The longest-surviving heart-transplant patient in the world was Dr. Stuart Jamieson’s seventh.
In the 40 years since, the UC San Diego professor of surgery has placed living hearts into about 1,000 more dying patients.
Born in Zimbabwe, Jamieson, 71, worked at Stanford University under Norman Shumway, regarded as the father of heart-transplant surgery. Then he directed the Minnesota Heart and Lung Institute, where he performed the first heart/lung, double-lung and lung transplants in the Midwest.
Jamieson’s just-published memoir, “Close to the Sun,” explores the research labs and operating rooms he occupied when both he and transplantation surgery were young and developing.
Considering the serious subject matter, Jamieson was unexpectedly warm and funny — just like his book — during the following recent conversation in his UCSD office.
Why did you become a heart-transplant surgeon?
“Even as a child, I loved the idea of surgery. I loved the idea that you could fix people by operating on them. And as a 5-year-old, I remember operating on grapes. I’d take a knife, make a little incision, take out the pits and sew them up again. And when I went to London, to medical school, the most exciting thing about surgery was heart surgery. And then once I got into heart surgery, the most exciting thing about heart surgery was transplantation.”
How long can a person today expect to live with someone else’s heart?
“It’s somewhere below 70 percent survival at five years. Of course, with time, the survival rates have gone up and up. And these are people, remember, whose lifespans otherwise were measured in months. The longest surviving heart-transplant is a patient I did in 1979. He was 20 then and he’s 60 now.”
How hard is it losing patients? Do you mourn them or are you able to resist putting your psyche through that?
“Many people say, as a physician, you shouldn’t get too intimate with your patients, because if you have an adverse outcome, it’s going to affect you psychologically. And that’s probably true. But I’m old-school, I guess. Also, the vast majority of the time now, you have a very successful outcome, and that’s what makes being a physician and surgeon worthwhile. Also, I think you’re a better physician if you understand the patient, their background, their relationships with their family. That’s part of being a doctor. It’s not just understanding their heart, it’s understanding the person. And they don’t teach that in medical school anymore — although they should.”
How many patients will reject a transplanted heart?
“Most people, to some degree, do reject. But part of the secret of our success is the surveillance for rejection. So if you pick it up early, it’s easily treatable.”
What percentage of people who come to you hoping for new heart are you forced to reject?
“In the late ‘70s, when I was at Stanford — which was the only place doing heart transplantation successfully — if you were an alcoholic or drug addict, you were eliminated, because fundamental to the success was rigidly adhering to your medical regimen. And if you were divorced, you were eliminated because the theory was that you didn’t have somebody to remind you to take your meds and stuff. Well, pretty soon, all the faculty at Stanford got divorced, so that requirement went out the window. And the upper age limit was 55. And then, it went to 60 and 65. Now, we really don’t have an upper age limit. Nowadays, pretty much everybody who presents, who we feel will do well, we take.
But there are still fairly rigid criteria that are accepted internationally. The assessments of the patients are prolonged and complicated. It’s extensive medical and psychological assessment, because it’s not like taking a heart valve off the shelf. There’s really no downside to that. But every year in the United States, there are only 2,500 donor hearts. So there’s a certain responsibility, at least to the donors, that that precious resource is allocated wisely.”
What gets someone to the top of the donor list faster — being the richest or the neediest?
“I believe, ethically, nobody really would do that anyway. But it’s very tightly controlled by the Organ Procurement and Transplantation Network. Every potential recipient is listed on that database, and there are various degrees of severity. For instance, if somebody’s on life support, they’re going to take precedence, and that’s appropriate.”
Why do you think more people aren’t organ donors?
“We’ve struggled with this for 40 years. I’m not sure why. In Europe, they have what’s called implied consent. So if you die in Europe, you’re a donor unless someone says, ‘Excuse me, he didn’t want to be a donor.’ Here, it’s the other way around. And you can imagine that after a traffic accident or gunshot wound, you have a grieving family, and often, it’s very difficult to approach them about donation. But the way to look at it is that it’s one way of at least retrieving something out of an otherwise great tragedy.”
Does anything about the heart’s previous person travel along with the heart? Do people report feeling different or craving different foods? Is this a silly question?
“It’s a great question. I’ve got a whole lot of cartoons from 40 years ago, and articles in the ‘National Enquirer’ and stuff: ‘Nun got a go-go dancer’s heart and now can’t stop dancing.’ But there’s no basis for any of that. The heart is just a pump and that’s it.”
What motivated you to write your memoir?
“I’m a second-generation heart surgeon. The first generation was in the ‘50s and ‘60s, and the people they taught were my generation. I knew all the original pioneers, and they’re dead now. And I wanted to preserve their memory and what I knew about them. So I started to write about them. Then I realized that the best way to do it was to talk about my experiences with them. And it morphed into this memoir with my life weaving into the history of heart surgery and heart transplantation.
The very first open-heart surgery was done in 1952 on a 5-year-old girl named Jacqueline Johnson at the University of Minnesota by F. John Lewis. She was my age and she had a hole in her heart at the entrance chamber. Nowadays, that’s a very easy thing to fix. But, in order to fix it, you have to stop the heart, which they couldn’t do before 1952 because blood would come out and air would get in. Many years later, I went to Minnesota and took Lewis’ job. And Jacqueline Johnson and I became friends. And I write about our friendship in the book.”
What’s the most misunderstood thing about heart transplantation?
“I think many people still think of the heart as the seat of the soul. You know? I love you with all my heart. My heart bleeds. You’ve broken my heart. But it’s a pump.”
Dang! The next question was going to be how can you mend a broken heart!
“You know, we do have broken hearts. Sometimes, people with a big heart attack, that area of the heart muscle dies and the heart can literally burst. King George III died of a broken heart. At autopsy, the thing had just ripped apart. You usually die when that happens. But if it’s contained within the pericardial sac, you can sew it up again. So if you get a broken heart, come see me, I’ll fix it.”
How’s your own heart?
“I’m 71 now. I don’t take a single pill. When I remember, I take a tablet of aspirin, and I don’t remember that often.”
Does the expression ‘It’s not brain surgery’ ever make you feel like a second-class specialist?
“I’ve often been sort of amused by the idea that brain surgeons must be the top of the heap because they operate on the brain. But actually, without the heart, the brain’s dead. I’m not a brain surgeon, and I’m sure brain surgeons are wonderful people and very technically gifted. However, there’s that old story ... A heart surgeon goes to a garage and a mechanic is working on a motorcycle. He’s got the pistons and valves out and he says, ‘See, how easy this is? Why are you so much better because you’re a heart surgeon?’ And the heart surgeon says, ‘Try it with the engine running!’”