Bioethics Ch. 10

Was Christiaan Barnard glorified for conducting the first heart transplant at the cost of other great heart surgeons who laid the foundation?

Barnard became very famous after the transplant, leaving people like Shumway, who had been preparing and researching for years, to be lost in history. Barnard relished his fame and reporters and journalists loved him.

Did Barnard go too far in treating Washkansky against his will? What is the best example to illustrates that?

Barnard went too far in treating Washkansky, with Barnard forcing treatment on Washkansky. When Barnard tried to enter the sterile tent to reopen the tracheotomy hole for a respirator, Washkansky grabbed the sides to prevent Barnard from entering while saying "No, Doc.". Barnard replied with "Yes, Louis," and put Washkansky on a respirator.

In what way was Barney Clark a bad candidate to receive the first Jarvik-7? What kind of patient would have been an ideal candidate?

Barney Clark was a lifelong heavy smoker and had other diseases like emphysema. An ideal candidate would have been someone who did not smoke and did not have other conditions affecting their health.

Discuss the first human heart transplant that was carried out by Christiaan Barnard. What were the findings from this transplant?

Before he knew how to how to control rejection, Christiaan Barnard conducted the first heart transplant in 1967. He gave the heart of Denise Darvall to Louis Washkansky, who at the point of the transplant had a heart that was near total failure. The operation was "successful" and the heart began to beat. Washkansky would then die 18 days later, after complications due to the heart being rejected by his body. This proved that it was in fact possible to transplant a heart, even though the patient would not live for very long.

How did Clark's case symbolize controversies about the quality of life for heart transplant recipients, such as the definition of quality of life, clots, and the quality of heart valves?

Clark and other recipients would only get more clots the longer they lived. Was all the pain and suffering worth the days or months of living? Were they living or just prolonging death.

How long did Barney Clark live? What did The New York Times say about how long he "was dying"?

Clark lived for 112 days with an artificial heart. The Times dubbed research on the artificial heart "The Dracula of Medical Technology" and said that Clark experienced "112 days of dying".

Why was there a trade-off in treating Barney Clark's medical problems?

Clark was hooked up to many tubes to keep him alive: a breathing tube, a feeding tube, a catheter, and two hoses connected he Jarvik-7 thumping through his upper abdomen to the 375-pound air compressor at his bedside.

Why was it awkward for Christiaan Barnard to ask Edward Darvall for his daughter's heart?

Darvall had just learned of his daughter's death.

How did Jarvik and DeVries fare after Barney Clark's death?

DeVries struggled as a cardiac surgeon to receive patients and retired in 1999. In 2001 he joined the army and teaches at the Uniformed Services University of the Health Sciences. Jarvik Modeled and appeared in television ads. He eventually founded a small company developing a cardiac pump.

What was the criterion used to declare Denise Darvall brain-dead? Why did Denise's heart stop beating?

Denise Darvall was declared dead by whole-body standards. Denise's heart stopped beating because Barnard injected potassium into Denise's heart, paralyzing it and causing it to stop beating.

Who is Dirk van Zyl, and how long did he live with his transplanted heart? How do you think he feels toward Christian Barnard?

Dirk van Zyl was Barnard's 6th and longest living heart transplant recipient, living for 23 years. I would venture to guess that he feels grateful towards Barnard for giving him 23 years he might not have had without the heart.

Describe the cases of Jean-Michel Dubernard and Maria Siemionow. Were their transplants successful?

Dubernard performed a partial face transplant on Isabelle Dinoire who had lost he face because her dog bit pieces off after she tried to commit suicide with sleeping pills. The surgery was successful, and the new face looks like and moves like her old face. She died 12 years later. Siemionow performed a transplant of 80 percent of a face onto Connie Culp. Culp had tried to shoot herself with a rifle and blew her face off. The surgery was successful.

Who received the first hand transplant, and where was it performed? What were the unexpected problems with compliance by the patient? How did the case end? Who was the first American patient to get a hand transplant? How did the transplant affect him or her? Approximately how many hand transplants have now been performed in the world?

In France in 1998, Clint Hallam received the first hand transplant. Hallam stopped taking the medicine prescribed to keep the hand from being rejected by his body and didn't go to his required physical therapy. In 2001 Hallam had the hand amputated. The first American to receive a hand transplant was Matthew Scott. Scott had an amazing recovery, eventually being able to throw a pitch at a baseball game with the transplanted hand. Approximately 85 hand-forearm transplants had been completed around the world.

Why did most reporters not understand the problem of post-transplant psychosis and a low quality of life?

Most reporters lacked medical background and the public wanted medical miracles, not messy clinical details about psychosis. Reporters only focused on the symbolism: implanting someone else's heart into them, and they were blinded to the clinical realities.

Medicine almost uniformly has judged that artificial hearts are not cost-effective. Should society still encourage the use of artificial hearts or promote a healthier lifestyle?

Promoting a healthier lifestyle is not only cheaper, but more effective. We can reduce heart disease by doing things like raising taxes on cigarettes to prevent addictions from forming.

How did Robert Tools fare with the Abiomed artificial heart? What was the essential problem of titanium artificial hearts?

Robert Tools lived for 151 days with a titanium heart. The essential problem is that the heart is not tissue, and our bodies are designed to reject foreign objects.

In treating Washkansky, what trade-off existed between fighting rejection and fighting infection? Was it ethical on Barnard's part to risk Washkansky's death and wait for a definitive diagnosis?

Washkansky had a very rough 18 days and went through a lot of treatment to keep the organ from rejecting the organ. This treatment was extensive and had a lot of negative side effects. It was unethical on Barnard's part because Washkansky clearly suffered and wanted to end the experiment.

What problems developed while implanting the Jarvik-7 in Barney Clark?

When connecting the Jarvik-7's plastic ventricles, the pressure ripped out the stitches from Clark's paper-thin, arterial walls. When the cuffs held, the plastic left ventricle didn't pump blood. Three times DeVries had to open the ventricle by hand, each time risking introducing air into the blood and causing a stroke.

What is the controversy surrounding whether Christiaan Barnard should have done the heart transplant in the first place?

Why would he attempt a surgery that had a problem he hadn't solved yet, how to stop the body from rejecting the new organ. In most cases in animals and humans, transplants barely lasted a month.

After implanting the Jarvik-7, what were the problems faced by William Schroeder and Jake Burcham with regard to the quality of life?

William Schroeder had a cascade of strokes, repeated bouts of endocarditis, and eventually had a tracheotomy. Jack Burcham's chest was too small for the Jarvik-7, so his chest was left partially open after surgery and died 10 days later due to complications from the surgery.