British Medical Journal of the 12th August 2000 carries the exciting news item that the first artificial heart had been transplanted into a patient in terminal heart failure very successfully. The operation was performed in Jerusalem by an Israeli surgeon. The operation lasted for twelve long hours and the patient is said to have recovered after the operation to the satisfaction of all concerned. Of course, as usual, the patient did die after three and half days of the operation. “The patient died of multi-organ failure, but his implanted artificial heart was found to be functioning well right up to the time of his death! said the hospital spokeswoman.



Here is good news and bad news both together. Good news is that the device, the price of which is not mentioned, has been tested to be working in a human being for the first time. The bad news is that the patient died so soon after the surgery. One could blame so many factors for the death. In fact, the surgeon who operated went on record to say that the patient “ would have lived for a few hours only if the operation was not performed. His condition was such that he had one foot in his grave already.” How did this divine doctor come to know the exact life span of this poor patient is anybody’s guess? I am not aware of any medical scientific method of accurately predicting somebody’s death.



This new device is called Heart Mate II and is manufactured by a company in Pittsburgh, Pennsylvania, Thermo Cardiosystems. The company which originally devised the artificial heart was the Developing Artificial Organs Centre in Pittsburgh. It is a small device weighing only 350 gms. powered by a lithium battery. This device had been tried in animals earlier and it did show good working for long periods of time. Being a small device it does not replace the heart. It is in fact only a left ventricular assist device. It could be implanted in the abdomen to pump oxygenated blood through the left ventricle to all parts of the body. The other chambers of the heart work in tandem with the device. Since most heart failures basically are left ventricular failures this device could work like an artificial heart. Like the implanted pacemaker it could have life long power supply systems attached to it if it functions well inside the human body.



The unanswered question, however, is the reason why this device was not tried first in the USA? Dr. Jacob Lavee, the chief of cardiovascular surgery at the Sheba Hospital in Tel Aviv, claims that his selection as the world’s first surgeon to have done this feat is because of his training in Pittsburgh for an year in 1989-90, although there were many aspirants in Europe who wanted to be the first. I am sure Indian surgeons would have tried their best if they had a chance to be the first in the field.



Reporters asked surgeon Lavee as to why the US surgeons were shying away? His answer has all the hidden agenda in such situations. “The Food and Drug Administration in the US does not permit its use there unless they are shown that it works in at 30-50 human patients elsewhere.”



It is not out of place here to remind one of the first ever heart transplant in humans by Christian Bernard in South Africa. Dr. Bernard’s former mentor, Norman Shumway, at the Stanford University, was the one who perfected the original technique. Now that Bernard does not have much respect for his teacher, he does not admit that he climbed to fame riding piggyback on Norman. He claimed in one of his recent interviews with Dimbleby of the BBC that the original idea was that of the father of British cardiac surgery, Sir Russell Brock. Be that as it may, the truth still is that the first operation was done neither in the US nor the UK, but in far off South Africa; that too the donor heart came from a black man at the height of the Apartheid regime!



The crux of the matter is that all these new devices are being tested to see if they work in humans in countries other than the advanced West. This particular operators have been silent on the miserable state in which the recipient lived for the next four days in the intensive therapy unit. He must have been kept alive with the technology in a vegetative state to claim the success of the procedure. Even if one were to believe the story of the surgeons at the Sheba Hospital that the patient would have otherwise lived for a few hours but died four days later instead the fact remains that it did not do any good anyway! Operation successful but patient died is the usual story.



Terminal heart failure is a state in which many other organs are also badly compromised in their functioning capacity. With the earliest sign of heart failure, when the patient is still asymptomatic, there are many changes in the vital organs and other organ functions to keep the patient going on for a long time. If this compensatory phase gets upset and the person starts to get symptoms, the vital organs suffer all the more. By the time the patient reaches the terminal stage of failure, where such expensive devices are indicated, many organs that keep the man alive are as bad, if not worse, than the heart. No organ in the human body works in isolation to be easily replaced by a new organ or a device to get the owner back to normalcy. This statement applies to the heart all the more, as it is the pump that gives the life sustaining oxygen to every cell in the human body. The longer does the heart suffer in the state of failure greater will be the damage to all other organs.



That is the main reason why heart transplants and artificial devices in that situation would not be as useful as in kidney transplant for that matter. The latter could be transplanted to do its limited function and post-transplant survival there is much better. All the sophisticated technologies could only palliate and never cure the condition. The very concept of quick fixes like the one described above defeat the very purpose of medicine. The highest technology is that which eradicates a disease. More work needs to be done to see why people get heart failure in the first place and to find out ways and means of preventing heart failure if possible.



Another lesson that we learn from the present tragedy is that human being should be viewed as whole and not in bits and pieces. It is unfortunate that we still believe Rene Descartes when he wrote in the seventeenth century that he believes that since the body is divisible and the mind is indivisible, the mind and body are separate. This mind body dualism and the consequent reductionist science have been our biggest bane in medical science. The mother of all medical wisdoms, Ayurveda, looks at the human body as a whole and as a part of this macrocosm. More research in that area using the modern technological touchstone could solve more problems for mankind than the entire hi-tech put together. Said Karl Popper, a great thinker: “Knowledge advances not by repeating known facts but by refuting false dogmas.”



Sheba Hospital gets the first rank in artificial heart transplant surgery. When it comes to India you would read about the first hospital in your National dailies which bend over backwards to advertise such stories of news value. It is like the man biting dog story!