The 20th century is remembered as a time of extraordinary scientific advancement. Leading nations not only actively exchanged knowledge but also resorted to various strategies in attempts to surpass their rivals. The medical competition between the USSR and the USA was as intense as the space race. Numerous medical professionals across the globe were striving for breakthroughs in transplantation. In the Soviet Union, a significant amount of research on organ transplants—kept secret from the West—was conducted at Moscow State University. The renowned Vladimir Demikhov was at the forefront, conducting several experiments involving dog head transplants. These operations, along with others, are discussed in the book by cardiothoracic surgeon Stephen Westaby titled “Surgeons, Saints, and Psychopaths: The Story of Medicine.” “Lenta.ru,” with the permission of the Bombora publishing house, presents an excerpt from the text.
1While the West remained unaware, a considerable amount of heart transplantation research was being carried out at Moscow State University. The outstanding Vladimir Demikhov began his experiments in the 1940s, though they were interrupted by the war.
His initial concept was to use a donor organ as a supplementary pump within the chest rather than removing the patient’s diseased heart.
He conducted over 250laboratory transplantations, experimenting with various methods
The dog named Borzaya lived the longest, having received a second heart transplant on October 4, 1956. The dog led as active a life as possible under laboratory conditions until it died on the 32nd day post-operation due to the donor heart's fibrillation.
Demikhov lacked ICU facilities, and he was concerned that the time taken for numerous vascular anastomoses often resulted in brain damage. Ultimately, he changed his approach and, with remarkable ingenuity, began transplanting the heart and lungs as a single unit.
2The dogs lay side by side on the operating table, and Demikhov utilized rubber tubes and temporary connections to achieve his objectives without interrupting blood circulation in the animals and the donor organ.
In 1951, after 67 attempts, he achieved six-day postoperative survival in a dog named Damka.
Although the results were astonishing for that time, other aspects of his experiments were questionable and angered many who learned about them.
He conducted a series of head transplant operations on puppies onto the necks of adult dogs.
Within minutes, the transplanted heads began to respond to environmental stimuli and drank water when thirsty.
Demikhov also succeeded in transplanting a head so that it was a continuous extension of the spine, allowing all four legs to perform running movements.
3The maximum lifespan following these bizarre experiments was 29 days, but afterward, Demikhov transplanted the entire gastrointestinal tract, including the pancreas and liver, and then the entire lower half of the body.
While his efforts represented a surgical achievement, they contributed little to science, as Demikhov lacked a method for suppressing the immune response in recipient animals. These were experiments of the “Why? Because it exists” type.
In 1960, Demikhov published a book that made his work accessible to researchers and even the general public in the West. David Whitley, then a medical student from Cape Town, recalled how he saw an article about Demikhov's head transplants in the Cape Argos newspaper while in the surgeons' locker room at Groote Schuur Hospital. Someone mentioned the article to Christiaan Barnard, and he was clearly upset. Barnard rushed out of the room exclaiming:
“Whatever those Russians can do, we can do too!”
That same day, Barnard performed a dog head transplant in his laboratory, and the dog lived for several days, seemingly conscious.
The sensational news stirred the ranks of animal rights activists. Medical students crafted a two-headed dog from papier-mâché for a student society parade, and in the university's eyes, Barnard had stepped onto thin ice between genius and vulgarity.
4By the late 1950s, Webb and Howard applied Melrose's cardioplegic solution to excised dog hearts, which were stored at 4°C for several hours before being transplanted. They speculated that if human heart transplantation ever became a reality, donor organs would need to be transported over long distances, necessitating ample time to access the heart, prepare the patient, and perform the surgery.
In 1959, Donald Ross and Sir Russell Brock from Guy's Hospital described six different techniques for removing a heart and transplanting it into a recipient. Their work was significant as it introduced the principle of separating the heart from the vena cava and pulmonary veins by simply incising the walls of the left and right atria. This allowed for the formation of wide cuffs at the right and left atria, making it the first method to reduce the need for labor-intensive individual connections between donor and recipient veins to two large cuffs instead of six small anastomoses. (...)
(...) The following year, Richard Lower and Norman Shumway from Stanford, California, published a crucial article that combined optimal transplantation techniques and the best methods for preserving donor organs into a comprehensive approach. All eight dogs subjected to it survived the surgery while connected to the ICU.
Five of them lived from 6 to 21 days and recovered sufficiently to eat and move normally. However, no immunosuppression was applied, and the test animals soon died from transplant rejection.
Microscopic examination of the transplanted hearts revealed significant lymphocytic infiltration, or white blood cells, which is the basis for acute rejection. Lower and Shumway predicted that if the destruction of the donor organ by the recipient's immune system could be halted, the organ would likely last for the recipient's entire lifetime. This prognosis was undoubtedly optimistic, but optimism was certainly necessary in this hostile, skeptical environment.
Lower became a professor of cardiothoracic surgery at the University of Virginia in Richmond, where he successfully applied another immunosuppressant—methotrexate. Many dogs lived over a year without transplant rejection, which was an incredible achievement at that time. One recipient dog even gave birth to puppies from a dog that also received a heart transplant. Adrian Kantrowitz from Maimonides Hospital in Brooklyn performed transplants on three-month-old puppies using hypothermia.
One of the puppies lived for 213 days without immunosuppression, an unexpected result due to the immunological incompetence of the young. Kantrowitz proved that the transplanted hearts grew steadily at the same rate as those in normal animals. Moreover, samples from adult subjects obtained at autopsy showed no signs of lymphocytic infiltration. However, when he attempted to repeat the experiments using the ICU, all animals died.
This was primarily attributed to blood damage from interaction with foreign surfaces, but the experience instilled optimism in Kantrowitz regarding transplants in infants with congenital heart defects.
Science advanced; by the 1960s, the ICU firmly entered surgical practice, cardioplegic solutions were refined, and intensive care units developed skills in cardiological postoperative care.
Thousands of dogs lost their lives, but why did no one dare to take the giant leap and transplant a heart into a human? There was one significant and rather obvious obstacle.
Someone had to die first and donate their precious heart, but the logistics in this case remained problematic. To put it mildly.
(...)
(...) In South Africa, life and death were indeed simpler. The law allowed for organ retrieval if the donor's death was confirmed by two doctors, one of whom had over five years of experience. Neither of them were to be part of the transplant team. There was no detailed definition of death, so the concept of irreversible brain damage was permitted. In this respect, the legal procedures related to organ donation were much more liberal in South Africa than in the USA. Permission had to be obtained either from the donor's relatives or from the coroner.
It should be noted that I had extensive knowledge of the circumstances surrounding that transplant thanks to Christiaan Barnard himself, with whom I was well acquainted, and members of his team who were present that night in the operating room. On the 50th anniversary of this event, many years after Barnard's death, the BBC asked me to create a program about the circumstances of the operation, and I was able to contact all the participants who were still alive. Thus, my version is based on the accounts of those involved rather than what was written about the event.
The recipient, Louis Washkansky, was a 54-year-old diabetic who had previously suffered three heart attacks, had irreversible damage to his left ventricle, and was experiencing severe heart failure. All traditional treatment methods had been exhausted, but several weeks earlier, Barnard had approached his cardiologist, Professor Shrir, to look for potential candidates for heart transplantation. Washkansky's angiogram was even sent to the Cleveland Clinic to place him on the waiting list for coronary bypass surgery, but after receiving a refusal, Shrir decided to propose Washkansky to Barnard.
He set only one condition—find a white donor. This was due to negative media coverage