Thursday, June 1, 2017

Remembering when deceased donor transplantation was regarded as repugnant

From New Zealand, a story with several notable features:
the patient received a heart-lung transplant, and her heart was successfully donated to another patient, at a time when deceased donation (and brain death) gave rise to some repugnance:
 Kay Burnett celebrates 30 years of a ground-breaking heart-lung transplant

"Sir Magdi Yacoub calls Burnett an outlier. One of the few who broke the statistics.  The 81-year-old transplant surgery veteran speaks from Egypt, where he still teaches. These days, Sir Magdi is a globally revered transplant pioneer. He has a professorship, a knighthood and a membership of the Queen's exclusive Order of Merit. But back then, as Burnett sat in a London flat awaiting her only hope at life, some were calling him a murderer.

"It's easy to forget that transplanting organs from braindead patients was once deeply polarising. "The hate was abundant," Sir Magdi says. He won't repeat the hate mail's contents, but there was a lot of it – "a lot, a lot, a lot". ...
They said he was killing a living person to take their heart. "But the patient is not living. If my brain is dead – I'm not there."


"The domino-donor idea was born of Sir Magdi's frustration at wasting useable hearts. At the time, lung transplants were technically risky – even today they have lower survival rates. But transplanting a heart and lung together ensured the pressure generated by the heart was matched exactly by the lung. It also ensured an instant blood supply, helping the windpipe heal immediately.

"But for those, like Burnett, who needed only a new lung, that meant binning a potentially functioning heart.

"We were very short of donor organs. We still are. So I did not want to be sending it to the pathology department when I could be transplanting it."

"And so domino-donor transplants were born. While the domino-donor hearts were compromised, having been subjected to high blood pressure from the lung, or pulmonary hypertension, Sir Magdi realised that could be an advantage. Heart patients with severe pulmonary hypertension could receive a heart pre-conditioned to that high pressure, which then normalises over time.

"Burnett's was not the first domino-donor transplant – that was undertaken by Sir Magdi 11 days earlier, on April 28. The heart-lung recipient survived; the heart recipient did not.

History now mostly says the first successful domino transplant was conducted in the United States, but contemporary news reports say Burnett's transplant happened just hours earlier. Burnett was all over the British press, with The Sun once reporting her dead.

Who was first is not important, Sir Magdi insists. What matters is learning from people such as Burnett and Andrew Whitby – another Harefield patient, named the longest-surviving heart-lung transplant recipient when his 30-year anniversary ticked over in 2015.

HT: Frank McCormick

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