Pig heart transplants hope
A tip-off from a friendly registrar paved the way for a milestone operation 40 years ago today
PIG hearts adapted for human use could be available within three years, the surgeon who pioneered heart transplants in the UK has said.
Sir Terence English, who performed Britain’s first successful transplant 40 years ago today, believes “xenotransplantation” could all but eradicate the donor waiting list. He told The Sunday Telegraph that his protégé in the 1979 operation is preparing to do the world’s first pig-to-human kidney transplant “before the end of this year”. If successful, it will open the door to more complex organs being transplanted.
There are around 280 patients now waiting for a heart transplant in the UK. But stringent conditions mean that suitable donated organs are scarce.
On Aug 18 1979 at Papworth Hospital near Cambridge, Terence English took a call from a friendly registrar at nearby Addenbrooke’s and learnt two equally crucial facts. The first was that a healthy donor heart had become available. The second was that the registrar’s boss, Prof Roy Calne, was out of town.
A few hours later, English sewed the organ into the chest of a gravely ill 52-year-old builder from London called Keith Castle.
Despite being a poor candidate, due to his heavy smoking, Castle survived and went on to live for another five years. Britain’s heart transplant programme was born.
Forty years on, Sir Terence, as he now is, reveals the rivalries and immense hostility from the medical establishment that nearly strangled the programme at birth.
“God, it was so crucially important that we succeeded,” he told The Sunday Telegraph.
“There were a lot of cardiologists who didn’t want to see it happen, and the Department of Health was furious.”
“But Keith was a great survivor. I actually think he did more in the months that followed to publicise the value of heart transplantation than I ever could.”
The first attempt at a heart transplant in Britain had taken place 11 years earlier, but the patient had lived for only 45 days. Similarly poor outcomes in a number of patients over the following year persuaded health chiefs to ban the practice.
But by 1979 the powerful immunosuppressant drug ciclosporin, which helped prevent the immune system rejecting donor organs, had become available.
During that time Sir Terence, now 86, had been training with top US transplant surgeons and building up a team of specialists at Papworth, waiting for the mood to change.
He was refused funding by the Department of Health, and told he must under no circumstances perform a heart transplant. But the NHS manager for Cambridgeshire believed in the programme and gave the money for two procedures.
However, this did not impress Prof Calne, now Sir Roy, a kidney transplant pioneer to whom Sir Terence had previously promised they would initiate a heart transplant programme together at Addenbrooke’s.
Sir Terence says the resulting disagreement was so profound that Sir Roy instructed units under his control – where most of the donors arrived – not to send donor hearts to Papworth.
“A lot of the units that were sending [donor] kidneys were told he wasn’t going to accept any if they were also sending hearts.
“It was difficult – I could have handled things better, I think.”
Sir Roy had not accounted for his senior registrar, Paul McMaster, who believed Sir Terence should have the chance to operate and offered the heart in his superior’s absence.
McMaster, subsequently the president of Médecins Sans Frontières UK, had done exactly the same thing seven months earlier.
But the recipient on that occasion, Charles McHugh, had suffered brain damage while waiting for the organ and died three days after the operation.
“I had to go to the Department of Health and explain what had happened,” said Sir Terence.
“But they did not know that I had one more shot, and that I was going to use it.”
Even after the success of Mr
‘There were a lot of cardiologists who did not want it and the Department of Health was furious’
‘It’s been a long journey but it has been worth it and eventually a lot of good came out of it’
Castle’s transplant, officials in Whitehall were initially reluctant to fund further transplants.
Sir Terence’s unit had to get by with grants from the British Heart Foundation and the reclusive millionaire Sir David Robinson, founder of Robinson College at Cambridge University.
During these early years the survival periods gradually improved, thanks to better understanding of how to use ciclosporin.
Today, about 200 heart or heartlung transplants are carried out on adults every year in the UK, around half of which take place at Papworth.
Tomorrow the hospital hosts an event which will be attended by relatives of Mr Castle and former patients of Sir Terence, including one woman who has lived 37 years since her transplant.
“It’s been a long journey, but it’s been worth it, and eventually a lot of good came out of it,” said Sir Terence.
“You just had to exert a bit of tenacity of purpose.”
Sir Roy, who could not be approached for comment, went on to perform the world’s first liver, heart and lung transplant in 1987, and then the UK’s first intestinal transplant in 1992.
Following Sir Terence’s unsuccessful first attempt at a heart transplant in January 1979, Sir Roy wrote to him expressing concern “at the effect that requesting for heart donation may have on our kidney donation”.
Prof John Wallwork, who worked with both men and is now chairman of the Royal Papworth Hospital, said: “There was a certain amount of friction,”
Reflecting on scepticism in the wider medical profession, he added: “Terence did exactly what you should do.
“He did his homework, took advice from other people, then did it methodically, which is why he succeeded.”
Prof Jeremy Pearson, associate professor at the British Heart Foundation, said: “One of the British Heart Foundation’s first grants was given to scientists conducting early research into transplant techniques.
“From that day in 1963 to the present day, the BHF has been funding pioneers just like Sir Terence to carry out cutting-edge research to improve surgical techniques, prevent transplant rejection and develop medical devices to help the failing heart.”