Reflecting on 500 Heart Transplants

The OR team for the 500th heart transplant included, front from left, Betty Cambronne, Barbara McDermott, Rose Ganim, Amy Patel and Prem Shekar; back from left, Ed Soltesz, Gregory Couper, Stavros Memtsoudis and Michael McAdams.

Until 22 years ago this week, a successful adult heart transplant in New England had never been performed. That changed on Feb. 2, 1984, when BWH surgeons successfully performed a heart transplant on patient Gerald Boucher and followed that up with New England's second heart transplant eight days later.
"It was a big deal. There weren't many heart transplant teams in the country," said Lawrence Cohn, MD, senior cardiac surgeon, who participated in the first heart transplant. "We had the right team, the right enthusiasm, the right support from the hospital and the right patient."
Today, BWH is the first hospital in New England to reach 500 heart transplants, a milestone achieved in December with patient Richard Briggs. "This milestone speaks to our leading role in management of end-stage heart disease," said James Fang, MD, medical director of the Cardiac Transplantation Program.

HISTORICAL EVENT AT BWH

Drs. Lawrence Cohn, John Collins, Richard Shemin and Gilbert Mudge received engraved Playmate coolers in celebration of the 1984 event.
BWH's first heart transplant was not only a significant medical achievement, but also an event that unified the newly formed Brigham and Women's Hospital, which opened its doors in 1980. "The first heart transplant helped bring divergent specialists together," said Gilbert Mudge, MD, who started the BWH heart transplant program. "For the first time, people began to say the hospital was truly bigger than the sum of its parts."
Those involved in the 1984 transplant recall the excitement as if it were this week. Rosemarie Maddi, MD, then chief of Cardiac Anesthesia, said the patient demonstrated a great deal of confidence in the BWH transplant team. "I asked him if he was scared, and he said, 'No. I have faith in all of you,'" Maddi said. "It was incredible."
Patients today can be just as confident in BWH transplant teams. "The outstanding record of heart transplants at BWH is reflective of the teamwork and talent of our nurses, doctors, technicians and researchers," said Chip Bolman, MD, chief of Cardiac Surgery.
With that first transplant, BWH had an experienced surgeon in Cohn, who trained at Stanford in the 1970s with Norman Shumway, the physician who developed the experimental basis for transplants and paved the way for the country's first adult heart transplant in 1968. Back then heart transplants required the organ donor to be in the next room, Cohn said. Since BWH has been performing heart transplants, a team of specialists travels to the hospital where the donor is, retrieves the heart and brings it back to BWH for the surgery.

TECHNOLOGY ADVANCES IMPROVE OUTCOMES

BWH’s first heart transplant.

The surgery itself has changed little over the last 22 years, with the exception of better medications to prevent infections and counteract organ rejections. Major advances in device technology, however, have changed the way that patients are cared for while waiting on the heart transplant list. "Now, many patients can have a ventricular assist device (heart pump) implanted and return home to await transplant," Fang said.
Some patients even return to working full time while they wait an average of four to six months for a heart. The devices keep patients healthier, leading to better outcomes after the surgery.
Such devices are especially important today as the number of people with end-stage heart failure is increasing and the nation faces an organ donation shortage. "It has taken us more than 20 years to perform 500 heart transplant operations because there are too few potential organ donors," Fang said. Such a shortage has necessitated the use of ventricular assist devices to bridge more and more patients to transplant. 
"The future of organ transplant is unfortunately not much bigger than it is now," Cohn said. "There just aren't enough donors."
BWH offers patients many therapies in addition to or instead of transplant, as well as the latest in medical and surgical investigational therapies.
To view the article in the 1984 issue of BWH Bulletin visit:   www.bwhpikenotes.org/hearttransplant.asp.

BWH’s first heart transplant team.