October 15, 2008

Symposium, Patient Reunion Will Help Mark 40 Years of Pioneering Work in Heart Transplantation at Stanford

The afternoon Elizabeth Craze was born 26 years ago, her parents held their breath.

"She is perfect," the doctor told them.

But within four months, Elizabeth, like the four siblings before her, would be diagnosed with heart failure. Three had already died in infancy. The fourth, her older brother Andrew, would be diagnosed shortly after Elizabeth. It was thought to be a death sentence.

"I thought I would go absolutely insane," said her mother, Susan Craze.

This was still the early days of heart transplantation surgery, especially for children. But there was no other choice for the Craze family, and the only place to go was Stanford.

"When I told my doctor in Cleveland we were considering heart transplantation, I can still picture him, backing up against the wall with just this look of horror on his face," Susan Craze recalled.

Forty years ago in 1968, the late Norman Shumway, MD, and a team of doctors performed the first successful heart transplant in the United States at Stanford Hospital on a 54-year-old steelworker from East Palo Alto amid an uproar of controversy and a media frenzy. Proving the naysayers and skeptics wrong, the landmark operation has since become almost routine, saving thousands of lives around the world.

"We both stood there and stared into this huge empty cavity for a good half a minute," said Edward Stinson, MD, who assisted Shumway in carving out the diseased heart in that first transplant surgery. "It was a fairly awesome sight. 'Do you think this is really legal?' I said."

The goal from the beginning wasn't scientific experimentation but to save lives, said Stinson, professor emeritus of cardiothoracic surgery at the Stanford University School of Medicine. To save lives like those of Elizabeth and her brother Andrew.

"It was in no way simply a stunt," said Stinson. "There was no denying there was controversy about the procedure, but we could foresee what the potential was. The underlying ambition was always to improve the quality of life and to extend life."

Transplant survivors and scientific experts in the field of transplantation will travel to Stanford Oct. 24 for a symposium titled "Looking to the Future: 40 Years of Heart and Lung Transplantation at Stanford University" to commemorate the event and to explore the future science of heart and lung transplantation (see full schedule below).

Among those survivors will be Elizabeth Craze, now 26 years old, an IT employee working for Facebook in Palo Alto who at the age of 2 years and 10 months was one of the youngest successful heart transplant recipients in the world.

"I think I'm more grateful about life than most people," said Craze, dressed in red Keds and a gray "Geeks for Obama" sweatshirt on a break from work. "I get excited about the littlest things."

Craze, who celebrated the 24th anniversary of her heart transplant operation this month, has taken medications all her life, struggled with the drugs' side effects that gave her hairy eyebrows during her teen years, and resulted in a kidney transplant operation 10 years ago. But she looks and feels so healthy that friends are always shocked when they find out she's had a heart transplant.

"You wouldn't know there's a thing wrong with her," said Susan, her mother, who moved the family from Cleveland to the Peninsula to be near Stanford in 1989. Elizabeth's older brother Andrew, 41, had the first heart transplant operation in the family, a year before Elizabeth when he was 16. Today he's a mechanical engineer living in Cleveland.

Because there was no Lucile Packard Children's Hospital at the time, both Andrew and Elizabeth received their new hearts at Stanford Hospital.

"My brother-in-law was the first to tell us about Stanford and how Dr. Shumway had continued the heart transplantation program even though so many medical facilities couldn't do it," Susan Craze said. "Stanford's team was just so on top of everything. It was amazing."

Part of the success of the Stanford and Packard programs continues to be their multidisciplinary team approach to patient care, which includes nurses, social workers and physicians. Social workers and nurses committed themselves to Elizabeth's care after the operation, Susan Craze said. During the month-long recovery period, they worked overtime, took the girl trick-or-treating on the hospital ward and camped out by her bedside.

"We could foresee what the potential was for creating a multidisciplinary team approach to treatment," Stinson said. "The whole idea was to transform what was brand-new technology into routine therapeutics."

Advancements in the years following that first successful operation paved the way for future patients. New developments were made, many emanating from Stanford, in anti-rejection drugs, techniques for predicting organ rejection and ways to care for patients after transplants. New laws would define death based on brain function rather than heart function so that beating hearts could be extracted from brain-dead patients.

"I remember harvesting a child's heart in North Dakota one night in 1986," Stinson said. "We preserved that heart for a good eight hours. It was a world's record at that time."

Another heart procurement, this one carried out by Shumway, involved a homicide victim in Oakland. A defense lawyer claimed the death was caused by removing the victim's heart after brain death had been declared. The legal opinion helped clear the way for heart extraction from brain-dead patients. The defendant was ultimately found guilty, Stinson said.

In 1984, when Elizabeth Craze showed up at Stanford in need of a new heart, the primary question was whether a donated heart would continue to grow along with her body. She was deathly ill and weighed only 23 pounds. An ethics committee was formed and, after listening to her brother's pleas, the decision was made to go ahead with the operation.

"It was difficult trying to find a donor," Susan Craze said. "It was really close whether she was going to make it another day." On Oct. 8, 1984, the healthy heart of a little girl from Utah, the victim of a car crash, was transplanted into Elizabeth's chest.

"My parents told my brother and me we could have whatever we wanted after surgery. I asked for pink ballet shoes," Elizabeth said. "Andrew said he wanted the car. He got the brown Volvo."

Susan Craze got her two children given back to her.

"I don't think I could have survived them dying," she said.

"Looking to the Future: 40 Years of Heart and Lung Transplantation at Stanford University" -- an Oct. 24 symposium at Stanford

Schedule of events:

-- 7:30 a.m. -- Registration

-- 8 a.m. - noon -- Scientific symposium

-- 12:15 - 1:10 p.m. -- Live interview about the first heart and heart-lung transplants with Edward Stinson, MD, professor emeritus of cardiothoracic surgery at Stanford, who assisted the late Norman Shumway, MD, in the first successful U.S. heart transplant; and Bruce Reitz, MD, the Norman E. Shumway Professor of Cardiothoracic Surgery at Stanford, who with Shumway performed the world's first heart-lung transplant.

-- 2-4 p.m. -- Transplant recipient reunion

Speakers and topics during morning symposium:

-- "40 years of progress in the treatment of heart failure," Michael Fowler, MD, professor of cardiovascular medicine, Stanford.

-- "Mechanisms of idiopathic dilated cardiomyopathy," Michael Bristow, MD, professor of medicine, University of Colorado.

-- "The future of mechanical circulatory support," Peer Portner, PhD, consulting professor of cardiothoracic surgery, Stanford.

-- "Effects of pediatric heart disease on adult heart failure and transplant," Daniel Murphy, MD, professor of pediatric cardiology, Stanford.

-- "The next generation of immunosuppression drugs," Randall Morris, MD, professor emeritus of cardiothoracic surgery, Stanford.

-- "The future of transplantation immunology," Philip Halloran, MD, PhD, professor of medicine, University of Alberta.

-- "The evolving challenge of infection in the setting of cardiac transplantation: 40 years of Stanford contributions," Jose Montoya, MD, associate professor of infectious diseases and geographic medicine, Stanford.

-- "Mechanisms of cardiac allograft coronary artery disease," Hannah Valantine, MD, professor of cardiology, Stanford.

-- "Future treatment strategies for antibody-mediated cardiac rejection," Adriana Zeevi, PhD, professor of immunology, University of Pittsburgh.

Stanford University Medical Center integrates research, medical education and patient care at its three institutions -- Stanford University School of Medicine, Stanford Hospital & Clinics and Lucile Packard Children's Hospital. For more information, please visit the Web site of the medical center's Office of Communication & Public Affairs at http://mednews.stanford.edu.

Stanford Hospital & Clinics is known worldwide for advanced treatment of complex disorders in areas such as cardiac care, cancer treatment, neurosciences, surgery, and organ transplants. Ranked #16 on the U.S. News and World Report annual list of "America's Best Hospitals," Stanford Hospital & Clinics is internationally recognized for translating medical breakthroughs into the care of patients. The hospital is part of the Stanford University Medical Center, along with the Stanford University School of Medicine and Lucile Packard Children's Hospital. For more information, visit www.stanfordhospital.com.

Ranked as one of the best pediatric hospitals in the nation by U.S. News & World Report, Lucile Packard Children's Hospital at Stanford is a 272-bed hospital devoted to the care of children and expectant mothers. Providing pediatric and obstetric medical and surgical services and associated with the Stanford University School of Medicine, Packard Children's offers patients locally, regionally and nationally the full range of health-care programs and services -- from preventive and routine care to the diagnosis and treatment of serious illness and injury. For more information, visit http://www.lpch.org.

(NOTE TO REPORTERS: If you are interested in covering either the heart transplant symposium the morning of Oct. 24 or the transplant patient reunion that afternoon, please contact one of the media representatives listed above so that they can add your name to the guest list.)