More than 11 weeks after the death of the world's first recipient of a permanent artificial heart here, University of Utah doctors have had to put off several new requests for the hearts because of extremely narrow patient criteria and university officials' delays in setting rules for the next operation.
John Dwan, a spokesman for the university's medical center, said that doctors had been particularly interested in a recent request from a young female heart patient whose general health was considered good enough for her to survive the operation and live far longer with the metal and plastic heart than did the first recipient, 62-year-old retired dentist Barney B. Clark. The prospective patient was rejected, however, because she was too small to accept the Jarvik-7 heart, which only fits individuals at least 5-feet-10 and 160 lbs.
University officials said the delay in approving a new implant operation arises not only from the device's limitations but also a lengthy process of rule-making by the medical center's institutional review board.
Delays are also anticipated because of staff summer vacations and the possibility of new leadership for the artificial heart program. A key administrator, Dr. Chase Peterson, university vice president for health services, is one of three finalists for president of University of Utah; announcement of an appointment is expected this week.
Clark died March 23, 112 days after receiving his artificial heart, from the consequences of a severe infection not directly related to the heart implant. The artificial heart, attached by two long air hoses to a television-sized air compressor, kept beating steadily until his death. One of the devices has also kept a sheep alive a record 10 months.
The institutional review board rules currently limit the experimental operation to severely ill patients such as Clark, who had emphysema and cardiomyopathy, a severe weakening of the heart muscle from which as many as 20,000 Americans suffer.
A.E. Rothermich, assistant vice president for health services, said that many involved in the artificial heart program would like the review board to permit operations on heart patients who are otherwise in good health, so that the device can increase their chances of resuming a healthy life. Some officials argue, however, that it may be wrong to subject patients who are not near death to painful surgery and a life permanently attached to a portable air compressor.
Dr. Don B. Olsen, director of the artificial heart research laboratory here, said he planned to begin animal experiments in July with a smaller artificial heart that could fit small and medium-sized individuals. But until the review board draws up new rules, expected to take several weeks, new patient requests will be put off "even if we have a 6-10, 20-year-old weight-lifter," Peterson said.
Under current rules, Dr. William C. DeVries, the surgeon who implanted the heart in Clark, has emergency authority to implant a second artificial heart if a patient in the midst of an ordinary heart operation appears unlikely to survive by any other means.