"BABY FAE" AND THE BABOON HEART

A Daring Surgical Procedure

On 15 November 1984 at Loma Linda University Medical Center in southern California, a tiny baby girl died twenty days after she had heart surgery. The hopes of many died with her. For "Baby Fae," as she had come to be known, died with the heart of a baboon pumping blood through her body. The baboon heart experiment offered hope that animal organs could be used in ailing infants for whom transplant organs were difficult to obtain. Baby Fae was born with a fatal congenital deformity known as hypoplastic left heart, which left the entire left side of her heart useless. A successful transplant from a baboon promised a new life for Baby Fae and a revolution in pediatric heart surgery.

Xenografts

Dr. Leonard Bailey, chief of pediatric heart surgery at Loma Linda, had experimented with interspecies transplants for seven years, grafting lamb hearts into baby goats. Many of the goats lived as long as 165 days. Bailey hoped his work could ultimately be used for humans, especially those newborns dying of hypoplastic left heart. For his xenografts ("foreign grafts" between species) he chose baboons because of their biological similarity to humans. Baboons were also more available compared to the much rarer, although genetically closer, chimpanzees. He was also encouraged to perform the surgery on Baby Fae because of the success of a new antirejection drug, cyclosporine, which could suppress the body's reaction to a new heart but not destroy its ability to fight off infections. His experiments with young animals convinced him that their immature immune systems made their bodies more receptive to transplants. He theorized that they might be able eventually to adopt a xenograft organ as their own.

Controversies

After the surgery on 26 October, the medical community, although usually receptive to technological innovation, was sharply divided. Controversy arose from many quarters. Physicians challenged the use of an animal heart when a human heart seemed preferable; and animal rights groups protested the sacrifice of a healthy baboon for what they saw as medical sensationalism. Those concerned with medical morality worried about the ethical questions of consent for an infant in such a risky undertaking; and there were questions about whether Baby Fae's young, unmarried parents were properly advised about the drastic procedure. Questions even arose about her psychological well-being once she was old enough to understand that the heart that beat within her chest was that of a baboon. But hopes ran high. Her progress and setbacks were followed throughout the country, and in a videotape made just four days after surgery, Baby Fae was seen yawning and stretching, looking for all the world like a normal infant.

Kidney Failure

Although her survival was not expected to be easy, her death came as a surprise to those Americans who had avidly followed her every heartbeat. According to her physicians, she had done well until the fourteenth day after surgery when her body began to reject the foreign heart. Doctors increased her dosages of antirejection drugs and put her back on a respirator and intravenous feedings. But her kidneys failed and put her other organs into danger, ultimately leading to her heart failure.

Medical Perspectives

A year later the transplant of the baboon heart into the newborn infant was strongly criticized in an editorial published in the Journal of the American Medical Association (JAMA) in December 1985. The editorial suggested that Bailey's belief that an infant's immature immune system would protect against the rejection of a foreign organ was "wishful thinking." Bailey himself had admitted that he had made a grave error when he used a heart from a baboon with a different blood type. The editorial concluded that the operation was doomed to failure from the beginning. In an article in the same issue of the JAMA and at a news conference after its publication, Bailey defended himself. He noted that human infant donors were extremely scarce and said that in future cases like Baby Fae's he would look for a human donor. But, if none were available, he would transplant an animal heart as a bridge until a human donor was found. The critics from the medical journal agreed that an animal heart transplant could be a way to keep an infant alive until a human donor could be found.

Unanswered Questions

In the end, many questions remained unanswered. Other members of the medical profession saw the doctors of Loma Linda as pioneers, and reminded the country that advances in medicine were only made by trying things that seemed daring. Some people asked if it were right to spend so much time, effort, and money to try to save a baby who had so little chance of survival when many millions of the world's children were dying for simple want of food. Baby Fae brought out defenders of medical experimentation, animal rights activists, and the press. But it was not clear who had defended Baby Fae. What exactly were the ethics of the case? The medical world and other Americans would reflect on the case of Baby Fae for a long time to come.