Doctor who pioneered heart transplant helped launch Oklahoma City program
Fifty years ago, the first heart transplant revolutionized what was humanly possible, but the procedure was still in its infancy when it came to Oklahoma City almost two decades later.
Dr. Christiaan Barnard, who died in 2001, made history with the transplant in South Africa on Dec. 3, 1967. He also contributed to bringing the surgery to Oklahoma in the early 1980s.
The first patient to undergo a heart transplant died of pneumonia after 18 days. The second lived only 19 months. The problem wasn’t Barnard’s work as a surgeon, but the difficult balance between suppressing the immune system enough that it wouldn’t reject the organ, but not so much that the patient died of infections that normally wouldn’t have bothered them, said Dr. John Chaffin, chief of cardiovascular surgery at Integris Baptist Medical Center.
More than 15 years after the first transplant, surgeons still had to tinker with the available drugs in the hopes of giving patients a chance, Chaffin said. Insurers wouldn’t pay for a procedure they viewed as experimental, and the only patients who underwent the surgery were those who faced certain death if they didn’t, he said.
“The whole concept of heart transplant in the ‘80s was pretty rudimentary,” he said.
Uncertain landscape
It was in that uncertain landscape that Dr. Nazih Zuhdi, a heart surgeon in Oklahoma City, decided to start the Oklahoma Transplant Institute. For help, he called up Barnard, who had been his roommate when the two were training at the University of Minnesota. By that point, Barnard had given up surgery due to rheumatoid arthritis, but he agreed to take the post of “scientist in residence” at Baptist Medical Center.
The institute, renamed for Zuhdi after he retired in 1999, now has transplant programs for the heart, liver, kidneys, pancreas and lungs. Close to 600 patients have received transplants there. Zuhdi died in February at age 91.
Though Barnard couldn’t perform surgeries anymore, he had an inventive mind and a deep knowledge of the heart, Chaffin said. When the team came across an unexpected quirk in the patient’s anatomy — something that happened far more often in the days before advanced imaging — Barnard usually could think of a way to proceed, he said.
“He was an incredible guy, just brilliant,” Chaffin said.
It was a two-way partnership, because Barnard had used tactics Zuhdi had developed when he performed the first transplant. Together, they recruited a team of surgeons, including Chaffin and two doctors who had worked with Barnard in South Africa.
Strong reputation
Zuhdi had built up a strong reputation, and failing to launch a successful transplant program would have tarnished his legacy, Chaffin said. Staff in other departments tried to get him to talk Zuhdi into abandoning the program, he said, and some laypeople made no secret of their belief that the surgeons were doing something sacrilegious.
“I always said that it took a great deal of courage on (Zuhdi’s) part to start a transplant program,” he said. “It was the frontier at that time.”
Zuhdi performed the first heart transplant in Oklahoma in 1985, one year after founding the Oklahoma Transplantation Institute. The first patient was Nancy Rogers, whose heart had been damaged by chemotherapy used to treat Hodgkin’s disease. She lived 54 days before dying of an infection. The second patient also died, Chaffin said.
“The rest of the staff became very nervous,” he said. “Dr. Zuhdi was undaunted. He said, ‘We can make it work.’”
‘A higher power’
Improvements came gradually, and by the early 1990s, heart transplantation was becoming an accepted option around the country, Chaffin said. As of 2015, about 73 percent of heart transplant patients worldwide are alive five years after the surgery. About one-fifth are alive 20 years later.
While assistive devices to pump blood now offer patients a better chance of living long enough to get a transplanted heart, there remains no alternative to donated hearts, Chaffin said. Some people still believe that it’s wrong to transplant organs, but he takes a different view.
“When I sew a heart in and start warm blood flowing and the heart starts beating spontaneously, it’s almost a religious experience,” he said. “There has to be a higher power than us.”