Part XIV- Dr. Leonard Bailey & Baby Fae – Standing on Tall Shoulders The History of Cardiac Surgery Thomas N Muziani PA-C, CP

Because I could not stop for Death…He kindly stopped for me…

The carriage held but just ourselves…And immortality

Emily Dickinson

28 July- 12 August 1984- The 1984 Summer Olympics, officially known as the Games of the XXIII Olympiad, were being held in Los Angeles, California. As a native Californian, raised in Burbank, a suburb of L.A., I marveled at the way the Los Angeles Olympic Committee had transformed a mundane megalopolis into a bright colored, ebullient city. Everywhere people were celebrating. At the foothills of the high desert, 60 miles from Los Angeles, a distinguished university went about business as usual.

Loma Linda University Medical Center was quietly preparing to make history. Stephanie Fae Beauclair (14 October 1984- 15 November 1984) was born with hypoplastic left heart syndrome. Historically, the best that parents of these little ones could hope for would be a quiet departure from this world. Dr. Leonard Bailey and the staff at Loma Linda were determined to offer a chance to live and thrive…

November 1984- With the completion of the donor panel, it appeared that the xenotransplantation was ready to go. It had come down to the day. Everyone knew that little Baby Fae was beginning to fail and closer to dying, so it was agreed upon they would proceed the next morning. Dr. Bailey and his group heard rumors toward the end of their preparation that some newspaper up in the high desert heard about the proposed procedure. No one knew how the leak had happened, but it did. The media staff at Loma Linda was able to placate the news people for the moment, until after the xenotransplant was completed. Fortunately, the pre-operative story stayed local and did not spread.

As Dr. Bailey explained; “We had done many of these newborn transplants in the laboratory; transplanting with a human newborn was just the next natural thing to do. I don’t recall being terribly nervous about it; I didn’t have much angst over it at all. Actually, I was at a restaurant in Redlands the night before with my wife, Nancy. We discussed the situation together a little bit- what the consequences might be. I didn’t have any idea of course what might happen, but we thought we should at least discuss it, and we did.”

“The next morning, I popped up and was down at the lab by about 6:00 in the morning. Howard Shattuck, our surgical assistant originally brought in from Johns Hopkins, was my right arm in the laboratory surgically, helping me with the transplants. So I had him on the other side of the table with me, as well as some residents.”

Dr. Bailey continues: “We gathered around the operating table. I brought the heart up from the lab. I remember taking the heart out and going up the back stairs and into the operating room. We had Baby Fae all ready. I arrived with the heart, we made the incision, and went to work. We’d done it so many times, although we’d never really worked with a hypoplastic left heart syndrome. It cast a slightly different nuance on the surgery, because the whole aortic arch had to be reconstructed as part of the process. We had dreamt of how it might go, but we’d never actually done it exactly this way in a baby.”

“We were blessed. It just turned out beautifully. Her response to the surgery was just perfect.”

“I expected some reaction to it. I remember what went on with Dr. Chris Barnard, for instance. It was like a three-ring circus in Capetown (South Africa).”

“I didn’t think that Baby Fae’s transplant would set off so many alarms. I thought there might be some regional interest, but the story became world news. That part of it was a little surprising. And it was a bit of a distraction- it did affect her care. We felt like we were operating in a fish bowl.”

Dr. Bailey continues: “Initially, Dr. Branson and others took over talking with the news people. Dr. Nehlsen-Cannarella and I, and our team were focused on Baby Fae. We were there day and night. We didn’t know exactly what to expect, and didn’t want to miss anything either, and so we were just there. And then of course, toward the end, it became heartbreaking- we were losing her and we didn’t quite understand why. Her heart was “gangbusters” still, and yet she was dying. We knew we hadn’t overdone the immunosuppression or anything like that.”

“Anyhow, she died and that was indeed heartbreaking. We invested a lot of time, energy and effort. We had gotten to know her family. I do not recall our institution (Loma Linda) ever being quite as unified on anything as over this little baby. We all wanted her to go further, and it was a major letdown. And then, of course, there were all sorts of second guessing, “Seventh inning” discussions that went on, some of which we tried to listen to with an objective ear and learn from. Some were just wild- show business, I guess you’d say.”

Dr. Bailey reflects: “The media frenzy finally boiled down to a simmer. It was an election year, and you hardly knew Ronald Reagan was being re-elected. This process was right at the same time. It nearly knocked him off the front page!”

“The hate mail and threats poured in for a long time, so much so that the Redlands police wanted us to let them open our mail and things like that. They were excellent. They were a great hometown police department. They just took over. Wonderful. We felt very secure. We had two little children, Conner and Brooks, who were quite impressed when the police came up to the house and gave us all lessons about how to take care of ourselves.”

“When we did the first allograft transplant a year later with Baby Moses (his real name was Eddie) wouldn’t you know there were several busloads of people who came out to picket the house. The Redlands police, stars that they are, only permitted these people to demonstrate in front of our neighbor’s house- I don’t think they were home at the time. Up on our property and in our house, there were officials from the police department guarding us.

“Just like Baby Fae, this first allograft transplant a year later was very serendipitous. It just so happened that Eddie was still in our hospital. An obstetrician from the Bay Area (San Francisco) called me and said: “I know what you did for Baby Fae. Are you still doing transplants, because I have a baby here with birth asphyxia, and the parents want the baby’s organs donated. Nobody else wants the baby organs except you.” I said: “Well, I think we do want that heart.”

“We talked to Eddie’s mom and dad. They wanted to move forward. They’d lost a baby the year before to heart disease. So we brought that donor baby down to Loma Linda and we performed what it turns out was the first successful clinical newborn heart transplant, done a year after Baby Fae. That hit the news too and went all around. I think initially the story received a life because people thought the heart was from another baboon donor. But then it took on a life of its own because he stayed alive. And for the next several months there was intense interest.

More important than the news- though that was vital- was the development of a donor base. Procurement agencies said: “Well, if Bailey’s really going to do this, we’d better get ourselves up to speed too.” So procurement agencies all around the country began to make something out of this human story that was out there. And people began to consider donating if their baby had birth trauma or brain death- they began to consider organ donation.

Postscript from the author;

• The general consensus as to the cause of death for Baby Fae was due to rejection caused largely by a humoral response against the graft, due to Fae’s type O blood creating antibodies against the type AB xenograft. The blood type incompatibility was seen as unavoidable: less than 1% of baboons are type O and Loma Linda only had seven young female baboons. – All of which were type AB.
• Many excerpts of this interview with Dr. Leonard Bailey came from accounts with the Loma Linda University Press in 2007. Mr. Jerry O’Brien, Dr. Bailey’s Chief Perfusionist for over forty years, provided invaluable anecdotes and information included in this article. My sole intent in writing this article was to provide a light on an individual and institution that accepted the majority of heavy lifting in creating what human transplantation has become today.