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Crossing the Rubicon: Death in ‘The Year of the Transplant’

  • Helen MacDonald (a1)

Abstract

How death should be measured was a subject of intense debate during the late 1960s, and one in which transplant surgeons had a particular interest. Legislation required a doctor to first pronounce ‘extinct’ the patients from whom ‘spare parts’ were sought for grafting. But transplant surgeons increasingly argued the moment of death was less important than was the moment of establishing that a patient was beyond the point of no return in dying, at which time she or he should be passed to the transplant team. This raised concerns that people identified as being a potential source of organs might not be adequately cared for in their own right. In 1968 the World Medical Association issued an international statement on death at its meeting in Sydney, Australia following a debate between delegates about how and by whom death should be assessed prior to organ removal. Soon afterwards Australian surgeons performed two of the one hundred and five heart transplants carried out around the world that year, dubbed by the New York Times to be one during which an ‘international epidemic’ of such grafts were carried out. This essay examines debates about death and transplanting, then analyses the pioneering Australian heart transplants, in the context of the Declaration of Sydney and continuing international discussions about whether these operations were moral and legal.

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Copyright

Corresponding author

* Email address for correspondence: h.macdonald@unimelb.edu.au

References

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1. Joan Holloban, ‘Hail Heart-Graft Triumph’, Globe and Mail, 23 June 1966, 5; Anon., ‘Blind of Ceylon Live in Hope’, Canberra Times, 13 February 1964, 29; Anon., ‘Soviets Plan Heart Swap’, Canberra Times, 8 August 1962, 13; Anon., ‘18 Days Life After Lung Transplant’, The Times, 20 December 1963, 8. On media interest in earlier scientific endeavours see Susan Lederer, Flesh and Blood: Organ Transplantation and Blood Transfusion in Twentieth-Century America (Oxford and New York: Oxford University Press, 2008) and Duncan Wilson, Tissue Culture in Science and Society: The Public Life of a Biological Technique in Twentieth-Century Britain (London: Palgrave Macmillan, 2011).

2. ‘Kidney Transplant Lasts Eight Years’, The Times, 1 November 1966, 13.

3. Anon., ‘Big Advances with Transplanted Organs’, Canberra Times, 23 August 1963, 16.

4. Rhona Churchill, ‘Spare-Part People’, Daily Mail, 29 April 1966, 10.

5. Anon., ‘Spare Parts’, Age, 5 January 1968, 4.

6. Christine Doyle, ‘Now Surgeons Fear Rush for Heart Transplants’, Observer, 10 December 1967: 2.

7. Anon., ‘ “Heart Bank” for Transplants’, The Times, 20 January 1968: 4.

8. Quoted in Lederer, op. cit. (note 1), 98.

9. Lord Brock, ‘A Plea for Anonymity in Heart Transplants’, The Times, 1 February 1968, 9.

10. Anon., ‘Transplant Surgery’, The Times, 14 February 1968: 11.

11. Harry Windsor, ‘Heart Transplantation, or Keeping Both Feet on the Ground’, Medical Journal of Australia, 1, 20 (1968), 869–70. ‘Donor’ appears in quotation marks because those from whom organs were taken at this time had rarely bequeathed them. For a discussion see Helen MacDonald, ‘Conscripting Organs: “Routine Salvaging” or Bequest? The Historical Debate in Britain, 1961–75’, Bulletin of the History of Medicine and Allied Sciences, 70, 1 (2015), 425–61.

12. Windsor, ibid., 869.

13. Ibid.

14. G.E. Bauer, ‘Cardiac Transplantation: Reflections of a Cardiologist’, Medical Journal of Australia, 2, 20 (1968), 915–7: 916.

15. Calne, quoted in Ayesha Nathoo, Hearts Exposed: Transplants and the Media in 1960s Britain (Basingstoke: Palgrave Macmillan, 2009), 99.

16. Ibid., 67.

17. Ibid., 111.

18. Cyril Kersh, Sunday Mirror, 4 February 1968, quoted in Nathoo, op. cit. (note 15), 103.

19. Fox, Renée C. and Swazey, Judith P., The Courage to Fail: A Social View of Organ Transplants and Dialysis (University of Chicago Press: Chicago, IL, 1974), 122123.

20. Most who discuss the Harvard report have not noticed the simultaneous release of the Sydney Declaration. See Renée C. Fox and Judith P. Swazey, Spare Parts: Organ Replacement in American Society (New York and Oxford: Oxford University Press, 1992); Mita Giacomini, ‘A Change of Heart and a Change of Mind? Technology and the Redefinition of Death in 1968’, Social Science and Medicine, 44, 10 (1997), 1465–82; Martin S. Pernick, ‘Brain death in a cultural context: The reconstruction of death, 1967–81’, in Stuart J. Youngner, Robert M. Arnold and Renie Schapiro (eds), The Definition of Death: Contemporary Controversies (Baltimore, MD and London: The Johns Hopkins University Press, 1999), 3–33; Margaret Lock, Twice Dead: Organ Transplants and the Reinvention of Death (Berkeley, CA: University of California Press, 2002); Lederer, op. cit. (note 1); David Hamilton, A History of Organ Transplantation: Ancient Legends to Modern Practice (Pittsburgh, PA: University of Pittsburgh Press, 2012); and Gary S. Belkin, Death Before Dying: History, Medicine, and Brain Death (Oxford: Oxford University Press, 2014).

21. Lesley A, Sharp, The Transplant Imaginary: Mechanical Hearts, Animal Parts, and Moral Thinking in Highly Experimental Science (Berkeley, CA: University of California Press, 2014), 29.

22. Anon., ‘Patient or Donor?’, Lancet, 292, 7569 (September 21, 1968), 671–2: 671.

23. The only article thus far on the Australian heart transplants is physiologist John Carmody’s ‘Trampled in the Rush: Ethical Casualties in the First Australian Heart Transplant’, Health and History, 16, 2 (2014), 87–106.

24. Thomas Schlich, The Origins of Organ Transplantation: Surgery and Laboratory Science 1800–1930 (Rochester, NY: University of Rochester Press, 2010); Lederer, op. cit. (note 1), 3–25.

25. Giacomini, op. cit. (note 20), 1470.

26. Anon., ‘Doctor Criticizes Heart Transplant “Vultures” ’, The Times,11 September 1968, 1.

27. Simpson, Keith, ‘‘The Moment of Death: A New Medico-Legal Problem’, paper, 46th South African Medical Congress, Durban, subsequently published’ in The Solicitors’ Journal, 31 (1968), 435436.

28. Further, the physician in charge of the patient should consult with one or more other physicians who were directly involved in the case, to protect against ‘later questions which might be raised’ (‘A Definition of Irreversible Coma: Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death’, Journal of the American Medical Association, 205, 6 (1968), 85–8: 85, 87).

29. Giacomini, op. cit. (note 20); Lock, op. cit. (note 20).

30. Belkin, op. cit. (note 20).

31. Somerville, Walter, ‘Problems in Cardiac Transplantation from the Cardiologist’s Viewpoint’, Progress in Cardiovascular Diseases, XII, 2 (1969), 174189 174.

32. Rothman, David J., Strangers at the Bedside: A History of How Law and Bioethics Transformed Medical Decision Making (New York, Basic Books, 1991), 159160.

33. Dr Gunnar Biørck, ‘On the Definitions of Death’, World Medical Journal, 14, 5 (1967), 137–9: 138. In England, R v Potter (1963) had revolved around the cause of such a patient’s death. Had death occurred when Mr Potter stopped breathing spontaneously due to an assault, or later, when the surgeons who cut out his kidneys had turned off the ventilating machine? For a discussion see Duncan Wilson, The Making of British Bioethics (Manchester: Manchester University Press, 2014), 108–9.

34. Godber to Himsworth 17 October 1967, National Archives, Medical Research Council Registered Files, Death: Correspondence Concerning Setting up the Working Group on the Definition of Death (1966–70), FD 23/1899.

35. Memorandum ‘Meeting at Royal College of Physicians on 27 June 1967’. Eight years later the Royal Colleges reluctantly issued a report on brain death following an incorrect assessment of this state in a case of an attempted kidney transplant (Helen MacDonald, ‘Guarding the Public Interest: England’s Coroners and Organ Transplants, 1960–75’, Journal of British Studies, 54, 4 (2015), 926–46).

36. Woodruff, M.F.A., ‘Ethical Problems in Organ Transplantation’, British Medical Journal, 1 (1964), 1457–60: 1459–60.

37. Wolstenholme, G.E.W. and O’Connor, Maeve, Ethics in Medical Progress: With Special Reference to Transplantation (London: J. & A. Churchill Ltd., 1966), 6869.

38. James D. Hardy and Carlos M. Chavez, ‘The First Human Transplant in Man: Developmental Animal Investigations with Analysis of the 1964 Case in the Light of Current Clinical Experience’, The American Journal of Cardiology, 22 (1968), 772–81: 776. In December 1967 heart transplant surgeon Adrian Kantrowitz also found that his colleagues at Maimonides Medical Center insisted he allow the donor’s heart to stop naturally before removing it (Adrian Kantrowitz, ‘America’s First Human Heart Transplantation: The Concept, the Planning, and the Furor[sic]’, ASAIO Journal, (1998), 244–52: 250).

39. Giacomini, op. cit. (note 20), 1469.

40. Editorial, World Medical Journal,14, 5 (1967), 133–4.

41. Quoted in Rothman op. cit. (note 32), 160–1.

42. Helen MacDonald, ‘Considering Death: The Third British Heart Transplant, 1969’, Bulletin of the History of Medicine,88, 3 (2014), 493–525: 495; MacDonald, op. cit. (note 11), 10–16.

43. Dr James Mowbray, quoted in MacDonald op. cit., (note 42), 513. On the involvement of the London transplant team with heart donors see MacDonald, ibid. and Nathoo, op. cit. (note 15).

44. Anon., ‘Transplant Safeguard’, Canberra Times, 7 August 1968, 3. On the Association see C. Machado, J. Korein, Y. Ferrer, L. Portela, M. de la C. Garcia, M. Chinchilla, Y. Machado, and J. M. Manero, ‘The Declaration of Sydney on Human Death’, Journal of Medical Ethics, 33 (2007): 699–703: 699.

45. Giacomini, op. cit. (note 20), 1466.

46. Susan Lederer, ‘Research without borders: The origins of the declaration of Helsinki’, in Ulf Schmidt and Andreas Frewer (eds), History and Theory of Human Experimentation: The Declaration of Helsinki and Modern Medical Ethics (Stuttgart: Steiner, 2007), 199–215.

47. World Medical Journal, 12, 6 (1965), 170–1; editorial, World Medical Journal, 13, 5 (1966), 141.

48. World Medical Journal, 14, 1 (1967), 6.

49. Editorial, World Medical Journal, 14, 5 (1967), 133–4: 133.

50. Biørck, op. cit., (note 33), 137–8.

51. Voigt, Jørgen, ‘The Criteria of Death Particularly in Relation to Transplantation Surgery’, World Medical Journal, 14, 5 (1967), 143–6: 145.

52. Machado et al., op. cit. (note 44).

53. Robert Johnston, ‘A Matter of Life – and of Death’, Sun, 7 August 1968, 8.

54. Machado et al., op. cit. (note 44), 701.

55. Ibid., 8; Anon., ‘The Ethics of Transplants: Defining Death Divides Doctors’, Sydney Morning Herald, 6 August 1968, 5.

56. Anon., ‘Priest had his Say to Doctors’, Sun, 7 August 1968, 3.

57. Anon., ‘Electric Test Found Faulty’, Sydney Morning Herald, 6 August 1968, 5.

58. Anon., op. cit. (note 56), 3.

59. Anon., op. cit. (note 57), 5. However, this study had been of EEGs performed on patients suffering from poisoning, whose brainwaves would have been affected by the barbiturates involved.

60. Anon., ‘Definition of Death Postponed’, Sydney Morning Herald, 8 August 1968, 1.

61. Ibid.

62. Johnston, op. cit. (note 53), 8.

63. Anon., ‘What W.M.A. Talked about Yesterday: Death Definition Unlikely – Doctor’, Sydney Morning Herald, 9 August 1968, 9.

64. Johnston, op. cit. (note 53), 8; Anon., op. cit. (note 63), 9. This part of the proposed statement would not be included in the Declaration of Sydney.

65. Anon., ‘Doctors Adopt “Statement on Death”: Definition of Death will not be Used’, Age, 10 August 1968, 5.

66. Ibid., 5.

67. Editorial, World Medical Journal, 15, 6 (1968), 129.

68. Anon., ‘Machine to be Guide to Death’, Herald, 9 August 1968, 3.

69. Stanley S.B. Gilder, ‘Twenty-Second World Medical Assembly’, British Medical Journal, 3, 5616 (1968), 493.

70. Anon., ‘Declaration of Sydney’, British Medical Journal, 3, 5616 (1968), 449.

71. Tillman Durdin, ‘Physicians Adopt a Code on Death’, New York Times, 10 August 1968, 25.

72. Robert Raymond, ‘When are you Dead?’, The Bulletin, 17 August 1968, 31–5.

73. Mr Hunter, ‘Tissue Grafting and Processing Bill’, New South Wales Parliamentary Debates, Session 1965–6, 3 $^{\text{rd}}$  series, Vol. 61, Legislative Council, 17 March 1966, 4331; Mr Crabtree, ibid., 4331–2.

74. Windsor, op. cit. (note 11), 869–70.

75. Harry Windsor, The Heart of a Surgeon: The Memoirs of Harry Windsor (Kensington, NSW: New South Wales University Press, 1988), 73.

76. Anon., ‘Sydney Team Makes First Heart Switch’, Sydney Morning Herald, 24 October 1968, 1; Anon., ‘Heart Transplants are Ethical: Surgeon’, Canberra Times, 23 May 1968, 4.

77. Bauer, op. cit. (note 14), 916.

78. Anon., ‘Heart Transplants are Ethical’, op. cit. (note 76), 4.

79. Anon., ‘The Man in “Windsor Castle” ’, Sun, 24 October 1968, 2. According to the nuns who staffed this hospital Windsor reigned there as a ‘king’. An ‘anticipatory tremor’ ran through the thoracic section when he walked through the wards. ‘The patients sort of lie down to attention’, one nun stated. ‘He has that effect on you’. See Robert Drewe, ‘Transplant Was “Terrible Job” ’, Age, 25 October 1968, 1.

80. Quoted in Fox and Swazey, op. cit. (note 19), 77.

81. Somerville, op. cit. (note 31), 175–6.

82. Fox and Swazey, op. cit. (note 19), 105.

83. John Sorell, ‘Heart Swap Surgeon Tells his Own Story’, Herald24 October 1968, 1. John Carmody notes that Pye, a war veteran, had also been assessed on 29 August by a committee appointed by the Repatriation Commission which would pay for this operation (Carmody, op. cit., (note 23), 94–5).

84. Sorell, op. cit. (note 83), 1.

85. Shaun McIlraith, ‘I Know how Barnard Felt’, Sydney Morning Herald, 25 October 1968, 10.

86. Editorial, ‘The Soft Machine?’, Sydney Morning Herald, 25 October 1968, 1.

87. Carmody, op. cit. (note 23), 90, 96.

88. McIlraith, op. cit. (note 85), 10.

89. Sorell, op. cit. (note 83), 1; 3.

90. Anon., ‘The Man in “Windsor Castle” ’, Sun, 24 October 1968, 2. On inter-hospital rivalry in Sydney see Carmody, op. cit. (note 23), 92–3.

91. Michael Symons, ‘Two More Teams Get Set’, Sydney Morning Herald, 25 October 1968, 11.

92. McIlraith, op. cit. (note 85), 10.

93. Anon., ‘The Point of No Return’, Sydney Morning Herald, 25 October 1968, 10; Anon., ‘Problem Overcome’, Canberra Times, 25 October 1968, 3; Windsor quoted in David Aldridge, ‘The Agony of a Surgeon’, Sun, 25 October 1968, 8.

94. Sorell, op. cit. (note 83), 1; McIlraith, op. cit. (note 85), 10.

95. Harry M. Windsor, ‘Cardiac Transplantation’, Postgraduate Medical Journal, 46 (April 1970), 237–242, 239; Harry Windsor, ‘A Heart Transplantation: 3. Surgical and Postoperative Surgical Aspects’, Medical Journal of Australia, 1, 13 (1969), 667–9.

96. Bleasel, Kevin, Bailey, R. J., Gunner, Warren and Dwyer, John, ‘A Heart Transplantation: 2. The Donor’, Medical Journal of Australia, 1, 13 (1969), 665666.

97. Sorell, op. cit. (note 83), 1.

98. Shaun McIlraith, ‘Eleven Hours of Drama at St Vincent’s’, Sydney Morning Herald, 25 October 1968, 2.

99. Ibid.

100. Sorell, op. cit. (note 83), 1.

101. McIlraith, op. cit. (note 98), 2.

102. Sorell, op. cit. (note 83), 1, my emphasis.

103. Ibid.

104. Anon., ‘Transplant Man Gives a Smile’, Canberra Times,26 October 1968, 3; Windsor, op. cit. (note 75), 75.

105. Goreham quoted in Anon., ‘Heart Swap at the Alfred’, Sun, 13 November 1968, 1–2: 2.

106. Anon., ‘First Heart Switch Here Under Way’, Age, 24 October 1968, 1–2; Anon., ‘Heart Transplant’, Sun, 24 October 1968, 2.

107. Leonard Radic, ‘Law and Transplants’, Age, 25 October 1968, 5.

108. Corneal Grafting Act, 1954 (State of Victoria, The Acts of Parliament Passed During the Year 1954, in the Second Session of the Thirty-Ninth Parliament of the State of Victoria (Melbourne: Government Printer), 1955).

109. Anon., ‘Victorian Newsletter’, Medical Journal of Australia, 2, 9 (1968), 416.

110. ‘Medical (Organ Transplants) Bill’, Victorian Parliamentary Debates (Legislative Council), Session 1968–69, vol. 292, 30 October 1968, 1342.

111. Of this the government was aware, but took no action. Dickie himself referred to the successful kidney transplant programme at the Royal Melbourne Hospital where, since 1963, results had been achieved that were equal to or excelled the best in the world (ibid., 1339).

112. Jeff Wells, ‘Heart Man Said $\ldots$ “Last Hope” ’, Sun 14 November 1968, 2.

113. Anon., ‘Victorian Heart Transplant “Smooth” ’, Canberra Times, 13 November 1968, 1.

114. Ibid.

115. Anon., op. cit. (note 105), 1.

116. Deposition of Irwin Bruce Faris, Medical Practitioner, Alfred Hospital. Inquisition before Coroner H.W. Pascoe, 23 January 1969, Public Records Office of Victoria, V/AC/012/05/07.

117. Peter McLaughlin and Jack Carmody, ‘New Heart Could Not Pump’, Age14 November 1968, 3.

118. Anon., ‘Surgery “Doomed” from Beginning’, Canberra Times,15 November 1968, 3.

119. McLaughlin and Carmody, op. cit. (note 117), 3.

120. Anon., op. cit. (note 113), 1.

121. Peter McLaughlin, ‘Heart Swap “Doomed” ’, Age,14 November 1968, 3.

122. McLaughlin and Carmody, op. cit. (note 117), 3.

123. Carmody, op. cit., (note 23), 102.

124. Anon., op. cit. (note 118), 3.

125. Anon., ‘Heart Team to Try Again’, Sydney Morning Herald,14 November 1968, 1.

126. McLaughlin and Carmody, op. cit. (note 117), 3.

127. Anon., op. cit. (note 112), 2; McLaughlin and Carmody, op. cit. (note 117), 3.

128. Carmody notes that the Melbourne surgeons operated knowing nothing of the donor’s general health and with very little time for tissue matching. Further, prior to his death Healy had been taking drugs that would have harmed his heart (Carmody, op. cit. (note 23), 101.

129. ‘Medical (Organ Transplants) Bill’, op. cit. (note 110), 20 November 1968, 1865.

130. Ibid., 21 November 1968, 1973.

131. Ibid.,20 November 1968, 1870.

132. Ibid., 1867.

133. Jenkins referred to a medical practitioner who had been an early critic of transplant surgery, questioning whether ‘some mental institutions are being used as organ farms’ (‘Medical (Organ Transplants) Bill’, Victorian Parliamentary Debates (Legislative Assembly), 4 December 1968, 2647).

134. Ibid., 2650.

135. ‘Medical (Organ Transplants) Bill’, op. cit. (note 110), 1870.

136. John Wright, letter to the editor, Medical Journal of Australia, 1, 4 (1969), 197.

137. Ian Monk, letter to the editor, ibid.,197–8.

138. Victor H. Wallace, letter to the editor, Medical Journal of Australia, 1, 7 (1969), 360.

139. H.P.B. Harvey, letter to editor, Medical Journal of Australia, 1, 8, (1969), 425–6.

140. Wallace, op. cit. (note 138), 360.

141. Harvey, op. cit. (note 139), 425–6.

142. Wallace, op. cit. (note 138), 360.

143. Harvey, op. cit. (note 139), 425–6.

144. Kempson Maddox, letter to the editor, Medical Journal of Australia, 1, 1 (1969), 34.

145. Harvey, op. cit. (note 139), 425–6.

146. Ibid.

147. Ibid.

148. Harry Windsor, letter to the editor Medical Journal of Australia, 1, 4 (1969),197.

149. Lederer, op. cit. (note 1), 170.

This work was supported by the Australian Research Council (project number 100100762). It has benefited from the questions, comments and suggestions made by the anonymous reviewers for Medical History, and from skilful research assistance provided by Dr Anna MacDonald and Dr Caitlin Mahar.

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