Nothing like a good feud to spark competition: First use of the total artificial heart.

As a native Houstonian, the notoriety surrounding Dr. Denton A Cooley's implantation of the total artificial heart on Good Friday, April 4, 1969, was inescapable. At the time, Drs. Cooley and Michael E. DeBakey were the two most famous surgeons in Houston and much of the world. They had worked together professionally for 18 years, revolutionizing cardiothoracic surgery and mastering aortic surgery from beginning to end. However, this working relationship ended abruptly, and one of the most famous feuds in medicine began. Little did I know at the time that I would train with both men, work in both their respective institutions (which are located on the most competitive block of the Texas Medical Center), and play a role four decades later as their relationship rekindled. Here, I recount what I have come to learn about these events.

Race, Kidney Transplants, Immunosuppression Research, and White Supremacy under Apartheid, 1960-80.

This paper uses the history of kidney transplantation in South Africa as a lens through which to write a racialized, micro history that illustrates the politics of medical discoveries and medical research at one of South Africa's most prestigious medical research universities, the University of the Witwatersrand (Wits) in Johannesburg. Between 1966 and the 1980s, the Wits team became the most advanced and prolific kidney transplant unit in the country. Yet the racist, oppressive Apartheid system fundamentally shaped these developments. Transplantation, as this paper shows, became an elite medical procedure, performed by a select group of white doctors on mostly white patients. For these doctors, transplantation showed their medical prowess and displayed the technical advancements they were able to make in research and clinical practice as they strove to position South Africa as a significant international player in medical research, despite academic boycotts and increasing sanctions. Transplantation became a symbol of white supremacy in a country where the black majority were excluded from anything but the most basic health care.

Leo Fabian: A Life of Accomplishment.

Leo Fabian played a role in many anesthesia firsts: the first halothane anesthetics in the United States, the first American electrical anesthetic, the first lung allotransplant, and the first heart xenotransplant. As was common for men of his generation, Fabian's first taste of medicine came during World War II, as a pharmacist's mate aboard the U.S.S. Bountiful. Afterward, he pursued his medical education before joining Dr. C. Ronald Stephen and the anesthesiology department at Duke. There he helped to create one of the first inhalers for halothane, the Fabian Newton Stephen (F-N-S) Fluothane Vaporizer. Fabian left Duke for the University of Mississippi Medical Center, where he consistently worked with the chair of surgery, Dr. James Hardy. Together they performed the first American electrical anesthetic, the first lung allotransplant, and the first heart xenotransplant. By the end of his time at Mississippi, Fabian and Hardy had several philosophical disagreements, and Fabian ultimately left for Washington University in St. Louis, where he rejoined Dr. Stephen. He served as Stephen's right-hand man and would oversee the department when Stephen was away. Fabian spent the final years of his career as chair of the department before his own health forced him to step down.

Commemorating 50 years since the first heart transplantation in Bratislava - Czechoslovakia.

The first human-to-human heart transplantation in Czechoslovakia, and the 25th transplantation in the world, was performed in Bratislava, the second largest city in Czechoslovakia on July 9, 1968. The operation was carried out by a team led by Professors Karol Siska and Ladislav Kuzela at the second Surgical Clinic at the Comenius University of the Medical Faculty in Bratislava, Partizanska Street-only seven months after the first heart transplantation performed by Dr. Christiaan Barnard in Cape Town. Other members of the team in Bratislava included surgery recipients Siska, Kuzela, Pivkova, Holoman; surgery donors Schnorrer, Kuzela, Holoman; an extracorporeal circulation team of Treger, Carsky, Podolay; anesthesiologists Sobesky and Neumanova; operating room nurses Machkova, Homerova, Kralova, and operating room laboratory technician Malinova. The donor was P.V., a 46-year-old man, who suffered from a deadly brain trauma. The recipient was S.H., a 54-year-old woman with a failing heart, heavily affected diseased lungs, kidneys and liver. Her heart began to work, but lasted only for five hours. (Additional members of the team, Prof. Simkovic and Drs. Silvay and Sujansky were in the USA at the moment of transplantation, in Houston and New York, subsequently) (Tab. 1, Fig. 2, Ref. 62). Keywords: first heart transplantation in Bratislava, 2nd Surgical Clinic at the Comenius University.

Common Postoperative Heart Transplant Complications.

Heart failure or congestive heart failure remains a major public health concern on the global scale. End-stage heart failure is a severe disease where the heart is unable to pump enough oxygen and nutrients to other tissues and organs of the body. When the lines of treatment of heart failure such as lifestyle adjustments, medical management, and device therapy fail, a patient may be deemed a candidate for heart transplantation. This article reviews the history of heart transplantation, complications post-heart transplantation, and nursing management considerations for the immediate period after heart transplant surgery.

Potential Impact of the Proposed Revised UNOS Thoracic Organ Allocation System.

The current United States heart allocation system faces 2 main challenges: an evolving landscape of device therapy in advanced heart failure and a rapidly increasing transplant waiting list. The proposed new heart allocation system involves expansion of the 3 tiers and enables greater distinction between different types of mechanical circulatory support devices. In this review, we discuss how the proposed revision reconciles key concerns of the current system to create a more fair and equitable allocation of hearts in the United States.

50 años de trasplante de corazón: la operación que enmudeció al mundo y cambió para siempre el concepto de muerte / 50 years after the first heart transplant: the operation that stunned the world and forever changed the concept of death

Resumen: Cuando el 3 de diciembre de 1967 Christiaan Barnard efectuó el primer trasplante de corazón no solo efectuó una operación que enmudeció al mundo sino que también cambió el concepto de muerte para siempre. Pero esta operación fue la culminación de un proceso que se inició con Alexis Carrel en 1910 y que no solo incumbe a la cirugía, sino que también a la inmunología y la infectología, así como a la ética, la filosofía y la teología. Como en todos los grandes avances de la cirugía, es posible reconocer 3 grandes etapas en el desarrollo histórico del trasplante cardiaco: investigativa, clínica y moderna, las cuales se revisan en esta publicación.

Abstracts: When on December 3, 1967, Christiaan Barnard performed the first human-to-human heart transplant, he not only performed an operation that stunned the world, but it also changed for ever the concept of death. This operation was the culmination of a process initiated by Alexis Carrel in 1910 concerning not only surgery but also immunology and infectious diseases as well as ethics, philosophy and theology. In the historical development of heart transplantation, as in all major advances in surgery, it is possible to recognize 3 eras: the research, the clinical and the modern eras, which are reviewed in this paper.