When James Hardy, MD, led the historic heart transplant on Jan. 23, 1964, controversy overshadowed the medical milestone.

 

"The media attention was furious and intense," recalled Hardy's daughter, Katherine Little, MD, a gasterontologist in Dallas who was an elementary school student in the mid-1960s. "Daddy had no regrets about doing the transplant. The patient was desperate. But the criticism from the media and our peers was vicious. Many believed that if you transplanted the heart, you transplanted the soul. Even at school, we were aware that people were upset. As a child, it was difficult to understand why. Daddy would say, 'you can't always believe what you hear in the press.'"

 

The transplant patient was Boyd Rush, a deaf mute who lived alone in a trailer in Hattiesburg. A retired upholsterer with a history of heart disease, he had fallen from a chair while changing a light bulb and never regained consciousness.

 

"The team kept waiting for a human heart from a patient with a severe brain injury who was dying," said Little. At that time, stringent donor requirements did not allow the classification of death by the cessation of brain activity. Death was only determined after the heart stopped beating and the lungs ceased breathing. "Transplanting a human heart required having someone die practically on the spot. The (transplant) patient had no hope otherwise, and kept getting worse and worse to the point that it was either transplant or die."

 

Many people falsely believed Hardy alone made the decision to proceed. According to The World of Surgery 1945-1985: Memoirs of One Participant, Hardy wrote:

"The prospective recipient went into terminal shock at approximately 6 p.m., with a blood pressure of 70 and virtually without respiration except for the continued use of the mechanical ventilation through a tracheotomy tube. Death was clearly imminent and it was obvious that if heart transplantation was to be performed, it had to be done at once. The family gave permission for heart transplantation, and they understood that a human heart might not be available - for at that time it was not ethically acceptable to stop a respirator before the heartbeat had ceased. 

 

"The patient was rushed to the operating room, and his heart arrested. We began cardiac massage immediately and soon had the patient on the pump. Meanwhile, the tranquilized chimpanzee had been anesthetized. At this point, there was sharp discussion among the members of the transplant team. We were all well aware that any transplantation of a heart in man would be followed by public consternation and major criticism. We also knew that the use of a chimpanzee heart would augment the criticism immeasurably. It was a profoundly sober moment for all, and an agonizing moment for some. 

 

"Therefore, I polled each of the five primary members of the transplant team individually, and their votes were recorded. Four voted to proceed with transplantation, even though the chimpanzee heart had to be used. The fifth abstained."

 

The Hardy team did not transplant another heart until Jan. 6, 1969, when Russell Whitten of Marks received a human heart that was not beating, but was preserved with a cold solution. He died within 24 hours from a ruptured brain aneurysm.

 

"Hardy never said why these were the last transplants he attempted," wrote Janis Quinn in Promises Kept. "He doesn't mention them in either of his two autobiographies. He does say that the early 1970s were marked by hostility from faculty from other departments who told him quite openly they wanted him gone. He may have thought he needed a lower profile to survive the threat."

 

Little said she was bothered that Hardy wasn't given credit for the first heart transplant.