-matching also reduces the operating room. A review of heart transplants released by the National Heart and Lung Institute observes that some 32,000 Americans under 65 could benefit annually from transplants—but only 22,000 hearts are likely to be available each year. Further experiments with animal and artificial hearts will have to be undertaken, and the possibility of strategically located “organ banks” around the country may have to be explored. Obviously the road ahead is a complex one; but the journey has had a hopeful beginning. @ Family Weekly, March 22,1970 7 |