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A Baby, a Baboon Heart, and the Transplant Heard Round the World: The Story of the First Neonatal Cardiac Xenotransplant in History

In 1984 surgeons put the beating heart of one species into another and it worked, even if only for a short while, and the boundaries between animal and human would never be quite the same.
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The year 1984... a year that is synonymous with cultural turning points. Apple introduced the Mac personal computer. NASA launched the space shuttle Discovery. The year George Orwell imagined in his dystopian novel 1984 predicted a future that was filled with political correctness which he called "Newspeak," and governmental surveillance he made famous with the phrase, "Big brother is watching you." The spot-on predictions are numerous, yet he did not go so far as to predict that in 1984 the medical establishment would break new ground and transplant a baboon heart into a human baby.

Stop and take in the enormity of that last statement. In 1984 surgeons put the beating heart of one species into another and it worked, even if only for a short while, and the boundaries between animal and human would never be quite the same.

Stephanie Fae Beauclair, better known to history as Baby Fae, was born October 14, 1984 with hypoplastic left heart syndrome. Hypoplastic left heart syndrome is a fatal condition in which the left side of the heart is severely underdeveloped. Baby Fae needed a heart transplant to survive but a human heart was not available to her. What happened next challenged the boundaries of medical science and bioethics.

Animal to human transplants had been attempted as early as the beginning of the 20th century. In the mid-1960s, Dr. Jim Hardy at the University of Mississippi, in Jackson, had transplanted a chimpanzee heart into a patient with terrible heart disease whom he couldn't wean off the heart/lung machine. The chimpanzee heart sustained the man's life for under an hour but he did not survive the operating room. When they performed an autopsy it turned out that the aged chimp who had served as the donor had been suffering from severe coronary artery disease and the transplant had been a poor trade. However, the results of the autopsy begged the question, what if the chimpanzee heart had been a healthy one... could it have worked?

Twenty years later Dr. Leonard L. Bailey of Loma Linda University Medical Center and his team decided to try to save Baby Fae's life by following in the footsteps of Dr. Jim Hardy and transplanting the heart of a non-human primate into the chest of an infant girl.

But where would they find a heart? Dr. Bailey quickly learned that a chimp's heart wouldn't work. Neither would a gorilla's or an orangutan's as they were all endangered species. However, baboons were not only not endangered they were the rabbits of the primate world in terms of their ability to breed rapidly. Furthermore, 80% of the DNA in a baboon is identical to that of a human being.

The transplant was scheduled. The procedure was a success. For three weeks Baby Fae lived with the heart of a baboon beating in her chest.

Unfortunately, she ultimately died on the 15th of November, 21 days after the surgery due to organ rejection. The rejection was probably caused by the differences in blood type. The blood type incompatibility was seen as inevitable as Baby Fae was type O and fewer than 1% of baboons are type O. But, it was hoped that either her neonatal immune system might be so undeveloped she could accept the organ for a considerable amount of time or that the transplant could be replaced by a human heart at a later date. However, a suitable donor could not be found in time.

The procedure was subject to a wide ethical and legal debate, but the attention that it generated is thought to have paved the way for Bailey to perform the first successful infant allograft heart transplant a year later. The Baby Fae case, and Dr. Bailey's role in it, has been a popular case study in the realm of bioethics. There were questions as to whether parents should be allowed to volunteer children for experimental medical procedures, and of course many religious groups and ethical traditions have questioned the morality and ethicality of sharing organs between species. But philosophical debates aside, there was an economic aspect to this case that cannot be ignored. Baby Fae's mother had no medical insurance, thus she could not afford to pay for the heart transplant procedure. The xenograft, on the other hand, was offered free of charge.

Charles Krauthammer, writing in Time, said the Baby Fae case was totally within the realm of experimentation and was "an adventure in medical ethics." The case further brought up debates regarding the risk/benefit ratio that should be considered ethical when dealing with experimental procedures on human subjects. Ultimately, the American Medical Association and medical journals criticized Dr. Bailey, concluding that xenografts should be undertaken only as part of a systematic research program with controls in randomized clinical trials. It seems fairly easy to criticize after the fact when the results are not optimal. But, Dr. Bailey's pioneering efforts have ultimately led to many infant transplants that have been successful.

Although Baby Fae's full name was not made public at the time of the procedure, her mother chose to reveal herself in 1997. One man who did know the true identity of Baby Fae was Dr. Jim Walters, noted bioethicist and professor of religion at Loma Linda University who wrote about the case at the time for the Hastings Center Report. When called recently to comment on this chapter in history and his view on the actions of those involved he said, "Although some may question whether the Bailey team had a sufficient scientific basis, as one who was close to the situation at the time, I applaud the team's noble intent in a desperate situation."

The procedure brought forth worldwide commentary and not just from the medical community. While the scenario of a baboon heart in a baby may not have found its way into the pages of George Orwell's work, another artist immortalized the moment in time in the lyric of a song. Paul Simon in his song "The Boy in the Bubble" from the 1986 Graceland album sings the words, "Medicine is magical and magical is art / Thinking of the Boy in the Bubble / And the baby with the baboon heart."

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