THENEWYORKER,FEBRUARY28, 2022 21
The cold pig heart was delivered to
the operating room. “Some people like
to blast music in an O.R., but I like to
hear pins drop,” Griffith said. “I like to
hear the sound of the heart-and-lung
machine.” Griffith estimates that he has
performed more than a thousand heart
transplants, but this one called for a dif-
ferent start: before he made the first in-
cision, he suggested that everyone pause
for thirty seconds to “think about what
this man is entering into.” He described
the transplantation as an opportunity to
learn. Griffith told me, “We don’t usu-
ally take a moment like that. But I think
it relaxed everyone. And then we went
to work.” The process of transplanting a
heart is both brutal and precise. An eight-
inch incision is made in the chest. The
breastbone is cut in half with a bone saw.
The ribs are opened outward to expose
the heart. One large vein and one large
artery are connected by tubes to a car-
diopulmonary-bypass machine; a third
tube washes the organ with a heart-stop-
ping fluid. That’s the beginning.
The human heart being replaced was,
of course, an ill one. It was dilated from
being unable to pump properly. The car-
diac chambers to which the pig heart
would be attached were large. The team
had to stitch the small “O” of the pig
part to a much larger “O” on the hu-
man’s. Griffith was accustomed to mak-
ing modifications, but less drastic ones.
When he first pulled the pig heart out
of its container, it looked small and pale.
“It had an opaqueness that was off-put-
ting,” he said. “I wondered, Did we do
something wacky?” He connected the
pig heart to the patient’s vessels. He re-
leased the clamp, allowing human blood
to flow into the organ. “It was as if we’d
turned on a light. And it was a red light.
The heart just brightened up. And it
went from trembling to pumping.” He
demonstrated the movement with his
hands. “Hearts don’t just squeeze when
they beat, they kind of twist, and this
heart—it was doing the hoochy-coochy.
It was one of the best hearts I’ve ever
seen after transplantation.”
A
n Irish tale tells of a ruler who loses
an arm in battle. Once maimed, a
king cannot rule. But a doctor shows up
at the king’s door. The doorkeeper, who
is half-blind, won’t let him in. The doc-
tor replaces the doorkeeper’s blind eye
with a cat’s eye, curing his sight. The
doctor then replaces the ruler’s missing
arm with a swineherd’s. The doorkeeper
with the cat’s eye is said to stay awake
at night thereafter, looking for mice.
Have our feelings about the extraor-
dinary weirdness of transplants changed
much over the centuries? The history of
transplantation has its horrors. In eigh-
teenth-century England, the poor would
sell their teeth; the rich would have those
teeth implanted. A reasonably eminent
twentieth-century scientist transplanted
second heads onto dogs. The physician
Charles-Édouard Brown-Séquard was
thought by his neighbors to be a sor-
cerer; his back yard had chickens with
rats’ tails affixed to their heads, and other
mutilated and altered creatures. Brown-
Séquard made serious contributions to
the field of neurology, and a syndrome
is named for him, but he may be better
remembered for having claimed, at the
age of seventy-two, that injecting him-
self with parts of dog and guinea-pig
testicles had sexually revived him. For a
few decades, “gland grafting” was all the
rage, especially in France.
In 1906, a French physician had two
patients dying of kidney disease; he gave
one a goat kidney and the other a pig
kidney. Both kidneys lasted three days.
It was years before even those dismal re-
sults were matched. Doctors were work-
ing without any substantial knowledge
of the human immune system and its
role in accepting or rejecting transplants;
it was as if one were trying to treat dia-
betes without knowing about insulin.
Transplanting human parts (other
than teeth and patches of skin) didn’t
really get going until the middle of the
twentieth century. How could fresh or-
gans be ethically obtained? A kidney,
unlike a heart, can be taken from a
living donor, and kidney transplants de-
veloped earlier. The first kidney trans-
plant with long-term success was per-
formed on the identical twins Ronald
and Richard Herrick, two days before
Christmas in 1954, by Joseph Murray,
in Boston. Richard, the recipient, mar-
ried one of the nurses who had cared
for him; Ronald, with just one kidney,
lived another fifty-six years. Murray per-
formed kidney transplants in non-twin
subjects for the next ten years, but the
patients didn’t do well. It was only with
the advent of effective immunosuppres-sants that transplants began to work
consistently. In 1990—thirty-six years
after the twin transplant—Murray re-
ceived the Nobel Prize in Physiology
or Medicine.
More than twenty-four thousand
kidney transplants were performed in
the United States in 2021, and more
than three thousand eight hundred heart
transplants. These surgeries are consid-
ered routine, and outcomes are gener-
ally very good. The median survival
time following a heart transplant is
about twelve years; for kidney trans-
plants, that number is nearing twenty
years. In the U.S., there are typically
more than three thousand people wait-
ing for a heart and more than ninety
thousand people waiting for a kidney.
The development of the Uniform Donor
Card in the U.S., a legal document that
was recognized in all states, made organ
donation more straightforward, and the
1984 National Organ Transplant Act
established some legal ethics for the
field, prohibiting the sale of organs and
providing a framework for trying to
distribute organs fairly.
In the U.S., as of 2019, the rate of
opting in to organ donation is around
fifty per cent, though ninety per cent
of people express support for the idea.
In some countries, people have to opt
out, rather than opt in. Spain has been
a global leader in organ donation for
decades; in addition to having an opt-
out system, it trains professionals in
talking to families about organ dona-
tion. Croatia adopted a similar model
and raised its donation rate to one of
the highest in the world. Japan has one
of the lowest rates of organ donation,
a situation attributed in part to gotai
manzoku, a belief that the body should
be intact. This idea connects to a fear
that, if a corpse is cremated without all
its organs, it cannot be properly put to
rest. Some Japanese stories feature a
ghost whose head is separated from its
body, and this is sometimes interpreted
as a disturbed soul.M
ohiuddin moved to the United
States from Pakistan in 1991,
when he was twenty-six, to train in car-
diac surgery. His first mentor asked him
to think about how many patients he
could help as a cardiac surgeon, and
then asked what he would think if he