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spotlight  IN THE SPOTLIGHT:

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2013 ISHLT Pioneer in Transplantation:
Jack Copeland, MD

Cardiac Replacement: A Journey "Outside the Box" - Another Form of Enlightenment

Vincent Valentine, MD
Editor, ISHLT Links Newsletter

By the end of the American Revolution roughly 230 years ago, a number of intellectuals were "hanging out" in a number of salons in Berlin and Paris talking about the Enlightenment. In an effort to clarify its meaning, the Editor of the Berlin Monthly posed a prized question, what is the Enlightenment? One of the entries was submitted by Immanuel Kant, a professor from Königsberg, Prussia. Kant characterized the Enlightenment as a waking up to a realization that we have created realms separate from ourselves on which we have become dependent. In other words, we are "boxed in" by our biases and opinions thus limiting our ability to objectively examine the truth. Kant further pointed out that we have erected transcendent religious realms also shackling our ability to be objective. We defer to these realms because we believe they make claims on us. Kant also said that once we are "Enlightened" we then have the courage to discern that we have been trapped in these realms and that we must act on them to get rid of these self-imposed dependencies.

Immanuel Kant was a champion of natural science in his day. Among the achievements were the remarkable strides of the great natural philosophers from the Enlightenment Era. The time frame from this era has been marked by its commitment to discover truth and by its confidence in reason as the means with which to do it. Today we refer to it as the Age of Reason. Among the many factors that kept our original philosophers thoughts confined to the box, the church was probably the single most important one. Today, we still have our own inherent biases, perhaps religion, politics and other social variables that can box us in. It is this box that becomes the symbol of how we must challenge ourselves.

During the opening Plenary Session our very own Pioneer, Jack Copeland, took us on a journey outside the box with cardiac replacement by challenging himself and societal pressures. He used Thomas Kuhn's concept of the paradigm and paradigm shift. In order to take a great stride as our great thinkers did in the Age of Enlightenment, Dr Copeland referred to our former pioneers including: Christian Barnard, Joel Cooper, Norman Shumway, Michael DeBakey, Bruce Reitz, Leonard Bailey, Richard Lower, Christian Cabrol, and Elizabeth Hammond. He paid special tributes to his mentors who were important in shaping his career: Richard Lower, Edward Hurley, Albert Iben, William Angell, and Edward Stinson.

No different from the Age of Reason, trying to escape or think outside the box could be very dangerous. There were no beheadings or boiling anyone in oil, however there were lawsuits in this Journey of Cardiac Replacement. Lower, Hume and Shumway were accused of murder during the procurement of hearts from our early days, but were proven innocent when indeed the donors died of brain death.

When Jack Copeland started heart transplantation in Arizona in 1979, he was confronted with a number of obstacles again confining him to another box. The possibility of no donors because of the risk of coccidioidomycosis, a waste of resources, and medico-legal risks did not stop him from thinking and escaping outside the box. Moreover, along with another one of our own Roger Evans, we must be grateful to Jack and Roger for finding that heart transplantation was both cost effective and improved quality of life over medical therapy. Now, Medicare and other third party payers pay for heart transplantation and continue to do so.

Jack turned his attention to Michael Hess, the Father of the ISHLT as well as Phil Oyer and Donald Hill who bridged our first bridges to heart transplantation with LVADs. Then there was the Phoenix Heart, the story of the Total Artificial Heart and the First Berlin Heart in the United States by Jack Copeland.

Finally, allow me to tie in nearly three centuries of thinking outside the box from the Age of Enlightenment to Cardiac Replacement (A Journey Outside the Box). This is how we make progress not just over a period of time, but day by day and perhaps minute by minute. Some decisions must be made over time and with patients in the operating room, in the ICU, in the hospital and in the clinic, and at times these decisions must be made snappy. Knowing when and how to make the right decision requires evidence and yet at times requires innovation. We will always be confronted by those factors that trap us in our biases or realms if you will. 300 years ago it was very likely the church or religion. Today, I refer to Jack Copeland's slide with Innovation in the Box, front and center and all the factors that try to trap us in that box. And remember, from Jack Copeland, "if you want someone to say "no," ask a committee."

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Disclosure Statement: The author has no conflicts of interest to report.