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50 years of heart transplants
Material posted: Publication date: 13-12-2017
3 Dec 1967, fifty years ago, South Africa hosted the first successful heart transplant. Dead heart in a car accident 25-year-old Denise Darvall was transplanted to a 55-year-old Louis Balkanskom. He lived only 18 days, but died not because of rejection by the body of the heart or failure of the new body, and from bilateral pneumonia. The second patient of the same surgeon lived for more than a year and a half, the third — more than twenty.

For fifty years the heart transplant is not considered fiction. Let us remember, thanks to whom people get a second chance at life.

The emergence of transplantation

By the beginning of XX century the world has been carried out the first successful transplant of organs, including humans. In 1905, a Czech doctor Edward Zirm used the cornea of both eyes of 11-year-old child to transplant a 45-year-old man. As a result, one eye could not be saved, and the second went to see for 12 years until the death of the patient. The cornea has no blood vessels, most often survives, but the most important in this case to consider the issue of preservation of donor material.

This problem was solved by Russian eye surgeon Vladimir Filatov: he began to transplant the cornea of cadavers and material for the operation were maintained for 1-2 days after the donor's death when the temperature is 2-4 degrees above zero in a humid chamber. The first successful operation of this kind took place in 1931. In addition, Filatov, together with the designer A. Marcinkowski developed tools that presented less risk to the lens and increased the efficiency of operations.

"Odessa is my only beacon
Some fights with the Mat and without a Mat,
And if you are in Odessa, beat out eyes
The eye will ustawic you Filatov."

                                  Odessa turns on the lights, E. Agranovich


Eye surgeon Vladimir Filatov at work

An important next step in the transplant was a kidney transplant. In Russia this direction was experimenting Eugene Chernyakhovsky. This surgeon only in 1903-1904 spent 554 operations on the abdominal organs, heart and blood vessels. In 1907 he experimented with kidney transplant, the animals, and talked about it in 1913: "the Experiences of kidney transplantation we were able, the vascular permeability was restored, but then the buds were gangrenization". In the 1920s he continued to experiment with his student Yury Black.

Yuri Voronoy in the 1930s at the III all-Union Congress of physiologists presented the dog with a transplanted her neck, the kidneys, which were functioning by that time more than six months. In 1933, Voronoy performed the first kidney transplant from a deceased human donor. Although the blood group of the donor and recipient do not match, the surgeon took the risk. Organ transplanted to the thigh, and he began to function. The patient lived two days. Important discovery of Yuri Voronoi was the possibility of using cadaverous of the kidney — the body, taken several hours after death. He found that this kidney after the transplant, "alive" and can function, what he wrote in the Italian scientific journal "Vіnervа Sys" in 1934.

Yuri Crow denied the opportunity to use the kidney, an important organ from a living person: "it is Impossible to put a deliberate disability healthy person, cutting his need for a transplant organ to the problematic of salvation of the sick". But today, such operations are carried out, and became the first successful kidney transplant one twin brother to the second on 23 December 1954. Richard Herrick with the authority that worked before in the body of his twin brother, Ronald, lived for nine years, married the nurse who cared for him during the Christmas holidays, and became the father of two daughters. In 1990, doctor Joseph Murray, who carried out this operation, received the Nobel prize.

An important question remained immunobiological factors, the authorities could cut off recipients. In the case of twin brothers immune suppression was not required, but it was the exception to the rule. In 1959, after the transplant from a postmortem donor who was not a relative of the patient, used body irradiation to suppress immunity — the result was 27 years of life after surgery for kidney transplant.

Our immune system protects the body from foreign cells, which can be as infection and foreign body. The development of immunosuppressive drugs has ushered in a new era of transplantation. The patients taking drugs to prevent rejection. A side effect of these drugs is obvious: the weakening of the immune system reduces the body's ability to resist infections.

image
Brothers Richard and Ronald Herrick

The first heart transplant

One of the founders of transplantation consider Soviet and Russian scientist Vladimir Demikhova. He conducted numerous experiments that have influenced medical science. In 1937, a dog with a mechanical device in the form of a motor pump instead of a heart lived for two hours and a half.

Vladimir Demikhov transplanted the dogs lungs, heart, liver, proving the possibility in principle of such operations. In 1946, he transplanted a second heart dog, and later completely replaced the heart and lungs. In 1954 he introduced the two-headed dog — head transplant with the neck and the front paws of the puppy to the adult dog. Twenty times he repeated this experiment, a record which was the month of life of such a being. His book 1960 "Transplantation of vital organs in the experiment" became the world's first monograph on Transplantology.

 
Vladimir Demikhov and dog with two hearts

In the 1960-ies began the race between several surgeons. American surgeon Norman Shumway of Stanford clinic successfully conducted a heart transplant dogs, some of which have lived up to six years. He created a method by which heart transplantation is performed today: he did not remove the heart completely, and left the upper part of the atrium together with the large veins that significantly reduced the time spent on the operation and its complexity. Norman has been waiting to carry out the operation on a human being. — he needed the donors.

Norman Shumway ahead of Christian Barnard, old buddy Minnesotsky University. Barnard has used the findings of Vladimir Demikhova, Norman Shumway and Richard lower. The surgeon had studied in the United States, and in 1960 and 1963 , came to the USSR to Vladimir Demihov.

The recipient was 55-year-old Louis Washkansky, who was admitted to the hospital, Groot Schuur, South Africa after three heart attacks. He agreed to the operation because in any case he only had weeks to live. Having problems with the donor: the political regime of South Africa was not allowed to use black heart. Previously this was a scandal by Barnard transplanted the kidney of a black citizen white. He was accused of experimenting on black. People one Louis Washkansky race was only 20% of the population. Even less with a suitable blood group. An accident on the road, which killed 25-year-old Bank employee Denise Darvall, gave Balkanskom chance of survival.


Louis Washkansky and Denise Darval

Denise's father agreed to the operation: "If you can't to save my daughter, you have to try to save this man".

The operation took place on 3 December 1967 and lasted about five hours. In the process it was noticed that the girl's heart, much less the heart of a recipient, but it is still operational. A few days later, Louis Washkansky was able to get out of bed, he ate, smiled constantly it came to journalists. He lived 18 days, and then died of pneumonia, enhanced suppression of the immune system to prevent rejection of the organ.

The next operation was more successful — Philip Bleiberg has lived for more than a year and a half. Dirk van Zyl after the surgery, in 1971, lived for 24 years. By December 1968, a year after the first surgery was performed nearly 100 heart transplants in the world.


The cover of the edition Life, December 1967: Christian Bernard and his patient, Louis Washkansky with the heart of a 25-year-old Denise Darvall

In the USSR the first heart transplant was carried out much later, in 1987. The USSR was not the donor centers. Valery Shumakov twenty years after operations in South Africa, together with colleagues tried to prove that brain death is human death, and that in this case, it should be sufficient grounds for the removal of organs to save other lives. In 1987, common sense prevailed, and the death of the Soviet Union started to accept brain death.

March 12, 1987 twenty-five year old Alexander Salikova with cardiomyopathy became the first in the USSR a patient who has undergone heart transplantation. The girl lived for more than eight years. "I think she could live today. But Shura did not accept one day in time put the pill to suppress rejection reactions. It killed ordinary negligence. This, unfortunately, happens. Not every human body can accept implanted in the body," told Valery Shumakov.


Surgeon Valery Shumakov and the patient Alexander Salikova, inspection after heart transplantation

One of the most famous patients of the research Institute of Transplantology and artificial organs named Shumakova was Vladimir Patkin, received a second heart in February 1992. At that time Patatino was 40 years, and in 2012 he celebrated the twentieth anniversary from the day of surgery. Donor organ he received from 27-year-old man. Already on the day of surgery Mr Patkin was able to sit up in bed and walk on my own two feet. Eighteen months later he took part in Canada in the World games transplants, and in 1994 received a bronze medal in the swim breaststroke for 50 metres to the competition among people with a transplanted heart in Finland.


Mr Patkin, 2012. RIA Novosti/Sergey Kuznetsov

One of the main enemies of the transplant, the time that should be spent looking for the right donor and the operation itself. Thanks to the experiments of Vladimir Demikhova and further development of the artificial heart today, patients can wait for a transplant long enough. Today, the market is, for example, the device SynCardia Freedom Portable Driver, the portable device that completely replaces the heart — although it is necessary to carry in a backpack. Such devices until clinical trials and are not commonly used.

When conducting operations using extracorporeal circulation — autojector. The first such devices were designed in 1926 in the USSR, scientists brukhonenko Sergei, and Sergei Chechulin. They experimented on dogs, but the first time such a device for open heart surgery was used in 1952 in the United States. It was a heart-lung machine Dodrill-GMR, who is himself a surgeon forest Dewey Dodrill developed with General Motors. In the USSR the first surgery with extracorporeal circulation was carried Alexander Vishnevskiy in 1957.


25-year-old Stan Larkin (Larkin Stan) held with the pump in the backpack for 17 months

Transplantation of heart has put before the scientific community and people new issues — religious, ethical, and legal. People mistakenly ascribe to the heart of emotions and often react more positively to death than to such interference in the life, "playing God". In the laws of different countries for the death was taken to be the time full stop of the human heart. Christian Barnard this definition was at least strange: he was a heart surgeon and in the course of operations, in this case, purposely killed, and then raised their patients. Laws, for example, was not allowed to take the heart of newborn babies without a brain who lived for more than two days, and use them to save lives of other newborns. To heart transplantation today has become almost common operation, needed changes in legislation and the introduction of accounting systems of donors.

Heart transplant today

For half a century, the patients get the hearts of the lost people thanks to the achievements in the field of transplantation. In Russia in 2014 was made 120 heart transplants in 2016 — 200. For comparison: in the United States for the year 2016 was held 3 thousand 191 heart transplant. According tothe chief freelance specialist of Ministry of health of Russia on transplantation, Director of the research center of Transplantology and artificial organs named after V. Shumakov Sergey Gautier, in Russia, this figure must raise a minimum of thousands per year.

Source: https://geektimes.ru/post/296313/


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