The amazing story of the UK's first heart-lung double transplant

After the introduction of the immunosuppressive drug cyclosporin A in 1982, and a steady improvement in the survival of heart transplant patients in the following eighteen months, Magdi Yacoub pushed the frontiers of cardiac surgery in Britain still further. Late in 1983, he accepted a patient that even the Americans working under Professor Norman Shumway at Stanford University considered to be a lost cause. 

The patient was Lars Ljungberg, a 33-year-old Swedish sports journalist who was suffering from a condition known as pulmonary hypertension. This is a form of high blood pressure in the pulmonary circulation that destroys the lungs and weakens the heart, causing the right ventricle to fail and, in the case of Ljungberg, early multi-organ damage. The only hope of prolonging his life was for him to receive a new heart—and new lungs. 

At Stanford, where the first successful heart-lung transplant was performed in 1981, 16 people had undergone the operation by the time Ljungberg was considered for treatment. Eleven were still alive and one had lived for two and a half years. The Swede, however, was considered untreatable. The deterioration in his health was shocking. Less than three years earlier, Ljungberg had been running 15 kilometres, three times a week, and playing football for an amateur team in his hometown of Falun in central Sweden. By the time he was assessed by the Americans, he could barely walk across a small room. Late in the day, Ljungberg turned to Yacoub, who had never performed the operation.

“Lars was intelligent and quite talkative, but matter-of-fact,” recalled Yacoub. “He knew it would be the first heart-lung transplant in Europe.”

For a man fighting for his life, the Swede made one unexpected request. According to Yacoub, he said, “I want you to play Mozart’s Requiem at my funeral.”

“I said, ‘How do you know you are going to die, Lars?’ And he said, ‘Well, it’s just a possibility.’”

Yacoub was all too familiar with the possibilities, through the many patients he had saved and those he had lost. While he always appeared to be calm and professional, Yacoub was a warm, empathetic man who identified with the plight of his patients. Echoing the sentiments of his mentor, Lord Brock, Yacoub said, “People think of the life of a cardiac surgeon as a rosy, wonderful, satisfying job with no pain, but it is far from that, of course.”

Ljungberg, who was married with three children, arrived at Harefield Hospital on October 20, 1983, after being flown from Sweden in an air ambulance. At the time, no heart transplants had been performed in his homeland; the first would not be until a year later.

While Yacoub was a committed internationalist who welcomed foreign patients and was building a truly global network of contacts, he—and the managers of Harefield Hospital—had to tread carefully. The treatment of foreign patients on the National Health Service, which does not charge for healthcare and is funded by the British taxpayer, was a vexed issue that often involved complex financial arrangements. The topic was fiercely debated in Parliament and by medical bodies and the press.

Amid arguments over policy, Harefield set out to balance the number of foreign patients given heart or heart-lung transplants with the number of organs harvested from overseas donors, which it pursued vigorously. While the hospital also used different international agreements on funding, these arrangements were far from straightforward, and led to disputes with the Department of Health and Social Security and between Britain and other countries. In the case of Ljungberg, his operation at Harefield was paid for by the Swedish health authorities; it cost about £20,000 (the equivalent of £70,000 today). A further £15,000 was raised by the people of Falun to pay for a Swedish nurse to accompany the patient and to cover his expenses.

Six weeks after Ljungberg’s arrival, Harefield found a suitable heart-lung donor: an unidentified woman from the south of England who had died of a brain haemorrhage. On this occasion, the brain-dead donor was intubated—the process by which a breathing tube is inserted into the airway and oxygen is pumped into the body to keep the vital organs “alive”—and then brought to Harefield. The heart-lung transplant started at 9:00am on Tuesday, December 6, and involved a team of 20 doctors, nurses, and technicians. It lasted more than five hours.

One member of the surgical team was Peter Alivizatos, who recorded events in a scientific paper entitled, “Sir Magdi H Yacoub, the Leonardo da Vinci of Cardiac Surgery.” “In two adjacent rooms,” wrote Alivizatos, “Yacoub first removed the heart and lungs from the donor, immediately afterward doing the same thing with the recipient. He then proceeded with the transplant operation without the slightest hesitation, underlining the difference between a meticulous well-prepared surgeon and a genius.”

A Surgeon and a Maverick—The Life and Pioneering Work of Magdi Yacoub, by veteran journalists Simon Pearson and Fiona Gorman (AUC Press, £24.95) is available now