An awestruck world knew her only as Baby Fae. The true identity of the two-week-old infant who made medical history on October 26, 1984 was kept strictly confidential by officials at California's Loma Linda University Medical Center, where the successful transplant of a young baboon's heart was performed to keep the baby alive. Run by the Seventh Day Adventist Church, Loma Linda was renowned for its pediatric surgery, and one of its most talented surgeons was Dr. Leonard Bailey. While working at a children's hospital in Toronto, Dr. Bailey proposed xenografts -- cross-species heart transplants -- as a possible way to save victims of hypoplastic heart, a fatal condition in which the left side of the heart is under-developed at birth. Infant hearts were rarely available for transplant, so Bailey had searched for a viable alternative. He met with resistance from many in the healthcare field. "People didn't understand," he said. "They weren't watching babies die."
A Loma Linda research grant permitted Bailey to proceed with his experiments. Devoting seven years to the project, he performed dozens of cross-species transplants on animals. Two days prior to Baby Fae's surgery, a review board gave him permission to replace his little patient's failing heart with that of a young female baboon. Before compatibility tests could be completed, however, Baby Fae's heart ceased to function. Placed on a respirator, the five-pound infant -- she had been born three weeks premature -- was put in a heart-lung machine to lower her body temperature to 68 degrees Fahrenheit, slowing the metabolism. In Loma Linda's basement, Dr. Bailey extracted the heart from one of the hospital's research colony of six baboons. After a four hour operation, Baby Fae's new heart was functioning on its own.
Cross-species transplants had been tried before, without success. Five simian hearts and twenty kidneys had been transplanted into humans prior to Baby Fae's operation. In 1964 a chimpanzee's heart was placed in a 68-year-old man, who died in a matter of hours, as did a young woman who also received a simian heart transplant in 1977. Most critics of such experimental surgeries were certain that a human patient's body would reject an animal organ. However, the drug cyclosporine, introduced in 1979, inhibited foreign tissue rejection, dramatically increasing the patient survival rate in the early Eighties. Pig heart valves had been successfully substituted for failing human heart valves. Still, many medical experts preferred a corrective surgery procedure developed by Dr. William Norwood at Philadelphia's Children Hospital, which had a 40 percent success rate in transferring left ventricle functions in a hypoplastic heart to the right ventricle. But Dr. Bailey had his supporters, too, including Christiaan Barnard, the South African pioneer in heart transplant surgery.
Animal-rights activists were up in arms. People for the Ethical Treatment of Animals and several other groups demonstrated at Loma Linda University Medical Center. Interviewed by U.S. News & World Report, a North Carolina State University professor of philosophy complained that even "if animal-organ transplants were good for humanity, they are not good for the animals." The Seventh Day Adventist Church found the sacrifice of animal life for the sake of human survival perfectly acceptable. Other religious groups, however, disapproved of replacing a human heart with that of an animal on spiritual grounds.
Dr. Bailey hinged his hopes for Baby Fae on cyclosporine and the fact that an infant's immune system is not fully developed. The baboon heart gave Baby Fae twenty one more days to live, making her the longest surviving recipient of an animal heart. She died on November 15 when her kidneys failed and her heart stopped beating. Her funeral was a nationally televised event.
A few weeks later, listening to a tape recording of Mendelssohn while he worked, Dr. William DeVries installed a Jarvik-7 artificial heart into William J. Schroeder at the Humana Hospital in Louisville, Kentucky. But Schroeder wasn't the first patient to have his malfunctioning heart replaced by a machine. In 1982 a 62-year-old Seattle dentist named Barney Clark made medical history as the first permanent artificial heart recipient. His surgeon was also DeVries, who on that occasion listened to Ravel's Bolero during the operation. Clark survived for 112 days, dying of multi-organ system failure. DeVries pointed out that the artificial heart was just about the only thing in the patient's body still functioning normally when Clark died. The Food and Drug Administration (FDA) okayed another six artificial heart transplants. Was the device destined for general use? A 1982 study revealed that as many as 66,000 Americans annually could qualify for an artificial heart.
But how many patients could afford one? The Jarvik-7, made of polyurethane and aluminum, cost $9,000, while the 375-lb. drive system, attached to the grapefruit-sized device by means of two air tubes entering the body beneath the ribcage, cost another $7,400. (Dr. Robert Jarvik, inventor of the artificial heart, anticipated that in ten years a 5-lb. battery pack would replace the original drive system, allowing the patient much more mobility.) At the time of his death, Clark's hospital bill was about $200,000. The expense of such a procedure raised ethical questions. In 1972 Congress had added kidney dialysis treatment to Medicare; by 1983 the government was spending $2 billion annually for 82,000 kidney patients. It was estimated that Medicare benefits for 50,000 patients receiving artificial or transplanted hearts would cost $7.5 billion a year. Most commercial insurers refused to cover what they viewed as experimental procedures -- such as heart transplants. High-tech medicine's expensive experiments, as represented by Baby Fae and Barney Clark, forced medical experts and the public at large to debate the diversion of resources for the benefit of the few. Was it fair to other sick people to expend so much in order to prolong the lives of heart disease victims for a few months or, at best, a few years? (The heart transplant survival rate in 1984 was 80 percent for one year, 42 percent for five years.) One hospital administrator calculated that William Schroeder's hospital bill would pay for one week's full treatment for 113 "ordinary" patients. The cost of a liver transplant, averaging #135,000, would keep an inner city clinic open for a full year. Other critics decried the fact that thousands were dying for lack of basic medical care while precious healthcare dollars were poured into what they considered to be extravagant novelties. A Harris poll (January 1985) revealed that by a 55-41 margin Americans thought it would be better to spend the money on the many rather than the few. Nonetheless, Humana Hospital announced its intention to conduct twenty-five more artificial heart transplants at a cost of $1 million each.
Those who had a more positive view pointed out that much might be learned from such experiments. A number of important tests were run on Schroeder, who accepted his role as human guinea pig in hopes that future patients would benefit. And Barney Clark had similar hopes. "If I can make a contribution," he said, "my life will count for something." Proponents claimed that what seemed extravagant today could become commonplace tomorrow. An example often used to support this position was the cardiac pacemaker, which years earlier had been the target of the same kind of criticism leveled at Barney Clark's artificial heart and Baby Fae's xenograft during the Eighties.
By 1985 the FDA had decided to permit the use of artificial hearts only as a temporary measure in emergency situations until a human heart transplant could be performed. By that time William Schroeder had survived 42 weeks, but suffered two strokes. (He would die in 1986.) Two other recipients of a Jarvik-7 device also had strokes. Michael Drummond showed signs of a mild stroke days after receiving an artificial heart, his device was replaced with the heart of a motorcycle accident victim. By 1986 heart transplants were becoming relatively common; the number had increased from 36 in 1980 to 730 in 1986. More private insurers were covering the procedure, and about 80 hospitals performed them. The government agreed to fund 65 transplants a year through Medicare, at a cost of $5 million. The problem by the late Eighties was a shortage of donor organs.
The Artificial Heart
Working with a number of other researchers, Dr. Robert K. Jarvik developed this device in the late Seventies. It consisted of a pair of polyurethane ventricles which contained air chambers and six titanium valves. It was surgically attached to the patient's upper heart chambers, the auricles. In August of 1985, a Jarvik-7 device was implanted in Michael Drummond and kept him alive for a week until he could have an organ transplant. This was the first time an artificial heart was used as a "bridge" to transplantation.
Time, 23 August 1982, 13 December 1982, 12 November 1984, 10 December 1984, 17 December 1984, 16 September 1985
U.S. News & World Report, 12 November 1984, 24 November 1984, 21 July 1986
Louis Harris (New York: Random House, 1987)