When the South African surgeon Christiaan Barnard carried out the first heart transplant in December 1967, the world held its breath. His patient, 53-year-old Lewis Washkansky, lived for only another 18 days. The drugs he needed to stop his body rejecting the new organ compromised his immune system to such an extent he couldn’t fight off other illnesses, and he died of pneumonia. But the precedent had been set:

the most powerful and emotionally iconic of human organs could be taken from the body of a dead person to give the chance of an extended life to another. It was a transforming, era-defining moment that reinforced our faith in medical science and ensured Barnard’s place in history. But how successful would heart transplantation be in the long term?

Just over 40 years later, the very same question is still being asked. The procedure, and the drugs needed to maintain a newly donated heart, may be much more sophisticated, and heart transplants may be regarded by the public as one of the most glamorous of surgical career paths, but surgeons themselves are carrying out significantly fewer of the operations. This is partly because a range of other treatments is available to patients, and partly because of the low number of suitable donor hearts.

When surgeons do operate, the outcome is often poor. Of the 100-plus people who receive a new heart each year, 10 are likely to die within 12 months as a result of donor-organ rejection and other complications; and of the remainder, a significant proportion will develop cancer within five years from the toxic anti-rejection drugs they must take for the rest of their lives. Specialists argue that the number of long-term survivors has increased, with some living for decades; but they admit that most transplant patients die within 10 years of receiving a new organ.

In the past year and a half, the deaths of 11 patients who had just received new hearts has raised more serious questions about our cardiac-transplant programme. In that time, both Papworth hospital in Cambridgeshire and Harefield, on the outskirts of London – the most prestigious centres in the UK for heart transplants – have had to suspend these operations because of a run of unexplained deaths: seven patients at Papworth from January to September 2007, and four at Harefield who died one after the other between July and October this year. None of the victims survived to leave hospital, each one dying within a month of their operation. An inquiry at Papworth, where the deaths represented more than one-third of the 20 transplants carried out there last year, was inconclusive. At Harefield, an inquiry is ongoing.

Meanwhile, the number of organ donations has plummeted to an all-time low: only 135 patients received new hearts in the year to April 2008; more than 500 hearts were offered for transplant, but many were not considered a suitable match or of sufficient quality for their intended recipients. At the procedure’s peak, in 1989/90, there were over 400 heart transplants. Today there are simply fewer good hearts to choose from, because seat-belt legislation has dramatically cut the number of deaths in road accidents, and thus the number of hearts

available for transplantation, and because families are often unwilling to offer up their newly deceased loved ones for organ harvesting. There are now so few heart-transplant surgeons in the country – 50 at most – that it’s easy to imagine a time when they outnumber the available donors; not a state of affairs Barnard could have imagined all those years ago.

Against this background, some heart surgeons are arguing that we need to think again and turn our attention to electric heart pumps, an apparently riskier medical solution, but one that offers a cheaper, off-the-shelf opportunity to save a life without someone having to die first; and one that has been proved to have therapeutic potential for those who merely need to rest their heart, not replace it.

Paul Maidment, an army chef, is a case in point. At the time that the unlucky patients at Papworth and Harefield were preparing themselves for transplant surgery last year, Maidment was larking about with his mates in the catering corps in Iraq, fronting a band called the Basra City Rollers. By May this year he was fighting for his life, his heart stopping every few minutes even as doctors struggled to keep it going. It was not a stray bullet that had caused the lethal damage, but a rare adrenalin-secreting tumour that was pouring toxic quantities of the fight-or-flight hormone into his bloodstream, sending his blood pressure soaring and putting a fatal strain on his heart. At the age of 28, Maidment appeared to have metamorphosed from a muscle-bound model for army recruitment into a near-corpse, wracked by repeated heart attacks.

Nobody at the Royal Devon and Exeter hospital knew what to do. David Smith, the cardiologist treating Maidment, was aware of implantable electric heart pumps that could take the strain off exhausted hearts like his, giving the muscle vital time to recover. Smith had read a paper produced by a team in Oxford – one of a small number of groups lobbying for the use of such devices – which had achieved remarkable results with the handful of patients who had received charitable funding for the devices (each unit costs between £40,000 and £60,000).

The problem in this case wasn’t funding but logistics: how to get Maidment to Oxford’s John Radcliffe hospital, where a pump could be fitted while he was still attached to the roomful of equipment that might or might not keep him going for the journey. A Sea King helicopter was scrambled by the army for the 40-minute trip. His parents, Steve and Sandy, followed by car. “We’d been told he would probably die on the journey,” says his mother. “He was cold and sweaty, and his skin was like candle wax, the most awful colour I have ever seen.”

By the time the couple reached the hospital, the pump was already in. Stephen Westaby, a cardiac surgeon turned professor of biomedical sciences, who has led the world in the use of the technology, assured them their son would live.

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