In December 1967, when Christiaan Barnard performed the first successful human heart transplant, it made front-page news all over the world and he became an instant celebrity. Today heart transplantation does not elicit the same wonder, but it is no less a miracle.
The heart, which by its nature supports all other organs, can breathe new life into a patient with irreversible end-stage cardiac failure. The transformation is quite breathtaking and the patient is literally reborn.
I was inspired to take up cardiac surgery as a young doctor when I witnessed a surgeon stopping the heart during surgery and reviving it after approximately an hour. I later came to understand how the technology of the extracorporeal circulation and the solutions to protect the heart allowed this phenomenon to happen.
But for me, way back in 1980, there was no turning back.
Eight years later I went to Phoenix, Arizona and Stamford, California to learn the techniques of heart transplantation, and was fortunate to spend some time with Norman Shumway, the father of transplantation. Soon after, with my mentor Steve Edmondson, we set up the unit and transplanted the first 22 patients at St Bartolomews Hospital, London.
Later on, as a senior resident at the University of Washington in Seattle, I performed further transplantation of hearts and lungs.
I came to Malta in 1995 to set up the local cardiothoracic programme and within 18 months we had performed our first transplant. The recipient was a 50-year-old man and he is still leading a fruitful and happy life 20 years on.
Transplantation of the heart is viewed as the ultimate operation. It requires a highly skilled team of surgeons, physicians, nurses, physiotherapists and pathologists, as well as an advanced hospital set-up in order to perform the surgery and nurse the patient through a complex post-operative course.
After a gruelling time, the smile on the face of the recipient of the new heart is overwhelming
The role of the transplant surgeon is pivotal in this entire process. Malta rose to the challenge and, over the years, we have transplanted 16 patients with an operative success of 88 per cent.
Eleven of the 14 operative survivors are still well many years after their operation. We also look after a young patient who underwent transplantation at Great Ormond Street Hospital in London. One of our patients recently received a kidney, making him the first local double organ transplantee.
Running a transplant programme means that one is on call 24/7 for any suitable heart that may become available. Foreign holidays may have to be curtailed and life stops for me for at least a week when I devote my whole energy to the transplantee.
The operation is long and complex as it involves coordination with foreign teams who travel to Malta to harvest the liver in a multi-organ donor operation. The death of a young donor, often in tragic circumstances, adds to the stress of the operation. But, after a gruelling time, the smile on the face of the recipient of the new heart is overwhelming.
Our latest recipient is a woman of 43 who has suffered from heart disease from the age of 18. She has been through many episodes of improvement, deterioration and disappointment, having been placed on the active transplant list only to come off it temporarily because of complications.
One can imagine the feeling of disbelief when her life was recently turned around after her long and arduous journey. In common with other patients she now tells me she has two birthdays.
Incidentally she is the second woman to receive a heart on our programme.
I am very proud of my team and it is certainly extraordinary for such a small country to have its own successful heart transplant programme. I hope that when I come to retire in about four years’ time my successor will take up this challenge. A surgeon’s life is certainly not easy, but the gratitude and friendship of patients makes it all worthwhile.
To end with Barnard: “Suffering isn’t ennobling, recovery is.”
Alex Manchè is a cardiothoracic surgeon.