Sir Terence English

I got involved in heart transplantation in a rather serendipitous way. I had been appointed cardiothoracic surgeon to Papworth Hospital at the end of 1972, and about two months later had a brief trip to America to see a great friend of mine who was working at the time for Norman Schumway in Stamford University. And while staying with Philip Caves, my friend, I saw a number of patients who were coming back for review, and others who’d been recently transplanted, who seemed to be doing very well. And it made me think that perhaps there was a need for a similar programme in Britain. Now at the time, there had been a moritorium placed on heart transplants by Sir George Godber, the Chief Medical Officer of Health. And that was understandable, in a way, because after Christian Barnard did his first case – it’ll be 50 years ago next December – surgeons all over the world started trying to do heart transplants, and the results were pretty disastrous. I think in fact that of the first 160-odd patients who had been transplanted in the years ‘68, ‘69 and ’70, there were only 10% of those alive at the end of two years.

I got my own big research grant to really study how best to preserve donor hearts after they’d been removed from the donor and before transplantation. And it went well. At the same time, in 1976, there was a very important development when the UK medical Royal Colleges and their faculties produced a report on the diagnosis of brain stem death, and equating that with death of the patient. So this meant that one was able to conceive of taking the heart out of a brain-dead patient who was known to be a donor, while the heart was still beating and in good order. And then it meant that we could look to getting donors from all over the UK and bits of Europe, in fact, and then bringing them back. And as I say most of my research work had been in trying to establish how long we could safely store a heart for. And we got up to feeling confident with at least 6 to 8 hours if necessary. If the heart was good to start with.

So by 1978 we were ready to go. We couldn’t get a donor for a long time. Eventually I did get a heart, in early 1979, in January. And the operation went well, I was … well, it didn’t go well, because what happened was, when I was in Addenbrokes taking the heart out, I was phoned by my anaesthetist to say that the recipient, who was very sick at the time, had had a cardiac arrest while he was being anaesthetised. And they’d resuscitated him as well as they could, and put him on bypass, but he said his pupils had gone up, and then come down again, but he couldn't be sure whether he’d suffered brain damage or not. So what did one do? It was a very, very difficult decision – I didn’t want to transplant a heart from a brain-dead person into another brain-dead person. But I knew that for the patient, if he
was ok, this was his only chance of survival, so I went ahead and did it.

Operation went beautifully, but he had sustained quite a degree of brain damage. He had to be kept on a ventilator, and he got an infection, inevitably, and died. And there was an enormous amount of criticism after that, both from the public, and from the profession. And indeed from the Transplant Advisory Panel.

However, I still had one more crack to go, and in July I managed to get another heart, and I used it for a man called Keith Castle, who wasn’t the ideal candidate: he was – remained – a heavy smoker, he had peripheral vascular disease, he had an ulcer, but he was a terrific character. He was a cockney builder from Wandsworth, and he was determined to show the world how good he was afterwards. And he lived for five years, and probably did more for heart transplantation in the early days than I ever did.

Just about then, Madgi Yacoub had started to do transplants at Harefield. And so the two of us were going, and fortunately, the people at Brunel University and in Cambridge agreed to do a very important cost-benefit analysis of the value of heart transplantation, working out the costs and the benefits and comparing that with other new technologies. And the result of that was very positive, and the report was published in 1984, now five years after I'd started, but it transformed our funding, because the Department of Health then funded Harefield and Papworth properly.