To the end, Dr. Barney B. Clark's plastic and metal heart worked like new, pumping blood at a steady beat to a body that was dead all around it.
Doctors eulogized the world's first recipient of a permanent artificial heart today as "a remarkable man, a pioneer to match these western lands."
Dr. Clark signed an 11-page consent form before undergoing the historic procedure, agreeing to face every possible dire consequence of the transplant, and before he died at 10:02 p.m. Utah time Wednesday (12:02 a.m. today EST) "most of them . . . happened," said Dr. William C. DeVries.
"His colon failed," DeVries said. "Then his kidneys failed . . . . Then his lungs failed. Then his brain failed and, lastly, when the key was turned off, his heart failed," the doctor said.
Clark's colon was hit by a massive infection apparently caused by antibiotics. The kidneys, lungs and brain quickly followed, all starved by blood vessels whose walls were too weak to carry oxygen and nutrients to them.
DeVries, the surgeon who implanted the device in the Seattle dentist when Clark's real heart failed--it had been transformed by disease into "tissue paper"--told reporters today that both he and Clark considered the experiment a success to the end.
He and other doctors at the University of Utah indicated that more patients would receive artificial hearts here after a few weeks of review and an updating of the hospital's consent form. The heart, driven by two long air hoses attached to a movable compressor, operated for 2,688 hours and beat approximately 12,912,400 times in 112 days.
"It is fair to say the artificial heart works well," said Dr. Chase Peterson, university vice president for health sciences.
DeVries said the artificial heart was removed from Clark's body during an autopsy today and is being studied for signs of stress. But it "looked as good as the day we put it in," he said.
About $10 million a year in federal funds is being spent on artificial heart research, with about $1 million a year of that spent here. Clark's operation and nearly four months of care cost $150,000 to $200,000, but was paid for by private donations, Peterson said.
Clark's wife, Una Loy, who doctors say was with him to the end, would make no public statement, Peterson said. He said a funeral is planned for Monday or Tuesday in Seattle, where the couple, both from Utah, had lived since World War II.
A White House spokesman said President Reagan telephoned Mrs. Clark today to express his sympathy for the family. Reagan told her her husband had been "a brave and courageous man," the spokesman said.
Clark had retired as a dentist in 1977, and was a skilled and enthusiastic golfer, a tall, rangy figure on the Rainier Golf and Country Club course with a six-to-nine handicap until he was struck by cardiomyopathy, a disease that weakens the heart, three years ago.
Throughout his ordeal, Clark maintained a gruff sense of humor that endeared him to nurses and others working in the intensive care unit where he spent much of his time. Just before he went into the operation Dec. 2, he smiled wryly at a group of doctors watching him go through the consent form for the second time.
"There sure would be a lot of long faces around here if I backed out now," he said.
Dr. Lyle Joyce, another of Clark's physicians, said "last night we lost my dear friend, a man who I believe will go down as one of the great pioneers in the advancement of science."
Peterson said, "More than three months ago he chose the unpredictable experiment over imminent but painless death."
The doctors said they would now cut off media contacts until at least the funeral and review what had been learned about the body's capacity to adjust to an artificial heart and the kinds of treatment needed to help ease that adjustment. Joyce said that as late as Saturday, Clark told him "he was glad he had made the choice he had made."
Although at one point Clark was well enough to move a few steps with the aid of a walker and do a brief television interview, Clark suffered recurrent crises and was always many weeks away from his dream of settling into a specially equipped Salt Lake City home and practicing his putting stroke. The last crisis began late Saturday, when he developed a fever that persisted, fluctuating between 101 and 104 degrees.
Doctors said they associated the fever with an impairment in the kidney function, a recurrent problem during Clark's stay here. They discussed with Clark and his wife putting him on a second artificial organ, a kidney dialysis machine, but by last night they realized he was too sick even for that.
DeVries said the autopsy showed a serious infection in the colon, which may have been caused by antibiotics disturbing the natural bacterial environment of that part of the intestine.
He said one part of the colon had suffered infarction, essentially death of the tissue. Peterson had said earlier that such a condition could be quickly fatal because Clark could not withstand the operation necessary to correct it.
Doctors also noted a buildup in fluids, particularly in the lungs, which raised Clark's blood pressure. Shortly after noon Wednesday, the artificial heart that had been pumping at 6 to 8 liters per minute suddenly dropped to 2.2 liters per minute and then to 1.3 liters per minute, the apparent result of the increased fluids and the failure of Clark's arteries to stay firm and maintain an even pressure.
The heart mechanism was adjusted and the output returned to normal, but the condition of Clark's natural organs continued to deteriorate.
At the end, DeVries said, Clark "clearly was not responding to any stimuli," a sign of brain death. The artificial heart, he said, was pumping blood to a dead man.
Asked if Clark's quality of life had improved enough to justify the operation, DeVries said "the quality of life was something Dr. Clark had to decide."
When, in a March 1 television interview, DeVries asked him what advice he might give to other potential artificial heart recipients, Clark said, "Well, I would tell them that it's worth it if the alternative is they either die or they have it done."