The Department of Second Chances

The cover of the September 17, 1971, issue of Life magazine read, "The Tragic Record of Heart Transplants." Nearly four years earlier, Christiaan Barnard, a South African surgeon, had made history at Groote Schuur Hospital in Cape Town by taking the heart from a 24-year-old victim of an automobile accident and implanting it in the chest of a 67-year-old grocer named Louis Washansky. Washansky lived 18 days with his new heart before succumbing to pneumonia.In the years immediately following this first heart transplant, hospitals around the U.S., including Johns Hopkins, rushed to copy the celebrated procedure. The surgery was not especially complicated: Connect the patient to a heart-lung machine, open the chest, excise the damaged heart while the machine kept the patient alive, suture in place the new heart, restart it, close the chest. The daunting complications came after the operation, when the patient's immune system did everything in its power to reject what it regarded as foreign tissue. Bill Baumgartner, Johns Hopkins Hospital's cardiac surgeon-in-charge, describes those days. "Everybody in the field was flying high in '68, '69," he says, "until they realized that all the patients were dying. You had a one-year survival rate of maybe 20 percent. It was dismal."Over the next decade, survival rates improved, but heart transplantation was by no means a routine procedure. In May 1985, a 33-year-old mother of three named Carolyn Kramer became the 27th patient to undergo heart transplantation at Hopkins. Kramer had given birth to her third child in December of the year before. Weeks after the birth, she began retaining fluids, coughing, and feeling short of breath. She thought she had the flu, but the symptoms persisted, then worsened. Soon she could no longer hold her infant daughter. The dire diagnosis was peripartum cardiomyopathy — a rare and mysterious condition in which pregnancy causes heart failure. Kramer's stretched heart muscle simply wasn't pumping enough blood to sustain her. She needed a new heart. The hospital quickly found a donor, and Kramer's transplantation surgery went smoothly. Then the real battle began. Her immune system repeatedly tried to reject her new heart.Read more at...Johns Hopkins Magazine, February 2007.