Advances in heart transplantation at Stanford saved thousands of lives

Lane Medical Library Archives

Norman Shumway and colleagues at Stanford perform on Jan. 6, 1968, the nation's first successful heart transplant on a 54-year-old steelworker.

The afternoon Elizabeth Craze was born 26 years ago, her parents held their breath.

'She is perfect,' the doctor told them.

But within four months, Elizabeth, like the four siblings before her, would be diagnosed with heart failure. Three had already died in infancy. The fourth, her older brother Andrew, would be diagnosed shortly after Elizabeth. It was thought to be a death sentence.

'I thought I would go absolutely insane,' said her mother, Susan Craze.

This was still the early days of heart transplantation surgery, especially for children. But there was no other choice for the Craze family, and the only place to go was Stanford.

'When I told my doctor in Cleveland we were considering heart transplantation, I can still picture him, backing up against the wall with just this look of horror on his face,' Susan Craze recalled.

Forty years ago in 1968, the late Norman Shumway, MD, and a team of doctors performed the first successful heart transplant in the United States at Stanford Hospital on a 54-year-old steelworker from East Palo Alto amid an uproar of controversy and a media frenzy. Proving the naysayers and skeptics wrong, the landmark operation has since become almost routine, saving thousands of lives around the world.

Courtesy of Craze family

Elizabeth Craze, at almost 3 years old, on the October night in 1984 before she became one of the youngest transplant patients.

'We both stood there and stared into this huge empty cavity for a good half a minute,' said Edward Stinson, MD, who assisted Shumway in carving out the diseased heart in that first transplant surgery. 'It was a fairly awesome sight. 'Do you think this is really legal?' I said.'

The goal from the beginning wasn't scientific experimentation but to save lives, said Stinson, professor emeritus of cardiothoracic surgery at the School of Medicine. To save lives like those of Elizabeth and her brother Andrew.

'It was in no way simply a stunt,' said Stinson. 'There was no denying there was controversy, but we could foresee what the potential was. The underlying ambition was always to improve the quality of life and to extend life.'

Transplant survivors and scientific experts in the field of transplantation will travel to Stanford Oct. 24 for a private symposium titled 'Looking to the Future: 40 Years of Heart and Lung Transplantation at Stanford University' to commemorate the event and to explore the future science of heart and lung transplantation.

Steve Fisch Photography

Elizabeth Craze, now 26 and an IT employee at Facebook, is celebrating this month the 24th anniversary of her transplant.

Among those survivors will be Elizabeth Craze, now 26 years old, an IT employee working for Facebook in Palo Alto who at the age of 2 years and 10 months was one of the youngest successful heart transplant recipients in the world.

'I think I'm more grateful about life than most people,' said Craze, dressed in red Keds and a gray 'Geeks for Obama' sweatshirt on a break from work. 'I get excited about the littlest things.'

Craze, who celebrated the 24th anniversary of her heart transplant operation this month, has taken medications all her life, struggled with the drugs' side effects that gave her hairy eyebrows during her teen years and resulted in a kidney transplant operation 10 years ago. But she looks and feels so healthy that friends are always shocked when they find out she's had a heart transplant.

'You wouldn't know there's a thing wrong with her,' said Susan, her mother, who moved the family from Cleveland to the Peninsula to be near Stanford in 1989. Elizabeth's older brother Andrew, 41, had the first heart transplant operation in the family, a year before Elizabeth when he was 16. Today he's a mechanical engineer living in Cleveland.

Because there was no Lucile Packard Children's Hospital at the time, both Andrew and Elizabeth received their new hearts at Stanford Hospital.

Heart surgery milestones at Stanford

1968 Surgeon Norman Shumway, MD, performs the nation's first heart transplant.

Early 1970s Medical school pioneers methods to preserve donated organs outside the body.

1972 Cardiologist Richard Popp, MD, pioneers the use of ultrasound to provide noninvasive images of the beating heart.

Surgeon Edward Stinson, MD, and Philip Caves, MB, FRCS, a visiting scientist, perform the first cardiac biopsy on a transplant patient, providing a better way to gauge the potential for rejection of a transplanted heart.

1978 Clinical fellow John Simpson, MD, PhD, develops over-the-wire angioplasty, simplifying the use of catheters to open arteries narrowed by atherosclerosis.

1980 Shumway and his colleagues establish the use of the drug Cyclosporine to lower the risk of rejection after heart transplantation.

1981 The first simultaneous transplant of both the heart and lungs is performed by Shumway and surgeon Bruce Reitz, MD. The operation is also the first successful lung transplant ever performed.

1984 Doctors develop and implant the first left-ventricular assist device and use it to keep a patient alive until a heart becomes available for transplantation.

Surgeons start doing pediatric heart transplants.

1992 Surgeons perform the first aortic repair using stent grafting.

1995 The first minimally invasive coronary artery bypass graft surgery is performed using the HeartPort procedure.

2004 to present Lucile Packard Children's Hospital is at the forefront of using an artificial pump, the Berlin Heart device, to keep toddlers and infants alive for months as they wait for a new heart to become available.

'My brother-in-law was the first to tell us about Stanford and how Dr. Shumway had continued the heart transplantation program even though so many medical facilities couldn't do it,' Susan Craze said. 'Stanford's team was just so on top of everything. It was amazing.'

Part of the success of the Stanford and Packard programs continues to be their multidisciplinary team approach to patient care, which includes nurses, social workers and physicians. Social workers and nurses committed themselves to Elizabeth's care after the operation, Susan Craze said. During the month-long recovery period, they worked overtime, took the girl trick-or-treating on the hospital ward and camped out by her bedside.

'We could foresee what the potential was for creating a multidisciplinary team approach to treatment,' Stinson said. 'The whole idea was to transform what was brand-new technology into routine therapeutics.'

Advancements in the years following that first successful operation paved the way for future patients. New developments were made, many emanating from Stanford, in anti-rejection drugs, techniques for predicting organ rejection and ways to care for patients after transplants. New laws would define death based on brain function rather than heart function so that beating hearts could be extracted from brain-dead patients.

'I remember harvesting a child's heart in North Dakota one night in 1986,' Stinson said. 'We preserved that heart for a good eight hours. It was a world's record at that time.'

Another heart procurement, this one carried out by Shumway, involved a homicide victim in Oakland. A defense lawyer claimed the death was caused by removing the victim's heart after brain death had been declared. The legal opinion helped clear the way for heart extraction from brain-dead patients. The defendant was ultimately found guilty, Stinson said.

In 1984, when Elizabeth Craze showed up at Stanford in need of a new heart, the primary question was whether a donated heart would continue to grow with her body. She was deathly ill and weighed only 23 pounds. An ethics committee was formed and, after listening to her brother's pleas, the decision was made to go ahead with the operation.

'It was difficult trying to find a donor,' Susan Craze said. 'It was really close whether she was going to make it another day.' On Oct. 8, 1984, the healthy heart of a little girl from Utah, the victim of a car crash, was transplanted into Elizabeth's chest.

'My parents told my brother and me we could have whatever we wanted after surgery. I asked for pink ballet shoes,' Elizabeth said. 'Andrew said he wanted the car. He got the brown Volvo.'

Susan Craze got her two children given back to her.

'I don't think I could have survived them dying,' she said.