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12B
i —FORSYTH COUNTY NEWS-SUNDAY, DECEMBER 4, 1987
YOU GET A WARM FEELING
WITH HOME FEDERAL’S
WOOD STOVE GIVE AWAY.
Enter Home Federal’s wood stove
give away! Be the winner of a pre
mium quality Jotul stove. Just come
in to any bank office and register.
Also, each branch office is giving
away two more prizes: a load of
firewood and a hand-forged wrought
iron fireplace tool set - beautifully
s' AV I \(, S BANK
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NO PAYMENTS UNTIL
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YOUR TOYOTA DISTRIBUTION CENTER
*6O MOS BUSINESS LEASE PLUS TAX ANO APPLICABLE FEE. 1 Vi Miles Outside 285 on Roswell Rd.
constructed by a well known
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The winners will be drawn on
December 23. So come on by, get
a juicy fall apple. Then register to
win from Home Federal, Northeast
Georgia’s warm and friendly bank.
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Transplants: The next 20 years
By Lawrence K. Altman, M.D.
New York Timas Wire Service
NEW YORK Transplant surgery in recent years has
started a revolution that eventually could rank with the
greatest in medical science.
“Surgeons in the 21st century will spend most of their
time replacing parts rather than removing them, as they
have for the last century,” said Dr. Keith Reemtsma,
chief surgeon at Columbia-Presbyterian Medical Center
and a transplant pioneer, as he reflected on a milestone
that took place 20 years ago.
It was on Dec. 3,1967, that Dr. Christiaan Barnard per
formed the first human heart transplant in Capetown,
South Africa, on Louis Washkansky, a 55-year-old grocer.
The technique he used had been developed in animal
studies by Dr. Norman E. Shumway and Dr. Richard R.
Lower at Stanford, and it remains the basic approach
today. Shumway’s Stanford team has now performed 473
heart transplants since 1968, more than any other center.
The post-revolutionary world will not be without prob
lems, though, including the need for wrenching ethical
decisions about who gets the limited number of available
organs. There also are concerns that the success rate
may have reached a ceiling. Heart transplant surgery,
however, still holds out hope for thousands of formerly
doomed people.
Organ transplants started long before doctors fully un
derstood the workings of the immunologic defense sys
tem. Because the body so often tries to reject implanted
organs, the transplants forced immunologists to learn
more about how the body attacks foreign tissues and how
it can be coaxed not to.
Already successful in varying degrees with transplant
ing kidneys, livers and lungs, surgeons are pushing into
new frontiers, such as working with animals on trans
plants of islet cells from the pancreas to treat diabetes.
And in humans, doctors are experimenting with implants
of patient’s own adrenal cells into the brain to fight Par
kinson’s disease.
But for many people, the symbol of the surgical revolu
tion remains the transplanting of human hearts. Only re
cently such transplants were considered daring proce
dures, but now they are almost routine.
Roger Evans of the Battelle Institute in Seattle estimat
ed that about 4,000 Americans live with someone else’s
heart. That number will rise as surgeons at 95 American
medical centers perform an estimated 1,6C0 to 1,800 heart
transplants this year.
By contrast, only five patients received permanent ar
tificial hearts all of whom have died. Perhaps 85 pa
tients have had artificial hearts implanted as temporary
“bridges” while awaiting human hearts.
Washkansky, the first transplant recipient, survived 18
days. Now, from 77 percent to 87 percent of transplant
patients survive at least one year, said Dr. Michael Kaye
at the University of Minnesota, and from 73 percent to 85
percent live five years.
The longest-living survivor, Willem Van Buuren, who
received his new heart at the age of 40 at Stanford, has
had a nearly uneventful course for almost 18 years. His
record was surpassed only by Emmanuel Vitria of Mar
seilles, France, who died last May at the age of 67, which
was 18% years after his transplant.
Transplant surgeons attribute their successes not to a
single breakthrough, but to several advances in several
fields. “It’s a medical revolution of which surgery is just
a part,” Reemtsma said.
One major advance was cyclosporine, a drug used ex
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perimentally in heart transplants in 1980 and licensed in
1983. It is now used in combination with other anti-rejec
tion drugs such as azathioprine and steroids.
Doctors have also learned to use smaller doses of such
drugs to cut the risk of sometimes horrendous side-ef
fects, such as kidney failure, bone damage and ulcers. In
addition, a new device called a bioptome allows doctors to
take tiny pieces of heart muscle to check for signs of
rejection, further limiting the use of the drugs to genuine
medical crises*
Still, a host of problems plague transplant surgery.
The most pressing is the need to find more donors. Ev
ans estimated that 12,000 Americans die each year of
heart diseases that would probably make them candi
dates for transplants. About one-third of patients on lists
as potential recipients of hearts die within three months
and virtually all within a year, he said.
As a result, many doctors believe society must find
ways to encourage more families of dying patients to sug
gest donation. Already some new state laws require doc
tors to discuss the possibility of organ donation with fam
ilies of dying patients. But, as Dr. Jack Copeland of the
University of Arizona in Tucson observed, it can be diffi
cult for doctors. He noted that physicians have “mixed
allegiances,” one to the family and the patient and the
other to gaining a donated organ for a different patient.
The doctor of a possible organ donor, he said, “wants
the family to believe he is doing everything he can to save
the patient, and a third party needs to enter the
situation.”
Some surgeons think they may have reached the limits
of success of heart transplants. They note that small
gains might be made if survival statistics from different
medical centers were compiled, spurring competition to
improve each hospital’s record. Additional gains might
come if training requirements were established and if
there were stronger controls on choosing recipients who
have the best chance of benefiting.
A controversial area is how many lives can be saved by
use of artificial hearts as bridges, keeping patients with
failing hearts alive until a human heart can be found.
Critics say this only changes who gets the hearts, not how
many will benefit.
Doctors, meanwhile, are using partial artificial hearts
called ventricular assist devices to help some patients. If
such devices become totally implantable, they may re
duce the demand for human hearts.
Another hurdle to further success is a puzzling condi
tion that many transplant recipients develop, forcing
some to look for another heart. Doctors debate whether
the condition is accelerated arteriosclerosis of the coro
nary arteries the clogging that results from deposits of
fatty substances or the result of severe rejection reac
tions. For now, researchers have no answer.
Deciding on the best use of a donor heart poses a dilem
ma. Is it to preserve the lives of the sickest, or to get the
most years out of every donor heart?
“If we were inclined to get the best result out of every
donor heart,” Copeland explained, “we would choose
only the best-risk patients for transplantation and ex
clude the sickest and oldest patients, and we could proba
bly approach 100 percent survival at one year.”
But most transplant surgeons believe they should try to
save the sickest patient, with the least stable getting the
first available heart, Copeland said, adding that “wheth
er that makes sense in a time of severe donor shortage” is
a point that “needs more public debate.”
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256-3392
1988 CRESSIDA
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