Most mornings of late, John Bastardo goes out jogging. He logs only a couple of hundred feet—but it is good exercise for his new heart. The one he was born with failed 11 months ago.
At the time, a mobile cardiac unit sped the 49-year-old music teacher from his Elizabeth, N.J. home 35 miles to the Columbia Presbyterian Medical Center in Manhattan. There a team of doctors headed by Dr. Keith Reemtsma, 53, Columbia’s chief of surgery, took over.
During the first decade of the procedure, there were 345 heart transplant patients, of whom 79 survived. But in recent years most surgeons have stopped trying the difficult operation. “As soon as Barnard’s first operation was done,” Reemtsma explains, “there was a great deal of premature publicity. All over the world physicians capable of the surgical feat began doing the operation. The results were bad, and the field got a bad name.”
Techniques have not been static. Dr. Barnard, for instance, has inaugurated a new procedure, inserting an additional heart alongside the patient’s own defective one, with 50 percent success. In the U.S., heart transplants have been performed primarily at two centers, at Stanford by Dr. Norman Shumway and at the Medical College of Virginia by Dr. Richard Lower. Then in 1977 Columbia Presbyterian threw its prestige behind a third major center, set up by Reemtsma, who had joined Columbia in 1971.
“I felt our group could make a contribution,” he says. “We have taken patients on mechanical suooorts—a very high-risk group—and replaced their hearts.” The greatest hurdles have always been the body’s iron-willed rejection of foreign organs and the fact that the drugs which suppress that rejection also impair the body’s defense against disease.
A team effort is required. “Heart transplant surgery,” Reemtsma observes, “is not just one surgeon in the operating room who does it whiz-bang. The operation is the moment of drama, but it is the long care by the cardiologist, the nursing staff and others that makes this effort successful.”
Reemtsma took seven years to build his transplant team. Now he awards members symbolic gold pins depicting the classic Greek chimera (a lion’s head joined to a goat’s body with a serpent’s tail); many of the 200 or so proud wearers never set foot in an operating room.
Reemtsma’s team had done nine transplants since February 1977; four of the patients were being artificially maintained by booster pumps. Two recipients are still alive. He foresees an expanded use of mechanical systems in the future to support the patient until a donor is found.
The surgeon notes that a calf has lived for six months with a mechanical heart. But he is not yet willing to transplant an animal heart into a human, though in 1963, while affiliated with Tulane University, he proved that a patient could live for a while with transplanted chimpanzee kidneys. (He wheeled the chimp into surgery covered with a human-size surgical gown to minimize curiosity in New Orleans’ Charity Hospital.)
That feat introduced Reemtsma to the media, including Judy Towers, now 42, a New York TV producer on the medical beat. “I was also brand new,” she remembers, “and he was the first doctor who was ever nice to me.” They were married in 1972 and now live in a duplex overlooking Manhattan’s Central Park. He has two grown sons by a first marriage.
Raised on a Navajo reservation in Fort Defiance, Ariz., where his father was a Presbyterian missionary, Reemtsma went to college at Idaho State under a Navy-sponsored program. He was offered the choice of training as a doctor or a chaplain. “I knew goddamn well I didn’t want to be a chaplain,” he remembers, so he went on to U. of Pennsylvania School of Medicine and later served as a doctor with the Marines in Korea.
There are moments that prove the wisdom of his decision. One is a successful operation: “Transplants are the future,” he says. But he also receives support from unexpected sources. During an audience in Rome last September he heard heart transplant work enthusiastically praised by a medical layman. The admirer was Pope John Paul I.