The first baby in the history of the world to undergo heart-transplant surgery was an infant in Brooklyn, New York. The surgery was performed on December 6, 1967, by Dr. Adrian Kantrowitz, using the heart of an anencephalic (or brain-absent) baby. The surgery took place just three days after Dr. Christiaan Barnard's famous first adult heart transplant in South Africa. The baby lived six-and-a-half hours.
The second baby in the world to undergo isolated heart-transplant surgery was a 10-day-old English baby, named Hollie Roffey. Dr. Magdi Yacoup performed the surgery in London, England, in July, 1984. The patient, born with hypoplastic left-heart syndrome, lived 18 days after the surgery.
The third baby in the world to have a heart transplant was Baby Fae. With the heart of a baboon, she lived 20-1/2 days. Between December, 1967, and October, 1984, the dates of the first two baby-heart transplants in the United States, an estimated 10,000 U.S. babies were born with the deadly hypoplastic left-heart syndrome. Not one of them underwent heart-transplant surgery. Evidently, nobody was willing to perform the delicate surgery on such a small patient. This is understandable, considering the fact that the heart of a newborn weighs only one ounce. Furthermore, organ procurement agencies did not keep files on newborns, probably because nobody had ever performed a successful organ transplant of any kind on a newborn. The lack of donors in this age group was the primary reason why Bailey researched the possibility of performing cross-species transplants on newborns and used a donor baboon with Baby Fae.
Baby Fae changed the course of history in Loma Linda. The institution was now recognized internationally. Loma Linda for a while became a household name. The magnitude and intensity of international interest had been genuinely overwhelming.
As the only California-designated, level 1, regional trauma center, serving the four Inland Counties of Southern California, Loma Linda University Medical Center provides the highest level of care for patients in more than one-fourth of the state. The institution had dealt with the news media about 1,000 times a year, giving routine patient-condition reports and aiding local reporters on stories of human interest.
Instead of 1,000 media contacts a year, Baby Fae motivated 1,500 a day. She was one of the top 10 U.S. news stories of 1984. There was a pathos about the story that reportedly touched many newspeople.
From the institution's perspective, based on mail, personal contacts, reported surveys, and an increased percentage of occupancy at the Medical Center, the overall response to the Baby Fae story was positive. With the exception of a vocal minority, primarily animal-rights groups, the general population was sympathetic to the effort. Most news people responded objectively and professionally.
More than a year after Baby Fae's death, Baby Moses was referred to Loma Linda for a heart transplant. On November 20, 1985, at four days of age, Baby Moses became the youngest person in the world to undergo successful heart transplantation. During that previous year, an estimated 500 to 650 babies with hypoplastic left-heart syndrome were born in the United States alone. Not one of them underwent heart transplantation, even though the scientific community had expressed an increasing interest in trying to help these doomed babies. Only Dr. Bailey, with a dream in his heart and years of experience in developing delicate surgical skills in his animal-research laboratory, was willing to try.
Baby Moses also generated considerable publicity. His case was newsworthy, not only because of his age, but also because the surgery was performed by Dr. Leonard Bailey, the same surgeon who performed the controversial baboon-heart transplant on Baby Fae. The scientific community watched closely to see what would happen.
In January, 1986, Baby Eve, at 17 days of age, became the second-youngest person in the world to undergo successful heart transplantation. Moses and Eve were both fictitious names, chosen by the parents to protect family privacy. Moses was named after an uncle who had died prematurely. The baby girl's mother chose to give her the name Eve, she said, "because Eve was the first woman, and my baby is the first girl" (to undergo heart transplantation).
Within two months of Eve's successful surgery, two more baby girls were placed on Loma Linda's infant-heart transplant list: Baby Rachel and Baby Vicki. When donors did not become available after more than six weeks, Loma Linda University Medical Center conducted a press conference to help raise the consciousness of the public to the need for donors in this age group. It was an unusual move, because organ-transplant centers usually do not go to the media on behalf of their patients. Such an act, although sincerely motivated, could be perceived to be unfair to other patients awaiting donors.
But in this case, nobody else in the world was performing heart transplants on newborns. Therefore, the notion that something unfair could result was not a consideration. The two babies also had different blood types, meaning that they were not in competition with each other if an organ should become available.
Within weeks, Baby Vicki died and Baby Rachel became Loma Linda's third infant-to-infant heart-transplant patient. As Baby Rachel grew and matured, the staff at Loma Linda sometimes wondered what Baby Vicki's future would have been had she also received a new heart.
Unlike Babies Fae, Moses, and Eve, who all had hypoplastic left-heart syndrome, Baby Rachel had hypoplastic right-heart syndrome. But she also had transposition (or reversal) of the great vessels, which meant that her heart acted exactly like the others.
By June, 1986, Loma Linda University Medical Center had received considerable attention by both print and broadcast media. The stories were mostly positive, and because the surgeries were performed by Bailey, they almost all referred to Baby Fae.
But then something happened that had been anticipated and dreaded. A baby who had been evaluated and found to be acceptable for heart transplantation ran into serious difficulties because of a perceived probability the baby might suffer from lack of appropriate follow-up care.
The decision regarding Baby Jesse was difficult for everybody concerned. It was difficult for the baby's family and the Medical Center staff. It was difficult for the public.
Baby Jesse's family went to the Right to Life League of Southern California, who in turn went to the news media. Loma Linda was again in the international spotlight, but this time the story was not positive. The news media reported that the baby had been turned down because the parents were not married and because the sixteen-year-old mother was too young.
Ethical concerns regarding patients' rights of privacy prevented the Medical Center from divulging the exact reasons why the transplant committee had reservations, except one: the parent's ability to provide the intense level of competent follow-up care needed to assure success was in question. At a press conference, Bailey reported that the age of the mother and the marital status of the parents were not the concerns. (The news media had widely publicized the fact that Baby Fae's parents were not married.)
In TIME magazine (June 17, 1986), Jesse Sepulveda, the baby's father, acknowledged, "I do think that Loma Linda had good reasons to turn us down."
Successful heart transplantation can be broken down into two major components: the surgery and the follow-up care. Each component carries equal weight as it relates to overall success. If either component fails, the patient dies. There would be a waste of resources, including the efforts of about 100 people.
If Baby Jesse did not receive proper follow-up care, he could have suffered from infection or rejection, and quite possibly died. Most critics had not thought about the possibility of the baby suffering from neglect.
While supporters argued that the family's background should not be a factor in evaluating potential transplant candidates, medical ethicist Arthur Caplan, Ph.D., then of the Hastings Center in New York, disagreed. "I can understand wanting to maximize as completely as possible the chances of success, and family stability and other factors play a role," he said.
The situation was at an impasse until legal guardianship of the baby was temporarily transferred to the paternal grandparents, who then accepted legal responsibility for the baby's well-being. When the transplant team was assured that the baby would receive proper follow-up care, the baby was placed on Loma Linda's infant-heart-transplant list. The surgery took place when a donor became available on June 10, 1986. That too became international news.
On Christmas Eve, 1986, Bailey contacted Baby Jesse's parents and congratulated them for a job well done. The parents had been intimately involved in his day-to-day care. Bailey announced that the legal guardianship would be returned to them. It was the best Christmas present they received that year.
It was a perfect Valentine's gift for Jesse Sepulveda and Deana Binkley, when the Pasadena (California) Superior Court officially awarded legal guardianship back to them as Baby Jesse's parents, on Friday, February 13, 1987.
On June 10, 1987, the Medical Center conducted a memorable one-year-anniversary celebration for Baby Jesse, complete with a huge arch of colorful, helium-filled balloons, professional entertainment, and refreshments. The occasion not only ended a very difficult year on a positive note, but honored a number of unsung heroes in the infant-heart-transplant program: Rose Bui, M.D., pediatrician; Robert Martin, M.D., anesthesiologist; and Cheri Mathis, R.N., pediatric-heart-transplant coordinator.
In retrospect, Bailey said it would have been a grave mistake not to have performed a heart transplant on Baby Jesse. One of the benefits of the Baby Jesse story was that millions of people around the world learned that follow-up care is just as critical as the heart transplant surgery.