Richard Lower Dies at 78; Transplanted Animal and Human Hearts

By JEREMY PEARCE [New York Times]

Dr. Richard R. Lower, whose daring heart surgeries on animals in the 1950s
helped pave the way for the first successful transplant of a human heart in
1967, died on May 17 [2008] in Twin Bridges, Montana. He was 78.

The cause was pancreatic cancer, his family said.

As a surgical resident at Stanford University in 1959, Dr. Lower
transplanted part of a dog's heart to a second dog, which lived for eight
days, shattering a previous survival record of seven hours. He was working
with Dr. Norman E. Shumway, who became a towering figure in cardiac surgery
and eventually oversaw the transplanting of 800 human hearts.

One innovation was to leave in place sections of the recipient heart's upper
chambers, which shortened the duration of the operation. But when an
infection took hold, Dr. Lower and Dr. Shumway euthanized the dog and drew a
prescient conclusion: that difficulties in transplants would no longer be
technical or tied to problems in surgery so much as to conquering infection
and the patient's immune response.

Dr. Lower (pronounced LAU-er) continued to experiment with animal
transplants after moving to the Medical College of Virginia, in Richmond, in
1965. A rush to apply the procedure in human cases of severe cardiac disease
and malfunction was inevitable, and a South African surgeon, Dr. Christiaan
N. Barnard, performed the first successful human heart transplant in 1967.
Dr. Barnard had visited Dr. Lower's laboratory in 1966 and studied the
Shumway-Lower approach and technique.

Dr. Lower declined an opportunity to perform an early heart transplant
because of incompatibility of the blood types of the potential donor and
recipient. Then, in 1968, he operated on a 54-year-old man, who died a week
afterward. In the same year, Dr. Lower operated on a 43-year-old man, and
that surgery proved to be highly effective; the patient survived for six and
a half years.

Scientific caution and startling patient mortality reduced the pressure for
transplants in the 1970s, although Dr. Lower and others continued to refine
the procedure. At Stanford, Dr. Shumway combined the use of cyclosporin, an
immunosuppressant drug, with an innovative biopsy technique that enabled him
to readily check the body's acceptance or rejection of a new organ. In time,
survival rates in the first year for transplant patients rose from roughly
60 percent in the 1970s to nearly 90 percent today. Transplant recipients
have lived as long as 27 years after the surgery.

From 1968 until his retirement in 1989, Dr. Lower took part in 393 heart
transplants and "persisted, along with Dr. Shumway, when many others quit or
doubted the procedure," said Dr. Marc R. Katz, a cardiothoracic and
transplant surgeon, and the medical director of Bon Secours Heart and
Vascular Institute in Richmond.

Dr. Katz, a former student of Dr. Lower, also said that he was instrumental
in sending organ-harvesting teams to the hospitals of potential donors, in
order to speed transplant schedules and in consideration of donors'
families. Before the late 1970s, he said, it was a common practice to send a
donor's entire body to the recipient's hospital, a cumbersome process that
was emotionally fraught for the donor's relatives.

Richard Rowland Lower was born in Detroit [Mihigan]. He graduated from
Amherst College and earned his medical degree from Cornell University in
1955.

He was an assistant professor of surgery at Stanford before moving to the
Medical College of Virginia at Virginia Commonwealth University, where he
was named a professor of surgery in 1967. He was also a former chairman of
the college's division of thoracic and cardiac surgery.

Dr. Lower is survived by his wife of 55 years, the former Anne Rutherford.
The couple lived in Richmond [Virginia] and Twin Bridges. He is also
survived by a daughter, Hilary Richardson of Keene, N.H.; three sons, Gavin,
of Hampden-Sydney, Virginia, and Frederick and Glenn, both of Middlebury,
Vermont; a brother, Frederick, of Mount Dora, Florida and six grandchildren.

After retiring in 1989, he spent most of his time in Montana, where he
managed a ranch and beef-cattle operation. But he returned to medicine in
1998, to practice in a very different capacity: He worked as a general
practitioner at the Cross-Over Clinic, an inner-city facility serving the
needy in Richmond, still consulting on transplant cases but spending most of
his time in primary care.

http://www.nytimes.com/2008/05/31/health/31lower.html?ref=obituaries