Understanding that the job was only temporary, Norman Shumway, MD, PhD, became the chief of cardiothoracic surgery at Stanford Hospital in 1964. The position was his until a "big name" came aboard.

Shumway, the Frances and Charles D. Field Professor of Cardiac Surgery, Emeritus, remained in charge for decades. In 1968, he performed the first human heart transplant in the United States. Then in 1981, he and colleagues performed the first-ever heart-lung transplantation.

Last Friday, Shumway recounted the history of heart transplantation to a packed house during the 28th annual Louis and Dorothy Kovitz Visiting Professorship Lecture at Lucile Packard Children's Hospital.

Norman Shumway (right) and his first resident, Richard Lower, were honored Friday for their groundbreaking work in heart transplantation. Forty years ago, the pair laid the foundation for successful procedures.

"Dr. Shumway is the recipient of virtually every award that surgery has to offer," said Thomas Krummel, MD, the Emile Holman Professor of Surgery and chair of the Department of Surgery. "Perhaps his greatest legacy is building probably the greatest department of cardiothoracic surgery in the world. He moved the field from a curiosity to a clinical reality, training several generations of cardiac surgery leaders,"

Also attending was Shumway's first resident, Richard Lower, MD. Their first major contribution to transplantation was research that showed cooling a patient's heart in a procedure called topical hypothermia caused it to slow down. Described in a paper published in 1959, this procedure allowed surgeons to perform delicate cardiac surgeries that otherwise couldn't have been done.

Shumway and Lower speculated that topical hypothermia would allow doctors to safely remove the heart for corrective surgery. As a trial run, Lower removed the hearts of dogs and re-implanted them. The surgery required exacting expertise in poor conditions. "These were really primitive circumstances, let me tell you. We had to boil the instruments in the corner before we could try any of these experiments," Shumway said.

Lower discovered it was easier to replace one dog's heart with another's. The trick was to cut such that both the patient's body and the replacement heart came with a margin for error. "By 1959, Lower had success with his experiments on the heart; it was the first time this ever had been seen," Shumway said.

Lower and Shumway had just created the modern heart transplantation procedure. By 1965, "the surgical reports were almost too much. It was certain that somebody would go ahead and perform a human transplantation," Shumway said.

"Christian Bernard, who was an old friend of ours, had visited Richard Lower at the Medical College of Virginia and had learned the technique. He realized it was a fairly easy operation."

Bernard later performed the world's first heart transplant in South Africa in 1967. "There was a lot of excitement after Bernard's operation. Everybody wanted to do a heart transplantation."

From 1967 to 1970, 166 transplants were done. But in 1970 only 23 patients were still alive. Even Bernard's initial patient died after 19 days. The transplanted hearts were being attacked by the patient's immune system, and while immunosuppressive drugs were available, they were not strong enough.

The low success rate called heart transplantation into question as the number of surgeries declined in the 1970s. Then came the next big change: cyclosporine. First isolated from a soil fungus, the drug had amazing immunosuppressive properties, Shumway said. He was among the first to test it in heart transplants. "There are two types of transplantations: those before cyclosporine and those after." Thanks to the drug's effects, nearly 80 percent of transplant patients now survive, he said.

"The big problem is that there is a constant and severe donor shortage because we've been so successful," he said. He offers two possible solutions: genetically engineering pigs whose hearts can be used, or relying on stem cell technology to grow replacement cells. Such options may sound unlikely today, but 50 years ago, so did keeping someone alive while their heart sat in a surgical pan.