Helped by a Baboon's Heart, An Imperiled Infant, 'Baby Fae,' Beat the Medical Odds
11/19/1984 at 01:00 AM EST
She was identified as Baby Fae, her real name known only to her parents and her doctors. Even the exact date of her birth was obscured to protect the anonymity her parents sought. But after doctors late last month gave her a walnut-size baboon's heart to sustain her fragile link to life, all the world oohed, aahed and worried over Baby Fae. In videotape pictures the tiny, dark-haired infant could be seen yawning and squirming, blissfully unaware of the elation—and some misgivings—that her medical miracle caused.
The doctors who performed the pioneering surgery at the Loma Linda (Calif.) University Medical Center, operated by Seventh-day Adventists, never had any illusions about the risk inherent in a cross-species transplant. Only three times previously had the heart of a chimpanzee or baboon been transplanted into a human. None had kept the recipients alive for long.
The first occurred in 1964 in Mississippi, where Dr. James Hardy implanted a chimpanzee heart into a 68-year-old man; he died an hour and a half later. In 1977 South Africa's famed Dr. Christiaan Barnard performed a pair of cross-species heart transplants. He placed a baboon heart in a 26-year-old woman and a chimpanzee heart in a 59-year-old man. In both instances the donor hearts were used as auxiliaries to the patients' own hearts, which were not removed. The woman survived about four hours, the man three and a half days. Until Baby Fae, that patient had been the longest-surviving recipient of a nonhuman heart.
Despite the dismal record of past attempts, Loma Linda officials decided on what surgeons call "heroic measures" to save Baby Fae. She had been born three weeks prematurely, weighing 5.07 pounds. After her pediatrician noted that the infant lacked color, she was rushed from her home in Barstow, Calif, to Loma Linda, where her problem was diagnosed as hypoplastic left-heart syndrome, a congenital disorder in which the left half of the heart remains undeveloped. It is almost always fatal, usually within the first two weeks of life. According to Loma Linda University's doctors, one newborn out of 12,000 is afflicted with the lethal defect.
Heading the team of doctors who discussed the medical options with Baby Fae's parents was Dr. Leonard L. Bailey, 41, director of pediatric cardiac surgery at LLU's medical school. Aside from a transplant, the only other known option was the Norwood operation. Developed by Dr. William Norwood, now of Philadelphia Children's Hospital, it is a two-stage surgical procedure in which the right side of the heart is induced to take over the functions of the left side. Loma Linda doctors insist that Baby Fae's parents were "fully apprised of the risks and possibilities in both procedures." Ultimately, the parents chose a transplant and signed the consent forms.
Bailey's research has focused on heart transplants in dissimilar newborn animals. To help supply him with animal subjects, the Loma Linda medical center has its own half-acre animal-care facility, containing sheep, goats, pigs, rabbits and dogs, plus a special section for about 40 baboons. Over the past seven years Bailey has performed more than 150 transplant operations on animals, many between species. While he is highly experienced in open-heart surgery with children, none of his animal transplants prior to Baby Fae had involved human patients.
With the exception of transplanted pig or cow tissues in human cardiovascular surgery, efforts to exchange organs between differing species generally have failed. Yet Bailey reported some remarkable results. Some of his goat recipients of lamb hearts, for example, survived nearly six months. Behind the improving prospect is the recent availability of cyclosporin-A, an immunosuppressive drug that combats the body's natural defenses against foreign agents, leading to its rejection of transplanted organs. The drug was approved by the FDA only a year ago. Bailey performed early tests of it with animals, preparing for his historic operation last month.
Baby Fae, then about 2 weeks old, was wheeled into surgery at 7:30 a.m. Through the use of a heart-lung machine, her body temperature was gradually lowered from 98.6 to 60 degrees, thus slowing her body functions as an aid to the surgical team performing the delicate operation. At 9:15 a.m. Bailey left to remove the donor heart from a 7-month-old female baboon (named "Goobers"), which had previously been tested for a tissue match to Baby Fae. He returned 15 minutes later to begin the intricate procedure of removing the infant's heart and implanting the donor's. Slowly Baby Fae was warmed, and as she was weaned off the heart-lung machine her new heart started spontaneously. The operation took five hours.
Even as the stunning initial success of the Baby Fae operation captured the headlines, controversy flared. Bailey stated that the baboon's heart represented Baby Fae's "only chance to live," but that was put in doubt when UCLA's Dr. Paul Terasaki, director of the California Regional Organ Procurement Agency, reported that the heart of a 2-month-old infant had been available at the time of Baby Fae's operation. That report later proved incorrect. Nevertheless, Terasaki said, "I think that they [Loma Linda's doctors] did not make any effort to get a human infant heart because they were set on doing a baboon."
Bailey acknowledged, "Our entire research endeavor has been aimed at xenotransplantation [i.e., between different species]." This is necessary, he argued, because human donor hearts are not always available, and getting one for an infant at precisely the right time and place is usually impossible. Explained an associate, Dr. Theodore Mackett, "It would have to be the sort of case where an infant fell out of a crib and was declared brain dead but the heart was okay. Then all these tests would have to be done to insure a proper matching. With Baby Fae we had five days to do those tests, getting the best possible [animal] donor. With a human heart we might not have been able to keep it or the recipient alive."
Another contentious point was whether Baby Fae's parents had been fairly briefed on their options. An early LLU news release described the Norwood operation as having achieved only "limited success in newborns." Later, Dr. William Norwood said that about 40 of his 100 patients have survived the first, stabilizing stage of his two-procedure operation. The oldest is now 4 years old. Four children have undergone the second stage, usually done several years later, and two survive. Since Norwood moved from Boston Children's Hospital to Philadelphia last January, Boston's chief of cardiac surgery, Dr. Aldo Castaneda, and his team have performed 19 first-stage operations; eight of the children have survived. Given such possibilities, said Norwood, "I would rather use other options short of transplants."
Not surprisingly, the implanting of a nonhuman heart into Baby Fae raised the hackles of animal-rights defenders, and pickets appeared on the Loma Linda campus, 60 miles from Los Angeles, bearing signs that read, "Stop the Madness" and "Mixing Human and Animal Proteins Is Just Bad Science." Said Lucy Shelton, Southern California coordinator of People for the Ethical Treatment of Animals, "We have two major objections—first to the killing of a perfectly healthy, nonhuman animal, and second, we feel that doctors at Loma Linda are prolonging the suffering of the baby." Michael Giannelli, science adviser for the Fund for Animals, took a similar view. "I don't believe what was done was in the best interest of Baby Fae," he said, adding caustically, "It may have been in the best interest of Loma Linda doctors."
"We're not in the business of uselessly sacrificing animals," Bailey protested. A baboon was picked as donor, he explained, because of the similarity of its heart to that of a human, and its availability. Chimps, orangutans and gorillas, he said, "are either endangered species or don't procreate well in captivity." Bailey described himself as a "supporter of animal rights. But I am a member of the human species, and I have to deal with helping the human species survive."
Born in Takoma Park, Md., Bailey is a graduate of Columbia Union College in his hometown and received his medical education at the LLU School of Medicine, where he also completed his surgical internship and residency. Married to a former nurse, Nancy, he is father to two adopted sons (aged 4 and 5) and is publicity shy. Indeed, after granting just one press conference, Bailey all but vanished. Colleagues said he was "literally camped out in Baby Fae's room" to provide round-the-clock attention.
The medical center's intensive care seemed to be paying off. As Baby Fae passed through her first dangerous period of organ rejection, in the seven to 10 days after her operation, and was able to digest diluted nursing formula, medical experts grew cautiously optimistic. But Dr. James Hardy, head of the department of surgery at the University of Mississippi, was positively exuberant. "They're making history out in Loma Linda," said the doctor who attempted the first transplant of a simian heart into a man 20 years ago. "Every day she lives is a medical miracle."