A "Basic" Predecessor of "Applied" Heart Transplantation

PERSPECTIVES IM BIOLOGY AND MEDICINE Volume 19 · Number 1 · Autumn 1975 A "BASIC" PREDECESSOR OF "APPLIED" HEART TRANSPLANTA TION PAUL A. WEISS* Much of my 56 years of scientific work and rationale have confirmed me in the tenet that,scientific knowledge is a unitary entity, continuous and coherent all the way from down the fortuitous discovery of novel facts and the emergence ofideas or insights, up to the most utilitarian exploitation oftheir lessons forthe good ofman in medicine, technology, or just a saner attitude in living and world view. No tenet can be supported more forcefully than by concrete samples of its validation. Yet, my experience , both in research and administrative functions, has not convinced me that medical education in general tends to blur that artificial distinction, which aims to part "basic research" from the "practice of application" sufficiently. It thus focuses the student's mind on either one or the other aspect, as if they were mutually independent. I fully realize the valiant efforts from both ends made currently to promote an ecumenical merger or, at least, coexistence, between both. But I do not believe that a better balance can be attained simply by inflicting upon a medical student a heavier dose of basic facts whether of biochemistry or genetic statistics or electronmicroscopy of cells or what not, rather than by giving him essentially a deeper understanding of how the underlying basic principles bear directly on the clinical problems and, conversely, how the "basic" researcher ought to scan the empirical experience ofthe practitioner for realistic guidance. I am far from submitting that any student's or practitioner's or research enthusiast's motivations and aptitudes should or could be homogenized into a common intellectual pulp. But I do believe that the display ofa greater variety ofexamples to illustrate the intimate blend between lessons from fundamental experimentation and from practical experience would automatically produce the desired linkage [I]. The Rockefeller University, New York, New York 10021. Perspectives in Biology and Medicine · Autumn 1975 | 1 As a simple contribution to this theme, I want to add here a development which, humbly speaking, is merely one of the many examples of its kind that demonstrates the loss or deprivation of our stock of available knowledge, not by too little support ofresearch to "learn more and more about less and less", but—speaking in the simile of exploitation of natural resources—by the rapidly mounting unfamiliarity with the existence of mineral ore that has been mined but has never been processed into usable products. Essentially unrelated to my major and more systematic experimental life work, the case in question might make the point. Strictly "basic" in design, it has a direct bearing on the recent issue of the transplantability in man of supernumerary hearts. In 1921 I had started to explore the transplantability of whole organs in amphibians. The accessory supernumeracy grafts were to serve as sort of "listening" devices to disclose any possible effects exerted upon them by the carrier organism and particularly by their intact normal counterparts in the body. As has become rather widely known, the transplantations of supernumerary limbs have revealed to me the phenomenon of "myotypic response" (matching specificity between innervation and end organs), the explanation of which is still full of enigmas [2]. Concentration on these limb experiments then forced me to cut short further studies on transplantability of other organs that had proven equally successful and promising. One of those was the heart, tests on which I had started about the same time and published preliminarily in 1922 [3] followed by a more detailed report 4 years later [4]. The main results were as follows. Grafts were whole hearts extirpated with their sinuses and arterial stumps from adult anurans (Bombinator igneus) or urodeles (Triton cristatus). They were inserted through a small incision in various locations of anesthetized specimens ofthe same species. The best permanent structural and physiological persistence ofgrafts for many postoperative months was obtained with anuran hearts lodged in the mesenterium within an intestinal loop; the lung, for instance, proved quite unsuitable as graft site. In general, there was wide variation in "takes" as well as in the restitution of blood flow through the cardial...