Baby Fae Loses Her Battle

The Baboon Heart Fails but a Doctor Defends the Transplant

Magazine article

By: Claudia Wallis

Date: November 26, 1984

Source: Claudia Wallis. "Baby Fae Loses Her Battle: The Baboon Heart Fails But a Doctor Defends the Transplant." Time 124 (November 26, 1984): 88-89.

About the Author: Claudia Wallis is a former managing editor of Time, the oldest weekly news magazine in the United States. Time was founded by Briton Hadden and Henry Luce of the Yale Daily News, the longest running daily college newspaper in America. It offers comprehensive and lively coverage of politics, economics, entertainment, medicine, and science. Time has a worldwide circulation of about 5.4 million and is distinguished by the red border around its cover.

INTRODUCTION

The first human-to-human heart transplant was carried out in South Africa by Dr. Christiaan Barnard (1922–2001) in 1967. The recipient was a middle-aged man. For infants, however, heart transplantation has always been more difficult. A baby's heart weighs, typically, about one ounce and is about the size of a walnut. An adult's heart would be too large to transplant into a baby and few babies die under conditions that make their organs suitable for transplantation. Nevertheless, the first human-to-human heart transplant in the United States was performed on an infant, using an infant donor. The surgeon was Dr. Adrian Kantrowitz (1918–) and the operation took place in New York just three days after Dr. Barnard's operation. Unfortunately, the child died soon after the surgery was performed.

For babies born with a congenital condition known as hypoplastic left-heart syndrome (HLHS), which affects one child in 12,000 born in the United States, transplantation would appear to be a good solution. The left side of the heart cannot work properly because of the malformation and it is common for infants with HLHS to die within a few days of birth. There is so-called palliative surgery available, but it is difficult and has a limited success rate.

Dr. Leonard Bailey (1942–) of Loma Linda Medical Center, California, had spent much of his career in pediatric cardiac surgery and had a special interest in HLHS. By 1984, transplant surgery had advanced to the point that he thought an animal-to-human transplant was possible and, indeed, desirable given the shortage of human hearts for infants. The drug cyclosporin could prevent the rejection of the new heart by the immune system. In addition, the infant immune system is not yet fully developed, making rejection less likely.

Xenotransplantation is the technical term for organ transplantation between species, such as from a baboon to a human. In the 1960s, there had been a few operations involving transplants of kidneys and hearts from baboons and chimpanzees to humans, but with little success. The species barrier created additional problems with rejection. However, by 1984, Dr. Bailey thought the time might be right to try a xenotransplant operation to treat a baby with HLHS. When "Baby Fae," as she was known, was born with the condition, her parents agreed to let Dr. Bailey and his team go ahead with a baboon transplant.

PRIMARY SOURCE

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SIGNIFICANCE

The Baby Fae case was controversial and there have been few animal-to-human organ transplants since that time. Bailey was accused by some medical and ethics experts of foolhardy experimentation and even child abuse. Animal rights activists complained of the sacrifice of a healthy baboon. There were questions, too, over whether a human heart transplant or palliative surgery might have been possible in this case. In short, had the parents and Baby Fae been exploited for the sake of pushing forward the boundaries of science? Many within the medical community did support the work, however, arguing there can be no advances without risk, and Baby Fae would surely have died without this intervention.

From a clinical point of view Baby Fae's case was interesting, since she survived for twenty-one days, which is longer than some recipients of human-to-human heart transplants survived at that time. Given that the latter is almost routine these days, thanks to advances in anti-rejection therapy and better understanding of immunology, perhaps xenotransplantation is now a feasible prospect? Scientists have been working to develop pig hearts for transplant, using genetic modification of the pigs to overcome rejection issues. However, there are still ethical and safety barriers to be crossed before those awaiting a transplant can be offered a pig's heart. Receiving an organ from another species may not be the main issue, since pig heart valves have been successfully transplanted into humans for some years now. With other organs, however, the risks have not yet been shown to be outweighed by the benefits.

The Baby Fae case may have done nothing, directly, to advance the cause of xenotransplantation. But it did have other benefits. First, it raised awareness of the tragedy of HLHS and led to further research. Second, more human-to-human heart transplants were carried out in infants. In November 1986, the Loma Linda team celebrated the first birthday of "Baby Moses"—the first successful newborn human heart transplant. Without Baby Fae it is unlikely that Baby Moses would have survived.

FURTHER RESOURCES

Periodicals

Donnelley, Strachan. "The Heart of the Matter; Using Primate Hearts as Human Heart Transplant Bridges." The Hastings Center Report 1 (January 1, 1989): 26-28.

Web sites

The Center for the Study of Technology and Society. "Today in Technology History." 〈http://www.tecsoc.org/pubs/history/2001/oct26.htm〉 (accessed November 5, 2005).

LLUMC Legacy. "Baby Fae." 〈http://www.llu.edu/info/legacy/Legacy3.html〉 (accessed November 5, 2005).