All newsletters are posted on the ISHLT website at: www.ishlt.org/publications/ishltLinksNewsletter.asp. ISHLT September 2011 ISHLTLinksLinks Volume 3, Issue 4 The Links newsletter welcomes Donald McRae, our Special Guest Editor for the September Issue. He is known by most of us as author of the first chapter of Volume 4 in the ISHLT monograph series: History of International Heart and Lung Transplantation. He should be known by all of us for his riveting work, Every Second Counts: The Race to Transplant the First Human Heart (2006). In ThIs Issue Mr McRae has distinguished himself as a two-time winner of the prestigious annual British literary Click to View Article award, William Hill Sports Book of the Year. His winning works are related to boxing and include Dark Trade: Lost in Boxing (1996) and In Black and White: The Untold Story of Joe Louis and Jesse Every Second Counts 1 Owens – which is also known as Heroes without a Country: America’s Betrayal of Joe Louis and Donald McRae Jesse Owens (2002). He is a respected, lively, articulate and knowledgeable author who is clearly full of passion about his subjects and topics. His other works include: Nothing Personal: The ISHLT Annual Meeting, April 18-22, 2012, Prague Heart Failure and Transplant Business of Sex (1992), Winter Colours: Changing Seasons in World Rugby (1998) and The Great Medicine Session Highlights 3 Trials of Clarence Darrow (2009). His next book, Under Our Skin, a memoir of life under apartheid Luciano Potena, MD, PhD in South Africa, will be published in March 2012. He was born and educated in South Africa and today lives with his family just outside London. His book Every Second Counts is a must read for Debate Corner 4 all members of the ISHLT. Third Prague Adventure of Mr/s. XYZ eveRy seconD counTs at ISHLT 2012: Czech Sports, Donald McRae Sportsmen, and Sportswomen 5 Tereza Martinu, MD Ten years ago this month, in as he declared that “growing old is humanity’s September 2001, Christiaan greatest tragedy.” Organ Allocation System for Heart Barnard died a lonely death Transplantation in Germany as in Cyprus. The reputation of The 78-year-old surgeon struggled for his last Participating Eurotransplant Country 7 the South African surgeon, painful breath in Paphos, close to the mythical Nicola E Hiemann, MD, PhD, Roland who gained sudden and birthplace of Aphrodite, the Greek goddess of Hetzer, MD, PhD and meteoric fame around the love and beauty, but it seems appropriate now Evgenij V Potapov, MD, PhD world when he transplanted to remember a more obscure anniversary this To Induce or Not To Induce? 9 the first human heart in 1967, month. Forty-five years ago, in September 1966, Kelly McCants, MD had long since succumbed to controversy and in the prosaic setting of a medical laboratory even infamy. But a few days before the world in Richmond, Virginia, Barnard watched with Transplant Community Slams PHS changed forever, with the devastating attacks something approaching awe as Richard Lower Guideline for Reducing on 9/11, it was still possible to be struck by used hypothermia and the surgical technique he Viral Transmission 9 the pathos in one of Barnard’s final laments. had perfected with Norman Shumway to coolly Reflecting on the skin cancer which had begun transplant a heart from one dog to another. What would Edward Jenner Say? 10 to eat away his face, he said, “I now look more Stanley I. Martin, MD like the elephant man than the handsome guy Turning to his former perfusionist, Carl Goosen, who was once voted one of the world’s five who had moved to America and begun working Assessing Health-related Quality of greatest lovers by Paris Match.” in a lab next door to Lower, Barnard said in quiet Life in Heart Transplantation 11 but breathless Afrikaans: “My God, is that all E Sarmiento, J Carbone Barnard, in his last days before dying of it is?” Meeting Links 12 bronchial blockage caused by a violent attack of asthma, had lost his health, his looks, his The pure simplicity of Lower’s operation had History, Hubris, Freedom three divorced wives, his fleeting sense of not happened by miraculous chance. Shumway and Fitness 13 glory and any remaining remnant of medical and Lower had been working methodically in Vincent G Valentine, MD renown. Most obituaries highlighted the fact the then experimental field of cardiac transplant that he had travelled to Cyprus in the flailing for eight long years. They were preparing for Sticky Links 14 hope of securing a contract to market olive oil “the golden moment” when they would at last Page 1 • www.ISHLT.org ISHLT Links “Every Second Counts” continued attempt the feat in a human being – and were “We never liked the idea of ‘a race’,” Lower only prevented from plunging ahead by their told me once. “Norm [Shumway] and I eDIToRIal sTaff own scientific caution, justified concerns thought in much broader terms – and that’s about the inevitable immunological problems where Chris Barnard maybe differed to us. EDITOR they would confront and the reality that US He had his eyes on the immediate ‘prize’. We Vincent G Valentine, MD legislation would not permit them to procure wanted something that went far beyond that. the heart of a brain-dead patient. But that doesn’t mean Barnard wasn’t a great character. I can understand why you wanted SENIOR Associate EDITORS Unshackled from such restraints in South to write about him.” Roger W Evans, PhD Africa, where the government was more intent Allan R Glanville, MD FRACP on bolstering the injustices of apartheid than Lower, as usual, was right. After his death Maryl R Johnson, MD debating antiquated medical ethics, Barnard I wanted to learn more about Barnard as a Lori J West, MD DPhil resolved that he would return home and make surgeon and a man. Even more pressingly, I history. Fifteen months later, in December wanted to discover who had preceded and 1967, a matter of days, hours, minutes and followed him in the annals of transplantation. Associate EDITORS even seconds separated four rival teams in And the deeper I went, and the more I Emma Birks, FRCP PhD, Cardiology a race to transplant the first human heart. uncovered, the closer the connections Nancy P Blumenthal, CRNP, Nursing Shumway in Stanford, Lower in Richmond, became between all four men – Shumway, Adrian Kantrowitz in New York and Barnard Lower, Kantrowitz and Barnard. They were Daniel F Dilling, MD, Junior Faculty & in Cape Town were all on the brink of “surgical closest friends or bitterest rivals, university Trainees immortality.” Barnard, the most audacious classmates or surgical adversaries. But they Stavros G Drakos, MD, Cardiology and least prepared of them all, “won” the were locked together in time as the pioneers of Lee R Goldberg, MD MPH, Cardiology race after a series of dramatic twists and human heart transplantation. Their individual turns of fate cleared his path. Celebrity soon stories seemed to matter less than the overall Stanley I Martin, MD, Infectious devoured him as the world celebrated his journey they had shared as leaders of teams Diseases success without really knowing much of the of men and women who transformed medical Tereza Martinu, MD, Pulmonary men whose groundbreaking research had history. made the operation possible. Five years ago this month, in a much more International Yet, by the time of his death in a different humble and personal anniversary, my book CORRESPONDENTS BOARD century, all the merits of Barnard’s bold about these four contrasting surgeons was Javier Carbone, MD PhD, Spain finally published. I reluctantly called it Every intuition and unequivocal devotion and Bronwyn J Levvey, RN Grad Dip Clin compassion for his patients had been Second Counts and, then, I squirmed a little at Ep, Australia distorted alongside his crumbling face. In the apparent banality of the title. It appeared medical circles Lower and, in particular, crass to me, as if I had traduced a surgical Takeshi Nakatani, MD PhD, Japan Shumway were revered for their perseverance milestone into a coarse sporting event. I knew Luciano Potena, MD PhD, Italy as they overcame the immunological and that Barnard being “the first” had ultimately Stephan Schubert, MD, Germany legislative trials that made the early history ruined his life and disfigured his more easily Andreas Zuckermann, MD, Austria of cardiac transplantation such a fraught forgotten contributions to medical science. and bloody business. The men who came Shumway, who had been hurt for forty years “second” to Barnard also liked to remind us by “losing” to Barnard, was the real “hero” of that, just as in ancient Greece, where Xerxes cardiac transplant history – and yet Shumway may have won his most famous battle before himself pointed out that we owed much to the ultimately losing the war, history teaches us often reviled South African. larger truths than stark facts. “What Chris Barnard did in focusing the C lick Here to return to the Page 2 • www.ISHLT.org Table of Contents ISHLT Links “Every Second Counts” continued world’s attention on brain death should never be forgotten,” but, rather than feeling sad or deflated, I tried to remember the verve Shumway told me in 2004. “He paved the way on that issue and and the passion each of them, alongside the South African nemesis it became central to our whole early struggle in transplantation.” they eventually outstripped. And I also thought of the hundreds of thousands of people whose lives have been lengthened and I always think of that generosity of spirit every September when, in a enhanced by the now routine procedure of cardiac transplantation.