Monday, Nov. 12, 1984Baby Fae Stuns the WorldBy Claudia WallisA baboon-heart transplant inspires both awe and angerExcept for the gauze-covered wound stretching almost the length of her torso, the tiny, dark-haired babygirl might have been just any infant. Lying in her crib with a pacifier close at hand, she gave a couple ofgaping yawns. She delicately stretched her scrawny arms in weariness. And mostly she slept. But last week,as television viewers got their first glimpse of the newborn known only as Baby Fae, it was her visiblyheaving chest that stole the show. There was no mistaking the pulsations of life and no forgetting that thepower source was the freshly implanted heart of a young baboon.One week after the historic transplant operation at Loma Linda University Medical Center in SouthernCalifornia, the first infant—though not the first person—to receive a simian heart was reported to be doingremarkably well. "All vital signs are still good, and there's no sign of rejection," said Hospital SpokeswomanPatti Gentry, noting that Baby Fae was "just gulping down her formula." Outside the hospital, there waswonder and excitement over this latest medical marvel, but the enthusiasm was dampened somewhat bycontroversy. Antivivisectionists around the country and abroad protested what they called "ghoulishtinkering" with human and animal life. "This is medical sensationalism at the expense of Baby Fae, herfamily and the baboon," charged Lucy Shelton of People for the Ethical Treatment of Animals. The groupwas one of several that demonstrated outside the Loma Linda hospital last week.The medical community, though normally receptive to technical innovation, was sharply divided. "Therehas never been a successful cross-species transplant," declared University of Minnesota Surgeon JohnNajarian, one of the country's leading pediatric-transplant specialists. "To try it now is merely to prolongthe dying process. I think Baby Fae is going to reject her heart." Others defended the experiment. "It's veryeasy to sit back and be negative when a new treatment is announced," said Dr. John Collins, chief of cardiacsurgery at Boston's Brigham and Women's Hospital. "If we all were afraid to attempt the untried, we wouldhave no new treatments."Little is known about the 5-lb. object of all this controversy or how she came to be the subject of so dramatican experiment. Loma Linda officials have refused to reveal the child's real name, the identity of her parentsor even her exact age. They did say that she was about two weeks old at the time of surgery and had beenborn three weeks premature. Baby Fae was referred to Loma Linda by a pediatrician in Barstow, Calif. The546-bed facility is one of more than 60 U.S. hospitals operated by the Seventh-day Adventist Church andhas a fine reputation in pediatric heart surgery. Fae was suffering from hypoplastic left-heart syndrome, afatal condition said to affect one in 12,000 newborns. In children with this defect, the left side of the heart,including its main pumping chamber, the left ventricle, and the aorta, is seriously underdeveloped. In Fae'scase, doc tors said, the left side of the organ was virtually nonexistent.Dr. Leonard Bailey, 41, the pediatric cardiac surgeon who treated Fae, over the years had seen dozens ofinfants with this defect die, generally within two weeks of birth. While a transplant from a human donorcould theoretically be used to help such babies, Bailey was discouraged by the drastic shortage of infanthearts. Seven years ago he began investigating the possibility of using hearts from other species, orxenografts. He performed more than 150 transplants in sheep, goats and baboons, many of them betweenspecies. Last December, after what Bailey called "months of agonizing," the Loma Linda institutional reviewboard gave him preliminary approval to implant a baboon heart in a human infant. The final go-ahead camejust two days before Baby Fae's surgery. "There is evidence that the chimpanzee, orangutan or gorilla maybe a better donor," Bailey noted last week, "but they are either an endangered species or don't procreatewell in captivity."Baby Fae, who had no defects other than her hypoplastic heart, was the first infant to come to Bailey'sattention who met the criteria for his experiment. As in the case of the late Barney Clark, who in 1982became the world's first recipient of a permanent artificial heart, an elaborate consent form had beenprepared. Fae's parents signed the form once, then thought over their decision for 20 hours before signing itthe required second time. According to the hospital, the couple were well informed of the risks and thealternatives.Meanwhile, Sandra Nehlsen-Cannarella, a transplantation immunologist brought in from New York City'sMontefiore Medical Center, conducted five days of laboratory tests to determine which of six baboons atLoma Linda most closely matched Baby Fae's tissue type. However, before the tests were complete, theinfant's heart suddenly deteriorated and her lungs filled with fluid. The dying child was swiftly transferredto a respirator and given drugs to keep her blood circulating. The measures were able to sustain her longenough for a baboon donor to be chosen and surgery to begin.Following what is now standard practice in heart transplants, Bailey transferred his tiny patient to aheart-lung machine, using it to gradually lower her body temperature from 98.6° F to about 68° F. Thelower temperature slowed the baby's metabolism, allowing her other organs to better tolerate a reducedblood flow. One hour and 45 minutes into the operation, Bailey descended three floors to the basement,where the hospital maintains a colony of 29 primates. There, he removed the walnut-size heart of a seven-month-old female baboon, the animal that had proved to be the best match for Baby Fae, and placed theorgan in a cold saline "slush." Elapsed time: 15 minutes.Back in the operating room, Bailey removed Fae's defective heart and replaced it with the heart from thebaboon. Because baboons have only two major arteries leaving the aortic arch, as opposed to the three inhumans (see diagram), two of the baby's vessels were first joined together before being connected to one ofthe two arterial openings in the baboon's aorta. When the delicate plumbing job was completed, doctorsslowly raised the infant's temperature and weaned her from the heart-lung machine. At 11:35 a.m. on Oct.26, four hours and five minutes after Baby Fae