Guy Alexandre, a Belgian transplant surgeon who within the Sixties risked skilled censure by eradicating kidneys from brain-dead sufferers whose hearts have been nonetheless beating — a process that enormously improved organ viability whereas difficult the medical definition of loss of life itself — died on Feb. 14 at his residence in Brussels. He was 89.
His son, Xavier, confirmed the loss of life.
Dr. Alexandre was simply 29 and recent off a yearlong fellowship at Harvard Medical School when, in June 1963, a younger affected person was wheeled into the hospital the place he labored in Louvain, Belgium. She had sustained a traumatic head damage in a site visitors accident, and regardless of intensive neurosurgery, medical doctors pronounced her mind useless, although her coronary heart continued to beat.
He knew that in one other a part of the hospital, a affected person was affected by renal failure. He had assisted on kidney transplants at Harvard, and he understood that the organs started to lose viability quickly after the guts stops beating.
Dr. Alexandre pulled the chief surgeon, Jean Morelle, apart and made his case. Brain loss of life, he mentioned, is loss of life. Machines can preserve a coronary heart beating for a very long time with no hope of reviving a affected person.
His argument went towards centuries of assumptions concerning the line between life and loss of life, however Dr. Morelle was persuaded.
They eliminated a kidney from the younger affected person, shut off her ventilator and accomplished the transplant inside a couple of minutes. The recipient lived one other 87 days — a big accomplishment in its personal proper, on condition that the science of organ transplants was nonetheless evolving on the time.
Over the subsequent two years, Dr. Alexandre and Dr. Morelle quietly carried out a number of extra kidney transplants utilizing the identical process. Finally, at a medical convention in London in 1965, Dr. Alexandre introduced what he had been doing.
“There has never been and there never will be any question of taking organs from a dying person who has a ‘nonreasonable chance of getting better or resuming consciousness,’” he informed the gathering. “The question is of taking organs from a dead person. The point is that I do not accept the cessation of heartbeat as the indication of death.”
Others within the room, together with a number of the best names within the organ transplant discipline, have been much less positive, and mentioned so.
“Any modification of the means of diagnosing death to facilitate transplantation will cause the whole procedure to fall into disrepute,” Roy Calne, a pioneering British transplant surgeon, mentioned in the course of the convention. (Dr. Calne died in January.)
Dr. Alexandre remained steadfast, and he provided a set of standards for figuring out if a affected person was mind useless. In addition to struggling a traumatic mind damage, the affected person ought to have dilated pupils and dropping blood strain, exhibit no reflexes, haven’t any capability to breathe and not using a machine, and present no indicators of mind exercise.
Within a number of years, Dr. Calne and others started to return round to Dr. Alexandre’s argument. In 1968, the Harvard Ad Hoc Committee, a bunch of medical consultants, largely adopted Dr. Alexandre’s standards when it declared that an irreversible coma must be understood because the equal of loss of life, whether or not the guts continues to beat or not.
Today, Dr. Alexandre’s perspective is extensively shared within the medical neighborhood, and eradicating organs from brain-dead sufferers has turn out to be an accepted apply.
“The greatness of Alexandre’s insight was that he was able to see the insignificance of the beating heart,” Robert Berman, an organ-donation activist and journalist, wrote in Tablet journal in 2019.
Guy Pierre Jean Alexandre was born on July 4, 1934, in Uccle, Belgium, a suburb of Brussels. His father, Pierre, was a authorities administrator, and his mom, Marthe (Mourin) Alexandre, was a private assistant.
He entered the University of Louvain in 1952 to review drugs. After finishing his research in 1959, he remained on the college to coach as a transplant surgeon.
He married Eliane Moens in 1958. She died in October. Along with their son, Dr. Alexandre’s survivors embody their daughters, Anne, Chantal, Brigitte and Pascale; 17 grandchildren; and 13 great-grandchildren.
By the late Nineteen Fifties the sector of transplant surgical procedure was evolving shortly. Among the main analysis facilities was Peter Bent Brigham Hospital (now a part of Brigham and Women’s Hospital) in Boston, one in all Harvard’s educating amenities, the place the primary kidney transplant was carried out in 1954.
Dr. Alexandre arrived at Brigham in 1962, overlapping by a number of weeks with Dr. Calne, who was wrapping up his personal fellowship time period. Both of them labored below Joseph E. Murray, who in 1990 shared the Nobel Prize in Physiology or Medicine for his work in transplant surgical procedure.
Dr. Alexandre observed that earlier than Dr. Murray eliminated an organ from a brain-dead affected person, he would flip off the respirator and wait till the guts stopped beating. This fulfilled a traditional definition of loss of life, however at a big value to the organ.
“They viewed their brain-dead patients as alive, yet they had no qualms about turning off the ventilator to get the heart to stop beating before they removed kidneys,” Dr. Alexandre informed Mr. Berman for his Tablet article. “In addition to ‘killing’ the patient, they were giving the recipients damaged kidneys.”
Dr. Alexandre returned to the University of Louvain after a 12 months, intent on placing his convictions into apply.
He made a number of additional contributions to the sector of transplant surgical procedure. In the early Eighties, he developed a technique to take away sure antibodies from a kidney in order that it could possibly be positioned inside a affected person with an in any other case incompatible blood kind.
And, in 1984, he carried out one of many world’s first profitable xenotransplants, the switch of an organ from one species to a different. In this case, he moved a pig kidney right into a baboon.
