Cardiac Transplantation: The Second Epoch of a Sacred Adventure.

Cardiac transplantation is one of the most dramatic, esoteric, and sacred procedures available to cardiologists and cardiac surgeons as treatment for a limited number of patients with advanced, end-stage heart failure at imminent risk of death. Since the first "successful" allographic heart transplant in Cape Town, South Africa-in which the patient survived only 18 days-the procedure has become sine qua non for dramatic cardiovascular surgical adventures. The sacred aspect of cardiac transplantation relates to its intimate link to circulatory death, brain death, organ donation-and the miraculous gift that follows the decision to donate. It has indeed been called the "Gift of Life," where remarkable donor organ reanimation is seen in recovered hearts removed from a deceased donor. While this issue of the Methodist DeBakey Cardiovascular Journal focuses mainly on the current state of cardiac transplantation, Houston Methodist Hospital recently celebrated the 40th anniversary of its reenergized and remodeled cardiac transplant program. The program was led initially by Michael E. DeBakey, MD, with surgeons George P. Noon, H. David Short, and Hartwell H. Whisennand, and received substantial support from the Methodist Hospital cardiology section for what was to become the Multi-organ Transplant Team. This second epoch of the heart transplant program began on February 21, 1984, following commercial availability of the immunosuppressive agent cyclosporin, and it has operated continuously since then. The following highlights several aspects of cardiac transplantation that have led to its success as a lifesaving last resort for the most severe cases, which ultimately helps explain why the procedure is, in fact, sacred.