Boyd Rusia Rush was an American retired upholsterer who was the recipient of the world's first heart transplant in the early morning hours of January 24, 1964, at University of Mississippi Medical Center in Jackson, Mississippi. In an emergency fall-back position with no human donor heart available, Boyd's doctor James D. Hardy used one of four chimpanzees he had acquired for just such an eventuality. This transplanted heart beat in Rush's chest for approximately one hour, and then failed without Rush regaining consciousness.
Biography
Rush was born on Independence Day, 1895, in Coldwater, Mississippi. During the U.S. draft for World War I, he was living in Enid, Mississippi and working as a day laborer. His physical build was listed as "stout." In 1936, he married Mary Senora "Nora" Bridges. In 1942, he and his wife were living in Baton Rouge, Louisiana, where he was working at Jack's Cookie Company. He has also been described as a "deaf mute."
Heart transplant
at the University of Mississippi Medical Center, who had previously performed the world's first lung transplant with a dead human donor, had also been impressed by the limited success of Keith Reemtsma in transplanting chimpanzee kidneys into human patients. Hardy acquired four chimpanzees for the possibility of a heart transplant. Dean of the Medical School Robert Marston and Hardy jointly established conditions for a heart transplant which included, that since a heart transplant was highly experimental, they could only consider a patient already close to death and who had no other hope of survival. On January 22, 1964, 68-year old Rush had been found unconscious by neighbors. His lower left leg was black with gangrene, his face was mottled with blood clots, and he only had a faint pulse. All these symptoms were likely caused by his heart's inability to pump enough blood. Rush was brought to the hospital in a coma. Mrs. J.H. Thompson, who was either his sister or stepsister was asked to sign the consent form which made no mention that an animal heart might be used. A 2012 article in the Baylor University Medical Center Proceedings stated, "Such was the medicolegal situation at that time that this 'informed' consent was not considered in any way inadequate." Hardy later stated that he had verbally discussed the procedure in detail with relatives including the possibility that a chimpanzee heart might be used, although in fact Mrs. Thompson was the only relative present. There was also a trauma victim in the hospital's ICU who was brain-dead and whose family had given permission for him to be a heart donor. However, the legal definition of death at the time required that the heartbeat stop, and this trauma victim's heart still beat. The concept of brain death had not yet received widespread acceptance. On January 22, Hardy amputated the gangrenous portions of Rush's left leg. On January 23 at approximately 11:00 pm, Rush went into shock and his blood pressure fell to 60. Hardy took him into the operating room. Rush's heart stopped just before they attached him to the heart-lung machine. Hardy then polled the other four doctors regarding whether they should continue with the transplant knowing that they would now use a chimpanzee heart and would likely receive much public criticism. He asked each quietly, "Are you prepared to proceed?" The first doctor agreed, the next abstained, and the last two nodded their consent. The five doctors began the heart transplant using the largest of the four chimpanzees. Just after 2:00 am on Friday, January 24, 1964, Hardy completed the stitching to connect the chimpanzee heart into Rush's chest. He used a defibrillator to start the donor heart beating. The heart beat for 60 minutes and then could not be restarted. After the transplant attempt, the hospital's director of public information put out a guarded statement which included the phrase "the dimensions of the only available donor heart." The Associated Press assumed the donor heart was that of a human being and widely distributed the story. The hospital was thereby put in the position of issuing a correction, which embarrassed both the hospital and Hardy. Hardy was further embarrassed at a medical convention two weeks later. He later wrote, "I had noted that when one loses his academic post, for whatever reason, he is not likely to get another one of comparable significance. I decided to wait until Shumway and his group transplanted a heart in man." Rush at the time was either living in Hattiesburg or in the Laurel Trailer Park on the outskirts of Jackson, Mississippi. The operation started at approximately 11:00 pm on January 23, but the chimp heart was inserted in Boyd's body at approximately 2:00 am. on Jan. 24, 1964. Almost four years later, Christiaan Barnard at Groote Schuur hospital in South Africa performed the world's first human-to-human heart transplant on December 3, 1967. The patient Louis Washkansky did regain consciousness, and in fact, lived for 18 days before dying of pneumonia. The donor heart was from 25 year-old Denise Darvall who had been rendered brain dead after she and her mother had been struck by a drunk driver. Her father gave permission for the transplant.
Overlooked by history?
Rush is sometimes overlooked by accounts of early transplant history. For example, a 2017 BBC retrospective article which covers Barnard's 1967 operation has a photo caption stating that Louis Washkansky was the first recipient of a heart transplant, when Rush was technically the first recipient of a heart transplant. The 2013 book Organ Donation includes James Hardy's 1963 lung transplant , but makes no mention of Hardy's 1964 heart transplant attempt with Rush as his patient.
