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Logo of medhistThe Wellcome Trust Centre of the History of Medicine (UCL)Medical History
Med Hist. 2010 July; 54(3): 423–424.
PMCID: PMC2889479

Book Reviews

Hearts exposed: transplants and the media in 1960s Britain
Reviewed by Fay Bound Alberti

Ayesha Nathoo.
Hearts exposed: transplants and the media in 1960s Britain,  Science, Technology and Medicine in Modern History Series, Basingstoke,  Palgrave Macmillan,  2009, pp.  xv, 262, illus., £52.00 (hardback  978-1-4039-8730-3). 

This is a timely and well-crafted contribution to current media debates over the moral and ethical responsibilities of the medical profession. Given today’s furore over organ donation, it provides a much-needed historical dimension to the anxieties facing physicians, surgeons and patients about the limitations and responsibilities of medical know-how. Through analyses of much previously un-theorized newspaper and magazine articles, medical association records and correspondence, Nathoo has situated the transplanted heart not only in terms of practical expertise, but also in the context of what we would now term the “trial by media” debates of the 1960s: should we transplant organs, even if it is mechanically possible to do so? What is the exact point of death? What is the status (and responsibility) of the cardiac surgeon? This latter question was asked again and again as Christian Barnaard, the cardiac surgeon responsible for the first “successful” heart transplant, was alternately sanctified and vilified by the media, and by a public that was more informed (and judgemental) about the role of the medical profession than ever before.

Nathoo provides a rich account of a process of increasing public intervention in the practice of medicine in general, and transplantation in particular. She acknowledges that part of the reason why the heart was so problematic was its historically spiritual and mythological status—indeed, its links to the emotional and psychological world of patients remains important today. Yet the first transplants were also controversial because they raised questions about privilege and knowledge, and reflected the possibility that doctors were becoming too egomaniacal in their desire to control nature—especially since the life expectancy of transplanted patients was so short as to be negligible. In the 1960s, then, transplantation was becoming a distinct clinical specialism at the same time as public hostility to the process was increasing.

Nathoo explains this apparent contradiction with reference to the fact that the first heart transplants—with all their godlike aspirations and their failings—were public events. Her context is one of transformed media communication in the UK—through the popularization of television from the 1950s, which coincided with the volatile world of reportage in the 1960s and greater demand by patients of their individual and collective “rights” (p. 33). “Public interest” became a contested notion and—given both the high cost (ethical and otherwise) of transplantation and the likelihood of failure—it was not at all certain that transplantations were in the public interest. Medical “advance” was greeted with ambivalence and even “dread” (p. 61). In this context, it would be interesting to see some analysis of the rhetoric and function of organ transplantation as a subject for horror movies—an interest that peaked in the 1960s with a shift from the realm of science fiction into psychological thriller.

Far from being assimilated into ordinary clinical practice, then, by the end of the 1960s (as was the promise at the beginning of the decade), heart transplantation stalled in the UK for a decade. It began again only in 1979 at Papworth hospital. It is a shame that Nathoo had not the space for an explanation of this resurgence—nor the transition from that point to the present day. As she acknowledges, the shift in fortunes of the heart transplant as a cultural, as well as a medical, event cannot be explained purely in terms of improved retro-virals. On a broader level, we might ask how far the politicization and disputation that Nathoo identifies as a 1960s phenomenon represents a “new” phenomenon, rather than part of a much longer process by which a broad and undefined “public” debated and negotiated the rights and responsibilities of medical practitioners. What was perhaps distinct about the 1960s seems less the existence of debates about the limitations of medical influence, than the speed and proliferation of means by which these debates took place. At the end of the twentieth century, the Internet arguably served a similar function to the print and television in heightening the speed and quantity of information being produced about the medical profession and in inviting patients as consumers or participants in determining what was and was not “ethical”. Thus the international debates in 2005 that followed the first “face transplant”—when the French surgeon Bernard Devauchelle, grafted part of a woman’s face that had been mauled by her dog—tested out the public palatability of medical knowledge in much the same way as Barnaard’s defining act had done. Indeed, face transplants (and even more brain transplants) seem to invoke the kind of dread in the media that heart transplants once did. I wonder what this tells us about the shifting status of the heart and the head as organs linked to our emotions, our personalities and our selves?

Articles from Medical History are provided here courtesy of Cambridge University Press