Vladimir P.

Demikhov, a Pioneer of Organ Transplantation

R.M. Langer ABSTRACT Vladimir P. Demikhov was born in a Russian peasant family in 1916. As a biology student at The Moscow University in 1937, he constructed a metal articial heart and maintained the circulation of a dog for 5.5 hours. From 1946, after his military service, he worked in the Surgical Institute of The Moscow Academy of Sciences performing heterotopic heart transplantations in dogs. In 1947, he performed the rst orthotopic lung transplant. Later he performed complex cardiothoracic transplantations as well as renal and hepatic transplantations. He restarted his investigations with the articial heart and performed coronary bypass operations in dogs. In 1954 he performed a head transplantation, for which he gained worldwide infamy. Stalinist propaganda advertised this fact as the superiority of Soviet science. In fact, it was the upper body of a smaller dog to the neck of a bigger one. The two heads could eat and drink separately. But he could not overcome the problems of rejection, so the longest survival was 1 month among 20 such operations. His inuence on the pioneers of transplantation is unquestionable. He was an innovative creative man, and many pioneers of transplantation highly appreciated his work. Demikhov contributed to clinical heart and lung transplantation by demonstrating the possibility of their experimental realization; furthermore, he motivated the pioneers of coronary bypass operations with his work. He died in 1998, but before that was honored with a high state award and the Pioneer Award of the International Society for Heart and Lung Transplantation.
ladimir Petrovich Demikhov was born in Russia in 1916 at Kulini farm. His mother raised 3 children alone, because his father was killed in the Russian civil war. Vladimir went to a vocational school for working youth to learn the trade of a tter. Maybe that education allowed him to later construct the articial heart. He was accepted to the university in Moscow as a biology student. He was interested in research, most likely owing to the inuence of Nobel Prize winner Ivan P. Pavlov. It was no wonder that the young student wanted to work in the eld of experimental physiology. In 1937 he constructed a steel heart which was too big to place into the thorax, but was able to maintain the circulation of a dog for 5.5 hours. The 21-year-old student published his experiment in the journal of the faculty of Biology. His studies were interrupted by World War II. He was sent to the front, served as a pathologist, and gained a lot of experience with surgery. Returning to the laboratory, he started to work in 1946 at the Vishnevsky Surgical Institute of the Academy of Medical Sciences of the Soviet Union. In 1940 he already tried to perform heterotopic heart transplants into the groin of dogs. The rst heterotopic heart transplant has been done by Carrel in 1905 into the neck. He resumed his activities by trying to place the heart into the thorax. He also performed transplantations of a lung lobe, the heart and lungs, the heart alone, and the lung alone, of course at that time without hypothermia or bypass possibilities. On June 30, 1946, he had success: A dog survived 9 hours 26 minutes after a heterotopic heart-lung transplantation. Later that year, an animal survived 5 days. Subsequently he continued to work on a nonauxiliary heterotopic heart transplant model and in 1956 achieved 32 days of survival.1,2 During World War II, Russian surgeons developed a series of suturing machines. Vladimir Demikhov was the

From the Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary. Address reprint requests to Robert M. Langer, MD, PhD Department of Transplantation and Surgery, Semmelweis University, Baross u. 23. H-1082 Budapest, Hungary. E-mail: roblanger@hotmail.com 0041-1345/see front matter doi:10.1016/j.transproceed.2011.03.070 1221

2011 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710 Transplantation Proceedings, 43, 12211222 (2011)

1222

LANGER

rst to use vascular staplers in experimental transplantation. This fact also demonstrates his inventive mind. In 1947 Demikhov performed the rst successful isolated lung transplantation, the dog survived for 7 days; subsequently he also demonstrated a 1-month survival. In 1948 he became interested in renal and liver transplantation, but soon he returned to the thoracic area. In 1950 he successfully developed a heart-lung preparation, which became the key for his later successes to preserve these vital organs. Already in 1886, Pavlov and associates created a functioning system of the 2 organs for pharmacologic studies, which was modied in 1912 by Starling and Knowlton. Demikhov simplied that system, achieving selfmaintaining preparation which kept the organs vital as long as 4 hours. In 300 experiments he used this method. Among 67 heart-lung transplantations, 44 were successful with survival times up to 6 days.3 One dog was even sent by train to a congress for a demonstration in 1950.4 In 1955 he formed a transplantation laboratory in the Sklifosovsky Emergency Institute in Moscow, serving as its director until retirement in 1986. He continued his work on heart transplantation, achieving a 15-hour survival of an orthotopic heart transplantation. He restarted his work with the articial heart, performing bypass operations. At that time the speed of the anastomosis of the internal thoracic artery to the coronary artery was crucial. In 1953 it took 1.5 minutes for him. He modied Payrs technique and later anastomosed vessels as quickly as 55 seconds.1 His achievements were due to his dexterity, his fanatic endurance, and the support of his family. He did most of his work after hours without much nancial support. A suicide attempt is also recorded. No wonder, as the life of such a creative man during the Cold War was quite frustrating behind the Iron Curtain. The ofcial opinion called his work tricks and could not see the pioneering efforts in it. However, when his famous operation with the 2-headed dog was successful, the Stalinist propaganda saw the superiority of Soviet science in it. The rst head transplant was done by A.G. Konevsky in Volgograd by accident. He wanted to perform a heart transplantation, but the donor suffered a trafc accident (!)

and rather than lose the opportunity, he performed a head transplant. Although technically successful, the so called head transplantin reality it was the upper body of a puppy transplanted to the neck of a bigger dogwas performed by Demikhov in 1954. The 2 heads moved separately and could eat and drink separately. The bigger dog tried to shake off the puppy but later accepted his fate. Among 20 such operations, the longest survival was 1 month. Demikhov inuenced the pioneers of the Western world too. Norman Shumway and Richard Lower were aware of his achievements, and Christiaan Barnard visited him. Impressed by Demikhovs work, Robert J. White in Cleveland, Ohio, performed the rst real head transplant between monkeys in 1963.5 In 1960 Demikhov published his monograph entitled: Transplantation of vital organs in experiments.3 The word transplantology is assigned to him from this work. His inuence is unquestionable for the human application of thoracic transplantation and coronary bypass surgery. He was not as lucky as his Western counterpart Alexis Carrel, who was awarded the Nobel Prize, but the circumstances were quite different. However, before his death in 1998, a high Russian state award was granted to him, and he received the Pioneer Award of the International Society for Heart and Lung Transplantation.6
REFERENCES
1. Konstantinov IE: A mystery of Vladimir P. Demikhov: the 50th anniversary of the rst intrathoracic transplantation. Ann Thorac Surg 65:1171, 1998 2. Shumacker HB: A surgeon to remember: notes about Vladimir Demikhov. Ann Thorac Surg 58:1196, 1994 3. Demikhov VP: Transplantation of vital organs in experiments. Moscow: Medgiz, 1960 4. Demikhov VP: Demonstration of the operation and of a dog with replaced heart and lungs at the extramural session of the AMN SSSR in Riazan in 1950. Discussion. In Nervous regulation of the circulation and respiration. Trans Acad Med Sci USSR 1:170, 1952 5. White RJ, Albin MS, Verdura J: Preservation of viability in the isolated monkey brain utilizing a mechanical extracorporeal circulation. Nature 202:1082, 1964 6. Cooper DKC: Vladimir Demikhov. Ann Thorac Surg 59:1628, 1995