My patient told me,
Forty years ago today legendary surgeon Professor Sir Magdi Yacoub carried out the UK’s first heart and lung transplant, saving the life of Swedish journalist Lars Ljungberg who had approached the surgeon – already famed for his heart transplants – as his last hope.
Experts in the United States had refused to operate as they felt Mr Ljungberg’s organs had deteriorated too far. And although, sadly, he died 13 days later of an underlying condition, the pioneering operation itself was a success and paved the way for thousands of life-saving transplants to follow.
“Mr Ljungberg was a wonderful man, very determined and intelligent, who came to Harefield Hospital and said, ‘It’s my last chance, what do I do now?’ I, for one, always feel you should have empathy with your patients, so we talked it over and I explained that it was a high-risk operation.
“It was a last chance, but a chance is a chance and I told him we were willing to give him that chance and, at the same time, it was very important that the operation should be established anyway. He was very motivated and happy to accept the risk, and said, ‘If I don’t make it, please play Mozart’s Requiem at my funeral, I will appreciate it.’ He was accepting, and very grateful we took him on. It proved to be a landmark operation which benefited many thousands of people.”
To date, more than 3,500 people have received dual heart and lung transplants at Harefield, where Professor Yacoub, now 88, developed the procedure in 1983.
He reveals to the Daily Express that he was on “auto-pilot” for the duration of the operation having already carried it out “hundreds of times” in his head while awake and as he slept.
“It is not a sleepless night. I do go to sleep, but my brain is so focused on the idea, which I have first cut into its component parts, that my subconscious continues to try to solve the problem,” he explains.
“When I got into the surgery it was actually very quick because the link between the hand and the brain is so well coordinated in my mind that I didn’t hesitate.”
Prior to this, he had introduced modifications to heart transplant surgery that proved to be the bedrock of this more complex operation.
“I try very hard to equip myself with as much knowledge and skill as I can. Sir Russell Brock [the surgeon at Guy’s Hospital who he trained under], said that people think heart surgery is glamorous,” he recalls.
“It is actually very hard work. You have to be dedicated.
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“And once you start an operation you have to stop being about emotion – even though you love this patient and their family – and concentrate completely.
“You become almost automatically fixed, like a machine, without emotion. During the operation, you have to be dedicated to the patient and think about nothing else beyond making what you are doing successful.
“Some people think surgeons are doing it for their own glory, but you are doing it for the sake of the patient who has nowhere else to go.”
Professor Yacoub tells me there were approximately 20 colleagues with him that day, each with an important role to play. The complex operation was actually in two parts: taking the existing organs out and putting the new organs in.
“The surgery itself was quite quick, but we don’t finish or give the reverse anticoagulation drugs [to help the blood clot] until we are absolutely sure [the patient is stable].”
So how does this humble, yet eminent surgeon balance holding someone’s life in his hands? He insists the responsibility is eased by the knowledge that, without his intervention, the patient has no future. “You are just a doctor trying to do your best.”
A biography of this giant of medicine has now been published to coincide with the momentous anniversary of the operation. Professor Yacoub began the transplant programme at Harefield Hospital in 1980 with Derrick Morris, who became Europe’s longest-surviving heart transplant patient until his death, aged 75, in July 2005.
Two years later, he performed a heart transplant on John McCafferty, who survived for more than 33 years, until February 10, 2016, and was recognised as the world’s longest-surviving heart transplant patient by Guinness World Records in 2013.
Both these pioneering operations were the building blocks for the more complex heart and lung transplant surgery he was to pioneer in the UK.
Although he retired from the NHS in 2001, his charity, Chain of Hope, is bringing his brand of life-giving medicine to those with nothing. It creates hospitals offering free healthcare in Egypt, Rwanda and Ethiopia. In the process, this giant among cardiovascular surgeons, whose wife Marianne passed away from cancer aged 71 in 2011, is providing a knowledge exchange programme to pass on his expertise.
He says: “A major part of my life right now is trying to present to humanity everything I have learned, with an element of continuity and sustainability.”
Born in Egypt on November 16, 1935, Professor Yacoub was inspired to become a surgeon after the death of his youngest aunt in childbirth from an undiagnosed heart valve issue that is particularly dangerous in pregnancy. In fact, he tells me he was only “five or six years old” when she died.
“It affected me because I saw my father having a nervous breakdown, and saying, ‘I lost my darling sister to a preventable cause’.
“And I said, ‘Don’t worry Dad, I will find a solution’. He told me about a Mr Brock who was working out how, and that he was in the UK.
“I told him I would study under him one day, and in fact I came the UK [in the early 1960s] and I did.” As the young Magdi had matured, his father Habib – also a surgeon – continued to shape his son for this important future work.
“He said, ‘You are a bit disorganised and haven’t got what it takes to achieve all that.’ So I got really determined to correct
that and equip myself to try. He was a huge influence.”
The professor has three children – pilot Andrew, 54, Lisa, 52, a charity manager, and doctor Sophie, 48.
But it is also the heart itself that inspires his work. “I am totally in love with the heart,” he says with feeling.
“For one, unlike neurological disease, if you do something to the heart you see a result immediately. The other thing is that I have major respect for an organ that goes on silently beating, millions of times, without bothering anyone or making a fuss. Each heart has a personality; you need to know when you are dealing with its particulars.
“Many people, including me, thought it was just a pump. But it has now been discovered that it is an endocrine organ, connected to the brain by many nerves, that affects the function of the brain, and is influenced by the brain. The heart has a massive influence on our personalities.”
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When I ask about reported cases where the recipient of a donor organ believes their personality has altered following surgery, as if some element of character has been transplanted along with the tissue, I expect him to be dismissive. He admits that, for many years, he did not believe this was possible.
“I used to deny it, but now I have my doubts. There could be something in it,” he says. He recently received a letter from a transplant recipient in Canada. “She had loved classical music but after the transplant, her taste in music changed dramatically and she found she liked fast cars. She appears to have acquired some of the particulars of the donor,” he reveals.
“I’m not sure how to take it. Now I know about the mechanisms in the hormones secreted by the heart and the nervous communication [between the two], there could be some truth in it.”
“If we disregard it and say it cannot happen we are disregarding science, which is a quest for the truth.”
Ethical questions underscore his work, and I wonder if he would always favour a younger recipient of an organ?
“It’s a very difficult question, and a good one,” he says. “In general, we base decisions on tissue-matching and organ size, but sometimes we ask, ‘Does the younger person always take precedence over an older person who could be helping many people, and having an impact on society?’
“We admit there are questions to which we have no answer.”
The conclusion of surgery finds him in a state of “muted calm, and sometimes exhaustion” having deployed “massive concentration over a long period of time” on behalf of the patients who trust him. Surgeons are sometimes criticised for playing god, deciding who lives and dies. Professor Yacoub is the antithesis of this mindset. “The most important thing is to have humility. When people ask me now, ‘What is the secret of success’, it is really relatively simple,” he says.
“I tell them about ‘PPH’. Passion for what you are doing, so it is not just a duty but a vocation. Persistence – to follow your path you don’t need to be a genius, you just need to be persistent.
“But the last and most important thing is to be humble. Even after you think you have arrived at the top of the mountain, there is so much more to discover, as you find you are just on a little hill.
“If you are humble you can speak with royalty and to the most desolate person in Africa who needs help. Never be full of yourself. The human genome has shown that we are all equal.”
· A Surgeon and a Maverick by Simon Pearson & Fiona Gorman (American University Press, £24.95) is out now. Visit expressbookshop.com or call 020 3176 3832. Free UK P&P on orders over £25
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